Dysregulation of peripheral and central chemoreflex responses in Chagas' heart disease patients without heart failure

被引:16
作者
Barreto, JAS [1 ]
Consolim-Colombo, FM [1 ]
Lopes, HF [1 ]
Sobrinho, CRM [1 ]
Guerra-Riccio, GM [1 ]
Krieger, EM [1 ]
机构
[1] Univ Sao Paulo, HCFMUSP, InCOR, Inst Heart,Hypertens Unit, BR-05403000 Sao Paulo, Brazil
关键词
hypoxia; hypercapnia; reflex; nervous system; autonomic; trypanosomiasis; Chagas' disease;
D O I
10.1161/hc4001.097039
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Background-The peripheral and central chemoreflexes are important autonomic mechanisms for regulating breathing and cardiovascular function. Although pathological inflammatory infiltration of the peripheral chemoreceptors and central nervous system has been reported in Chagas' disease, functional evaluation of chemoreflexes has not yet been performed. Methods and Results-The hypothesis that chemoreflex function is altered in patients with Chagas' heart disease (CH) but normal left ventricle function was tested in 12 CH patients and 13 matched control subjects. The ventilatory rate, minute ventilation, heart rate, mean arterial pressure, forearm blood flow, forearm vascular resistance, and venous norepinephrine responses to hypoxia and hypercapnia were determined. During hypoxia, the decrease in oxygen saturation was smaller in CH patients, despite a similar ventilatory response between groups. Both groups showed an increase in heart rate during hypoxia, but this response was blunted in CH patients. Although the mean arterial pressure response to hypoxia was similar in both groups, forearm vascular resistance significantly decreased in control subjects while remaining unchanged in CH patients. Moreover, a significant increase in plasma norepinephrine levels elicited by stimulation of peripheral chemoreceptors was observed only in the CH group. During hypercapnia, the increase in minute ventilation was smaller in CH patients, who did not exhibit the increase in norepinephrine observed in control subjects. Conclusions-These data suggest that CH potentiates respiratory, cardiovascular, and autonomic responses to peripheral chemoreceptor activation by hypoxia in patients with normal left ventricular function. The ventilatory and sympathetic responses to central chemoreceptor activation by hypercapnia, however, are significantly blunted.
引用
收藏
页码:1792 / 1798
页数:7
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