Chemoreflex and Baroreflex Sensitivity Hold a Strong Prognostic Value in Chronic Heart Failure,JACC: Heart Failure

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Chemoreflex and Baroreflex Sensitivity Hold a Strong Prognostic Value in Chronic Heart Failure
JACC: Heart Failure ( IF 10.3 ) Pub Date : 2022-05-04 , DOI: 10.1016/j.jchf.2022.02.006
Alberto Giannoni ₁ , Francesco Gentile ₂ , Francesco Buoncristiani ₃ , Chiara Borrelli ₂ , Paolo Sciarrone ₂ , Jens Spiesshoefer ₄ , Francesca Bramanti ₃ , Giovanni Iudice ₃ , Shahrokh Javaheri ₅ , Michele Emdin ₁ , Claudio Passino ₁

Affiliation

Background

Novel treatments targeting in baroreflex sensitivity (BRS) and chemoreflex sensitivity (CRS) heart failure (HF) are grounded on small prognostic studies, partly performed in the pre–beta-blockade era.

Objectives

This study assesses the clinical/prognostic significance of BRS and CRS in a large cohort of patients with chronic HF on modern treatments.

Methods

Outpatients with chronic HF with either reduced (≤40%) or mildly reduced left ventricular ejection fraction (LVEF) (41% to 49%) underwent BRS (SD method) and CRS to hypoxia and hypercapnia (rebreathing technique) assessment and were followed up for a composite endpoint of cardiac death, implantable cardioverter-defibrillator shock, or HF hospitalization.

Results

A total of 425 patients were enrolled (65 ± 12 years of age, LVEF 32% [IQR: 25%-38%], 94% on beta blockers). Patients with decreased BRS (n = 96 of 267, 36%) had lower exercise tolerance and heart rate variability (P < 0.05), whereas those with increased CRS to both hypoxia and hypercapnia (n = 74 of 369, 20%) had higher plasma norepinephrine and central apneas across the 24-hour period (P < 0.01). During a median 50-month follow-up (IQR: 24-94 months), the primary endpoint occurred more often in patients with decreased BRS (log-rank: 11.64; P = 0.001), mainly for increased cardiac deaths/implantable cardioverter-defibrillator shocks, and in those with increased CRS (log-rank: 34.81; P < 0.001), mainly for increased HF hospitalizations. Patients with both abnormal BRS and CRS showed the worst outcome. Reduced BRS (HR: 2.76 [95% CI: 1.36-5.63]; P = 0.005) and increased CRS (HR: 2.91 [95% CI: 1.34-6.31]; P = 0.007) were independently associated with the primary outcome and increased risk stratification when added to standard HF prognosticators (P < 0.05).

Conclusions

In subjects with HF on modern treatment, abnormal BRS and CRS are frequently observed. BRS and CRS elicit autonomic imbalance, exercise limitation, unstable ventilation, and predict adverse outcomes.

中文翻译：

Chemoreflex 和压力反射敏感性在慢性心力衰竭中具有很强的预后价值

背景

针对压力反射敏感性 (BRS) 和化学反射敏感性 (CRS) 心力衰竭 (HF) 的新型治疗基于小型预后研究，部分研究是在β-阻断前时代进行的。

目标

本研究评估了 BRS 和 CRS 在大量接受现代治疗的慢性 HF 患者中的临床/预后意义。

方法

左心室射血分数 (LVEF) 降低（≤40%）或轻度降低（41% 至 49%）的慢性 HF 门诊患者接受 BRS（SD 方法）和 CRS 对缺氧和高碳酸血症（再呼吸技术）的评估并进行随访用于心源性死亡、植入式心脏复律除颤器休克或心衰住院的复合终点。

结果

共有 425 名患者入组（65 ± 12 岁，LVEF 32% [IQR: 25%-38%]，94% 使用 β 受体阻滞剂）。BRS 降低的患者（n = 267 中的 96 例，36%）具有较低的运动耐量和心率变异性（P < 0.05），而 CRS 升高到缺氧和高碳酸血症的患者（n = 369 中的 74 例，20%）具有更高24 小时血浆去甲肾上腺素和中枢性呼吸暂停（P < 0.01）。在中位 50 个月的随访期间（IQR：24-94 个月），主要终点更常见于 BRS 降低的患者（对数秩：11.64；P = 0.001），主要是心源性死亡/植入式心脏复律器-除颤器电击，以及 CRS 升高的患者（对数秩：34.81；P <0.001），主要是因为心衰住院人数增加。BRS和CRS都异常的患者表现出最差的结果。BRS 降低 (HR: 2.76 [95% CI: 1.36-5.63]; P = 0.005) 和 CRS 增加 (HR: 2.91 [95% CI: 1.34-6.31]; P = 0.007) 与主要结局独立相关并且增加添加到标准 HF 预测器时的风险分层（P < 0.05）。