PMID- 9708664
OWN - NLM
STAT- MEDLINE
DCOM- 19980901
LR  - 20190622
IS  - 0002-9149 (Print)
IS  - 0002-9149 (Linking)
VI  - 82
IP  - 3
DP  - 1998 Aug 1
TI  - Ventilatory response to exercise correlates with impaired heart rate variability 
      in patients with chronic congestive heart failure.
PG  - 338-44
AB  - In chronic congestive heart failure (CHF) an overactivity of muscle ergoreceptors 
      and peripheral chemoreceptors may lead to an increased ventilatory response to 
      exercise and contribute to the autonomic imbalance. The analysis of heart rate 
      variability (HRV), which is a reliable method of studying autonomic regulations 
      within the cardiovascular system, showed depressed HRV indexes in CHF, but 
      predictors of abnormal HRV pattern in CHF remain controversial. Considering a 
      common mechanism involved in generation of both abnormal ventilation and 
      autonomic dysfunction in CHF, we hypothesized that impaired ventilation may be 
      better than other variables of CHF severity in determining HRV parameters. 
      Seventy-two patients with CHF (57+/-9 years, ejection fraction: 28+/-11%) 
      underwent cardiopulmonary exercise testing; the relation between ventilation and 
      carbon dioxide production (VE/VCO2) was used as an index of the ventilatory 
      response to exercise. Time and frequency-domain measurements of HRV were derived 
      from 24-hour electrocardiographic monitoring. Patients had reduced exercise 
      tolerance with abnormal ventilatory response (peak oxygen consumption [VO2max]: 
      17.8+/-5.5 ml/kg/min, VE/VCO2: 36.0+/-9.8). Correlations were found between HRV 
      measures and etiology, New York Heart Association (NYHA) functional class, and 
      VO2max, but the strongest relation was observed for VE/VCO2 slope (r values from 
      -0.33 to -0.65, p <0.01). In the multiple regression analysis only VE/VCO2 was 
      found to correlate independently with all HRV measurements. To investigate the 
      role of peripheral chemoreceptor overactivity as the mechanism of autonomic 
      imbalance and the increased ventilatory response to exercise, we assessed 
      peripheral chemosensitivity in 22 patients (mean value of peripheral 
      chemosensitivity: 0.62+/-0.34 L/min/%SaO2, significantly higher than in normal 
      controls, mean value: 0.29+/-0.20 L/min/%SaO2 in our laboratory). The activity of 
      the peripheral chemoreflex inversely correlated with all parameters of HRV. 
      Increased ventilatory response to exercise correlated with depressed HRV measures 
      in patients with CHF better than other clinical variables. An important role of 
      the increased peripheral chemosensitivity in this relation may be relevant, being 
      also a potential link between functional severity and sympathovagal imbalance in 
      CHF.
FAU - Ponikowski, P
AU  - Ponikowski P
AD  - Cardiac Medicine Department, Imperial College National Heart and Lung Institute, 
      London, United Kingdom.
FAU - Chua, T P
AU  - Chua TP
FAU - Piepoli, M
AU  - Piepoli M
FAU - Banasiak, W
AU  - Banasiak W
FAU - Anker, S D
AU  - Anker SD
FAU - Szelemej, R
AU  - Szelemej R
FAU - Molenda, W
AU  - Molenda W
FAU - Wrabec, K
AU  - Wrabec K
FAU - Capucci, A
AU  - Capucci A
FAU - Coats, A J
AU  - Coats AJ
LA  - eng
PT  - Comparative Study
PT  - Journal Article
PL  - United States
TA  - Am J Cardiol
JT  - The American journal of cardiology
JID - 0207277
RN  - N762921K75 (Nitrogen)
SB  - IM
MH  - Administration, Inhalation
MH  - Autonomic Nervous System/physiopathology
MH  - Chemoreceptor Cells/physiopathology
MH  - Chronic Disease
MH  - Electrocardiography, Ambulatory
MH  - Exercise/*physiology
MH  - Female
MH  - Heart Failure/*physiopathology
MH  - Heart Rate/*physiology
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Multivariate Analysis
MH  - Nitrogen/administration & dosage
MH  - Predictive Value of Tests
MH  - Respiration/*physiology
MH  - Respiratory Function Tests
EDAT- 1998/08/26 00:00
MHDA- 1998/08/26 00:01
CRDT- 1998/08/26 00:00
PHST- 1998/08/26 00:00 [pubmed]
PHST- 1998/08/26 00:01 [medline]
PHST- 1998/08/26 00:00 [entrez]
AID - S0002-9149(98)00303-8 [pii]
AID - 10.1016/s0002-9149(98)00303-8 [doi]
PST - ppublish
SO  - Am J Cardiol. 1998 Aug 1;82(3):338-44. doi: 10.1016/s0002-9149(98)00303-8.