645 Increased chemoceptive sensitivity to carbon dioxide during Cheyne-Stokes respiration in chronic heart failure is associated with adrenergic and cardiac natriuretic hormone

Introduction. The relation between minute ventilation (VE) and carbon dioxide production (VCO2) can be characterised by the instantaneous ratio of ventilation to carbon dioxide production, the ventilatory equivalent for CO2(VEqCO2). We hypothesised that the time taken to achieve the lowest VEqCO2(time to VEqCO2 nadir) may be a prognostic marker in patients with chronic heart failure (CHF).Methods. Patients and healthy controls underwent a symptom-limited, cardiopulmonary exercise test (CPET) on a treadmill to volitional exhaustion.Results. 423 patients with CHF (mean age years; 80% males) and 78 healthy controls (62% males; age years) were recruited. Time to VEqCO2 nadir was shorter in patients than controls ( s versus s; ). Univariable predictors of all-cause mortality included peak oxygen uptake (), VEqCO2nadir (), and time to VEqCO2nadir (). In an adjusted Cox multivariable proportional hazards model, peak oxygen uptake () and VEqCO2nadir () were the most significant independent predictors of all-cause mortality.Conclusion. The time to VEqCO2nadir was shorter in patients with CHF than in normal subjects and was a predictor of subsequent mortality.

Download Full-text

779-3 L-arginine Acutely Reduces Increased Ventilatory Cost of Carbon Dioxide Excretion on Exercise in Chronic Heart Failure: Evidence of Pulmonary Endothelial Dysfunction?

Journal of the American College of Cardiology ◽

10.1016/0735-1097(95)92687-z ◽

1995 ◽

Vol 25 (2) ◽

pp. 296A

Author(s):

Adrian P. Banning ◽

Bernard Prendergast ◽

Stuart Elbourne ◽

David Tyler ◽

Andrew H. Henderson

Keyword(s):

Heart Failure ◽

Carbon Dioxide ◽

Chronic Heart Failure ◽

Endothelial Dysfunction

Download Full-text

The prognostic value of hypoxia biomarkers in older patients with chronic heart failure

European Heart Journal ◽

10.1093/eurheartj/ehab724.0842 ◽

2021 ◽

Vol 42 (Supplement_1) ◽

Author(s):

E Efremova ◽

A.M Shutov

Keyword(s):

Heart Failure ◽

Chronic Heart Failure ◽

Cystatin C ◽

Older Patients ◽

Prognostic Value ◽

Total Mortality ◽

Natriuretic Hormone ◽

Cox Regression Analysis ◽

Endogenous Erythropoietin ◽

Annual Mortality

Abstract Chronic kidney disease (CKD) worsens the prognosis of chronic heart failure (CHF). Hypoxia is the leading link in pathogenesis, especially in older patients with comorbidity. The aim of this study was to investigate the prognostic value of biomarkers of myocardial, renal dysfunction and hypoxia in older patients with CHF. Materials and methods 80 older hypertensive patients with CHF (48 females, mean age 70.7±8.7 years) were examined. CHF was defined according to ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure, 2016. CKD was diagnosed and classified according to the KDIGO guidelines (2012). Serum levels of hypoxia-inducible factor 1-alpha (HIF-1α), endogenous erythropoietin (eEPO), N-terminal propeptide of type B natriuretic hormone (NT-proBNP), cystatin C were assessed. The follow-up period was 12 months; the primary endpoint was total mortality. Results CKD was diagnosed in 49 (61.3%) older patients with CHF. The HIF-1α level was significantly higher in the group of deceased patients than in the survivors (0.08 (IQR 0.06; 0.11) and 0.05 (IQR 0.04; 0.07) ng/ml, p=0.02), as well as the level of NT-proBNP (1126.3 (IQR 551.8; 2750.0) and 164.4 (IQR 135.5; 1100.9) pg/ml, p<0.0001), eEPO (16.92 (ICR 5.43; 64.57) and 5.36 (IQR 1.65; 8.85) mIU/ml, p<0.0001), cystatin C (1.49 (ICR 0.86; 2.13) and 0.99 (IQR 0.82; 1.32) Mg/l, p=0.0005). Cox regression analysis adjusted for sex, age and comorbidity (χ2=36.8, p<0.0001) showed that endogenous erythropoietin, independently of other factors and biomarkers, determined the prognosis of annual mortality in patients with chronic heart failure (HR 3.27 (95% CI 1.08–9.91, p=0.03); χ2=30.7, p=0.0002). When constructing classification trees, in older patients with CHF in the presence of eEPO less than 16.19 mIU/ml NT-proBNP more than 232.5 pg/ml is an unfavorable factor (in patients with NT-proBNP <232.5 pg/ml the risk decreased to 0) (for model: sensitivity – 57.1%; specificity – 92.3% (AUC=0.87); p=0.0015). Conclusions The level of eEPO in older patients with CHF has an independent and closer relationship with the annual mortality of patients than the NT-proBNP – currently accepted biomarker of the severity and prognosis of CHF. FUNDunding Acknowledgement Type of funding sources: None.

Download Full-text