对缺氧和高碳酸血症的化学敏感性均有增加可预测心力衰竭的发生
Combined Increased Chemosensitivity to Hypoxia and Hypercapnia as a Prognosticator in Heart Failure
Objectives:
The aim of the present study was to investigate the prognostic significance of chemosensitivity to hypercapnia in chronic heart failure (HF).
Background:
Increased chemosensitivity to hypoxia and hypercapnia has been observed in HF. The potential value of enhanced chemosensitivity to hypercapnia to risk prediction in systolic HF has not been specifically evaluated.
Methods:
One hundred ten consecutive systolic HF patients (age 62±15 years, left ventricular ejection fraction [LVEF] 31±7%) underwent assessment of chemosensitivity to hypoxia and hypercapnia (rebreathing technique) and were followed up for a median period of 29 months (range 1 to 54 months). The end point was a composite of cardiac death and aborted cardiac death (ventricular tachyarrhythmia treated by cardioverter-defibrillator).
Results:
At baseline, 31 patients (28%) had enhanced chemosensitivity to both hypoxia and hypercapnia. Although they had the same LVEF as the 43 patients (39%) with normal chemosensitivity, they were more symptomatic (New York Heart Association functional class), had higher plasma brain natriuretic peptide and norepinephrine, steeper regression slope relating minute ventilation to carbon dioxide output (VE/VCO2 slope), more Cheyne-Stokes respiration, and more ventricular arrhythmias (all p<0.05). Four-year survival was only 49%, in marked contrast to 100% for patients with normal chemosensitivity (p<0.001). On multivariate analysis, combined elevation in chemosensitivity was the strongest independent prognostic marker, even when adjusted for univariate predictors (VE/VCO2 slope, Cheyne-Stokes respiration, LVEF, and brain natriuretic peptide, p<0.05).
Conclusions:
Increased chemosensitivity to both hypoxia and hypercapnia, eliciting neurohormonal derangement, ventilation instability, and ventricular arrhythmias, is a very serious adverse prognostic marker in HF (Fig 1).
The aim of the present study was to investigate the prognostic significance of chemosensitivity to hypercapnia in chronic heart failure (HF).
Background:
Increased chemosensitivity to hypoxia and hypercapnia has been observed in HF. The potential value of enhanced chemosensitivity to hypercapnia to risk prediction in systolic HF has not been specifically evaluated.
Methods:
One hundred ten consecutive systolic HF patients (age 62±15 years, left ventricular ejection fraction [LVEF] 31±7%) underwent assessment of chemosensitivity to hypoxia and hypercapnia (rebreathing technique) and were followed up for a median period of 29 months (range 1 to 54 months). The end point was a composite of cardiac death and aborted cardiac death (ventricular tachyarrhythmia treated by cardioverter-defibrillator).
Results:
At baseline, 31 patients (28%) had enhanced chemosensitivity to both hypoxia and hypercapnia. Although they had the same LVEF as the 43 patients (39%) with normal chemosensitivity, they were more symptomatic (New York Heart Association functional class), had higher plasma brain natriuretic peptide and norepinephrine, steeper regression slope relating minute ventilation to carbon dioxide output (VE/VCO2 slope), more Cheyne-Stokes respiration, and more ventricular arrhythmias (all p<0.05). Four-year survival was only 49%, in marked contrast to 100% for patients with normal chemosensitivity (p<0.001). On multivariate analysis, combined elevation in chemosensitivity was the strongest independent prognostic marker, even when adjusted for univariate predictors (VE/VCO2 slope, Cheyne-Stokes respiration, LVEF, and brain natriuretic peptide, p<0.05).
Conclusions:
Increased chemosensitivity to both hypoxia and hypercapnia, eliciting neurohormonal derangement, ventilation instability, and ventricular arrhythmias, is a very serious adverse prognostic marker in HF (Fig 1).
Figure 1: Chemosensitivity and survival in heart failure. Kaplan-Meier survival plot in heart failure patients with normal chemosensitivity (norm HVR & HCVR) compared with patients with augmented chemosensitivity to: hypoxia alone (↑HVR), hypercapnia alone (↑HCVR), and hypoxia and hypercapnia combined (↑HVR & HCVR). HCVR="hypercapnic" ventilatory response; HVR="hypoxic" ventilatory response. (Reprinted from Giannoni A, Emdin M, Bramanti F, et al. Combined increased chemosensitivity to hypoxia and hypercapnia as a prognosticator in heart failure. J Am Coll Cardiol. 2009;53:1975-1980.)
学科代码：心血管病学 关键词：对缺氧和高碳酸血症的化学敏感性均有增加可预测心力衰竭的发生
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