Excessive Sympathetic Activation in Heart Failure Associated With Anemia: PP.32.260

Franchitto, Nicolas; Despas, Fabien; Labrunée, M.; Boveda, Serge; Galinier, Michel; Senard, J. M.; Pathak, A.

doi:10.1097/01.hjh.0000379798.77141.d6

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“…Chemoreflex-mediated ventilatory and sympathetic responses are elicited via common afferent input to the central nervous system (84). A substantial number with either sleep apnea or heart failure exhibits augmented ventilatory or sympathoneural responses to acute peripheral and central chemoreflex stimulation by hypoxia and hypercapnia (67,(85)(86)(87)(88)(89), particularly if anemia or chronic kidney disease also are present (90,91). Such augmented chemoreflex sensitivity can be absent at rest yet unmasked by exercise (92).…”

Section: Chemoreceptor Reflexesmentioning

confidence: 99%

The 2021 Carl Ludwig Lecture. Unsympathetic autonomic regulation in heart failure: patient-inspired insights

Floras

2021

American Journal of Physiology-Regulatory, Integrative and Comp

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Defined as a structural or functional cardiac abnormality accompanied by symptoms, signs or biomarkers of altered ventricular pressures or volumes, heart failure also is a state of autonomic disequilibrium. A large body of evidence affirms that autonomic disturbances are intrinsic to heart failure; that basal or stimulated sympathetic nerve firing or neural norepinephrine (NE) release more often than not exceed homeostatic need, such that an initially adaptive adrenergic or vagal reflex response, becomes maladaptive; and, that the magnitude of such maladaptation predicts prognosis. This Ludwig lecture develops two theses: that the elucidation and judiciously targeted amelioration of maladaptive autonomic disturbances offers opportunities to complement contemporary guideline-based heart failure therapy; and, that serendipitous single-participant insights, acquired in the course of experimental protocols with entirely different intent, can generate novel insight, inform mechanisms, and launch entirely new research directions. I précis 6 elements of our current synthesis of the causes and consequences of maladaptive sympathetic disequilibrium in heart failure, shaped by patient-inspired epiphanies: arterial baroreceptor reflex modulation; excitation stimulated by increased cardiac filling pressure; paradoxical muscle sympathetic activation as a peripheral neurogenic constraint on exercise capacity; renal sympathetic restraint of natriuresis; co-existing sleep apnea; and, augmented chemoreceptor reflex sensitivity, then conclude by envisaging translational therapeutic opportunities.

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Section: Chemoreceptor Reflexesmentioning

confidence: 99%

The 2021 Carl Ludwig Lecture. Unsympathetic autonomic regulation in heart failure: patient-inspired insights

Floras

2021

American Journal of Physiology-Regulatory, Integrative and Comp

View full text Add to dashboard Cite

show abstract

Excessive Sympathetic Activation in Heart Failure Associated With Anemia: PP.32.260

Cited by 1 publication

References 0 publications

The 2021 Carl Ludwig Lecture. Unsympathetic autonomic regulation in heart failure: patient-inspired insights

The 2021 Carl Ludwig Lecture. Unsympathetic autonomic regulation in heart failure: patient-inspired insights

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