Elsevier

JACC: Heart Failure

Volume 10, Issue 9, September 2022, Pages 662-676
JACC: Heart Failure

Clinical Research
Chemoreflex and Baroreflex Sensitivity Hold a Strong Prognostic Value in Chronic Heart Failure

https://doi.org/10.1016/j.jchf.2022.02.006Get rights and content
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Abstract

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.

Key Words

autonomic nervous system
baroreflex
mortality
chemoreflex
heart failure
hospitalization

Abbreviations and acronyms

AHI
apnea-hypopnea index
BRS
baroreflex sensitivity
CAI
central apnea index
CPET
cardiopulmonary exercise test
CRS
chemoreflex sensitivity
CRT
cardiac resynchronization therapy
eGFR
estimated glomerular filtration rate
HCVR
hypercapnic ventilatory response
HF
heart failure
HRV
heart rate variability
HVR
hypoxic ventilatory response
ICD
implantable cardioverter-defibrillator
LVEF
left ventricular ejection fraction
NT-proBNP
N-terminal pro–B-type natriuretic peptide
OSA
obstructive sleep apnea

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