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

Baroreflex activation therapy in heart failure: targeting the right patient

“…14 Given that BAT aims at restoring the baroreflex control of the ANS, its efficacy may be even greater in patients with residual autonomic dysfunction. 5 The blunted improvements observed in patients with CRT, restoring per se baroreflex function and sympathovagal imbalance, 7 seems hence in line with this hypothesis. Unfortunately (and surprisingly), data about autonomic function and baroreflex sensitivity/resetting were not collected in the BAT trials conducted so far, even in selected subsets.…”

“…In a recent study enrolling stable HF patients (mean age 65 ± 12 years, median left ventricular ejection fraction [LVEF] 32% [interquartile range 25–38%]) on optimal drug and device treatment (>90% on beta‐blockers and RAAS inhibitors/ARNI, 35% with CRT and/or implantable‐cardioverter defibrillator [ICD]), baroreflex sensitivity was reduced in 96/267 individuals (36%). Decreased baroreflex sensitivity was associated with worse functional capacity and lower HRV, and with a significantly higher risk of cardiac death, appropriate ICD shocks, and HF hospitalization at a 50‐month median follow‐up 5 . Restoring baroreflex function in HF patients, even on optimal HF treatment, may then improve autonomic balance, exercise tolerance, and impact on outcome.…”

“…Consistent evidence links abnormal baroreflex control to autonomic imbalance typical of HF. [3][4][5] While the underlying mechanisms are not completely understood, reduced cardiac output, increased vascular stiffness, and the interaction with other reflexes (most notably the chemoreflex) may contribute to baroreflex impairment. 3 The blunted baroreflex response may sustain systemic sympathetic overdrive and decreased cardiac vagal control, increasing norepinephrine cardiac spillover and reducing heart rate variability (HRV).…”

Sex‐related difference in sympathetic chemoreflex response: does it matter in clinical disease?

“…A pathophysiological role for increased response to chemoreflex activation has long been observed in various cardiovascular diseases, including systemic hypertension, and, most notably, chronic heart failure (HF) (Shivkumar et al., 2016). Despite recent therapeutic advances, a substantial subset of HF patients shows an increased hypoxic (HVR) and/or hypercapnic (HCVR) ventilatory response, which is associated with sympathovagal imbalance, exercise intolerance and a significantly higher risk of HF‐related hospitalizations and death (Giannoni et al., 2022). Such relations are even stronger when both peripheral and central chemoreflex responses are elevated (Giannoni et al., 2022).…”

“…Despite recent therapeutic advances, a substantial subset of HF patients shows an increased hypoxic (HVR) and/or hypercapnic (HCVR) ventilatory response, which is associated with sympathovagal imbalance, exercise intolerance and a significantly higher risk of HF‐related hospitalizations and death (Giannoni et al., 2022). Such relations are even stronger when both peripheral and central chemoreflex responses are elevated (Giannoni et al., 2022). Furthermore, an increased ventilatory response to chemoreflex activation, together with an increased plant gain and circulatory delay, has been identified as a crucial pathophysiological determinant of highly prevalent breathing disorders in HF patients, such as period breathing, central apnoeas and Cheyne–Stokes respiration (PB/CA/CSR) (Giannoni et al., 2019).…”