Modulation of ventilatory reflex control by cardiac resynchronization therapy

Ivan Cundrle, Bruce David Johnson, Robert F. Rea, Christopher G. Scott, Virend Somers, Lyle J. Olson

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

Background Heart failure (HF) is characterized by heightened sensitivities of the CO<inf>2</inf> chemoreflex and the ergoreflex which promote increased ventilatory drive manifested as increased minute ventilation per volume of expired CO<inf>2</inf> (V<inf>E</inf>/VCO<inf>2</inf>). The aims of this study were to evaluate the effects of cardiac resynchronization therapy (CRT) on carbon dioxide (CO<inf>2</inf>) chemosensitivity and the arterial CO<inf>2</inf> setpoint. Methods and Results Consecutive HF patients (n = 35) who underwent clinically indicated CRT were investigated by means of cardiopulmonary exercise testing and CO<inf>2</inf> chemosensitivity evaluation with the use of a rebreathe method before and 4-6 months after CRT. Pre- and post-CRT measures were compared with the use of either paired t test or Wilcoxon test. Decreased peak V<inf>E</inf>/VCO<inf>2</inf> (44 ± 10 vs 40 ± 8; P <.01), CO<inf>2</inf> chemosensitivity (2.2 ± 1.1 vs 1.7 ± 0.8 L min<sup>-1</sup> mm Hg<sup>-1</sup>; P =.04), and increased peak end-tidal CO<inf>2</inf> (29 ± 5 vs 31 ± 5 mm Hg; P <.01) were also observed after CRT. Multivariate analysis adjusted for age and sex showed the decrease of peak V<inf>E</inf>/VCO<inf>2</inf> from before to after CRT to be most strongly associated with the increase of peak end-tidal CO<inf>2</inf> (β = -0.84; F = 21.5; P <.0001). Conclusions Decrease of V<inf>E</inf>/VCO<inf>2</inf> after CRT is associated with decreased CO<inf>2</inf> chemosensitivity and increase of the arterial CO<inf>2</inf> setpoint, which is consistent with decreased activation of both the CO<inf>2</inf> chemoreflex and the ergoreflex.

Original languageEnglish (US)
Pages (from-to)367-373
Number of pages7
JournalJournal of Cardiac Failure
Volume21
Issue number5
DOIs
StatePublished - May 1 2015

Fingerprint

Cardiac Resynchronization Therapy
Reflex
Heart Failure
Carbon Dioxide
Ventilation
Exercise

Keywords

  • chemosensitivity pacing
  • exercise testing
  • Heart failure cardiopulmonary

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Modulation of ventilatory reflex control by cardiac resynchronization therapy. / Cundrle, Ivan; Johnson, Bruce David; Rea, Robert F.; Scott, Christopher G.; Somers, Virend; Olson, Lyle J.

In: Journal of Cardiac Failure, Vol. 21, No. 5, 01.05.2015, p. 367-373.

Research output: Contribution to journalArticle

Cundrle, Ivan ; Johnson, Bruce David ; Rea, Robert F. ; Scott, Christopher G. ; Somers, Virend ; Olson, Lyle J. / Modulation of ventilatory reflex control by cardiac resynchronization therapy. In: Journal of Cardiac Failure. 2015 ; Vol. 21, No. 5. pp. 367-373.
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title = "Modulation of ventilatory reflex control by cardiac resynchronization therapy",
abstract = "Background Heart failure (HF) is characterized by heightened sensitivities of the CO2 chemoreflex and the ergoreflex which promote increased ventilatory drive manifested as increased minute ventilation per volume of expired CO2 (VE/VCO2). The aims of this study were to evaluate the effects of cardiac resynchronization therapy (CRT) on carbon dioxide (CO2) chemosensitivity and the arterial CO2 setpoint. Methods and Results Consecutive HF patients (n = 35) who underwent clinically indicated CRT were investigated by means of cardiopulmonary exercise testing and CO2 chemosensitivity evaluation with the use of a rebreathe method before and 4-6 months after CRT. Pre- and post-CRT measures were compared with the use of either paired t test or Wilcoxon test. Decreased peak VE/VCO2 (44 ± 10 vs 40 ± 8; P <.01), CO2 chemosensitivity (2.2 ± 1.1 vs 1.7 ± 0.8 L min-1 mm Hg-1; P =.04), and increased peak end-tidal CO2 (29 ± 5 vs 31 ± 5 mm Hg; P <.01) were also observed after CRT. Multivariate analysis adjusted for age and sex showed the decrease of peak VE/VCO2 from before to after CRT to be most strongly associated with the increase of peak end-tidal CO2 (β = -0.84; F = 21.5; P <.0001). Conclusions Decrease of VE/VCO2 after CRT is associated with decreased CO2 chemosensitivity and increase of the arterial CO2 setpoint, which is consistent with decreased activation of both the CO2 chemoreflex and the ergoreflex.",
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AU - Olson, Lyle J.

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N2 - Background Heart failure (HF) is characterized by heightened sensitivities of the CO2 chemoreflex and the ergoreflex which promote increased ventilatory drive manifested as increased minute ventilation per volume of expired CO2 (VE/VCO2). The aims of this study were to evaluate the effects of cardiac resynchronization therapy (CRT) on carbon dioxide (CO2) chemosensitivity and the arterial CO2 setpoint. Methods and Results Consecutive HF patients (n = 35) who underwent clinically indicated CRT were investigated by means of cardiopulmonary exercise testing and CO2 chemosensitivity evaluation with the use of a rebreathe method before and 4-6 months after CRT. Pre- and post-CRT measures were compared with the use of either paired t test or Wilcoxon test. Decreased peak VE/VCO2 (44 ± 10 vs 40 ± 8; P <.01), CO2 chemosensitivity (2.2 ± 1.1 vs 1.7 ± 0.8 L min-1 mm Hg-1; P =.04), and increased peak end-tidal CO2 (29 ± 5 vs 31 ± 5 mm Hg; P <.01) were also observed after CRT. Multivariate analysis adjusted for age and sex showed the decrease of peak VE/VCO2 from before to after CRT to be most strongly associated with the increase of peak end-tidal CO2 (β = -0.84; F = 21.5; P <.0001). Conclusions Decrease of VE/VCO2 after CRT is associated with decreased CO2 chemosensitivity and increase of the arterial CO2 setpoint, which is consistent with decreased activation of both the CO2 chemoreflex and the ergoreflex.

AB - Background Heart failure (HF) is characterized by heightened sensitivities of the CO2 chemoreflex and the ergoreflex which promote increased ventilatory drive manifested as increased minute ventilation per volume of expired CO2 (VE/VCO2). The aims of this study were to evaluate the effects of cardiac resynchronization therapy (CRT) on carbon dioxide (CO2) chemosensitivity and the arterial CO2 setpoint. Methods and Results Consecutive HF patients (n = 35) who underwent clinically indicated CRT were investigated by means of cardiopulmonary exercise testing and CO2 chemosensitivity evaluation with the use of a rebreathe method before and 4-6 months after CRT. Pre- and post-CRT measures were compared with the use of either paired t test or Wilcoxon test. Decreased peak VE/VCO2 (44 ± 10 vs 40 ± 8; P <.01), CO2 chemosensitivity (2.2 ± 1.1 vs 1.7 ± 0.8 L min-1 mm Hg-1; P =.04), and increased peak end-tidal CO2 (29 ± 5 vs 31 ± 5 mm Hg; P <.01) were also observed after CRT. Multivariate analysis adjusted for age and sex showed the decrease of peak VE/VCO2 from before to after CRT to be most strongly associated with the increase of peak end-tidal CO2 (β = -0.84; F = 21.5; P <.0001). Conclusions Decrease of VE/VCO2 after CRT is associated with decreased CO2 chemosensitivity and increase of the arterial CO2 setpoint, which is consistent with decreased activation of both the CO2 chemoreflex and the ergoreflex.

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