Document Detail


Muscle ergoreceptor overactivity reflects deterioration in clinical status and cardiorespiratory reflex control in chronic heart failure.
MedLine Citation:
PMID:  11696473     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: In chronic heart failure (CHF), overactivation of ergoreceptors (afferents sensitive to the metabolic effects of muscular work) may be a link between peripheral changes, sympathetic overactivation, and increased hemodynamic and ventilatory responses to exercise. The relationship between ergoreceptors, autonomic changes, and the progression of the syndrome has not yet been studied. METHODS AND RESULTS: Thirty-eight stable CHF patients (age, 57+/-1 years; ejection fraction, 26+/-2%) were compared with 12 age-matched normal control subjects. The ergoreflex contribution to the ventilatory and hemodynamic responses to exercise, together with peripheral and central chemoreceptor sensitivity, arterial baroreflex sensitivity, plasma norepinephrine, epinephrine, and heart rate variability, were measured. Enhanced ergoreflex effects on ventilation (78+/-2% versus 50+/-8%), peripheral chemosensitivity (0.6+/-0.4 versus 0.2+/-0.1 L/min per percent SaO(2)), and central chemosensitivity (2.9+/-0.2 versus 2.0+/-0.2 L. min(-1). mm Hg(-1)) and an impaired baroreflex function (4.1+/-0.6 versus 9.1+/-5.6 ms/mm Hg) were confirmed in CHF compared with control subjects (P<0.01 in all comparisons). Ergoreceptor overactivity was associated with a worse symptomatic state (NYHA class, P<0.05), lower exercise tolerance (peak VO(2), P<0.05), and pronounced exercise hyperventilation (VE/VCO(2), P<0.01). It was also a strong predictor of increased central chemosensitivity (independently of clinical parameters), baroreflex impairment, and sympathetic activation (plasma catecholamines and heart rate variability indexes; all P<0.05). In multivariate analysis, among all reflexes studied, the ventilatory component of the ergoreflex was the only independent predictor of peak VO(2) and VE/VCO(2). CONCLUSIONS: In CHF, overactivation of the ergoreflex is associated with abnormal cardiorespiratory reflex control, independently of clinical severity. Among impaired reflexes, overactivation of the ergoreflex is an important determinant of exercise hyperventilation and reduced exercise tolerance.
Authors:
P P Ponikowski; T P Chua; D P Francis; A Capucci; A J Coats; M F Piepoli
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Publication Detail:
Type:  Clinical Trial; Controlled Clinical Trial; Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Circulation     Volume:  104     ISSN:  1524-4539     ISO Abbreviation:  Circulation     Publication Date:  2001 Nov 
Date Detail:
Created Date:  2001-11-06     Completed Date:  2001-12-04     Revised Date:  2008-11-21    
Medline Journal Info:
Nlm Unique ID:  0147763     Medline TA:  Circulation     Country:  United States    
Other Details:
Languages:  eng     Pagination:  2324-30     Citation Subset:  AIM; IM    
Affiliation:
Clinical Cardiology, Imperial College School of Medicine at the NHLI, London, UK.
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MeSH Terms
Descriptor/Qualifier:
Autonomic Nervous System / physiopathology
Baroreflex*
Chemoreceptor Cells / physiopathology*
Chronic Disease
Disease Progression
Electrocardiography
Energy Metabolism* / physiology
Epinephrine / blood
Exercise Test
Female
Heart Failure / physiopathology*
Heart Function Tests
Heart Rate
Hemodynamics
Humans
Male
Middle Aged
Muscles / metabolism
Neurons, Afferent
Norepinephrine / blood
Prospective Studies
Regression Analysis
Respiration*
Vascular Resistance
Chemical
Reg. No./Substance:
51-41-2/Norepinephrine; 51-43-4/Epinephrine

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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