Better Respiratory Function in Heart Failure Patients With Use of Central-Acting Therapeutics

IF 2.5 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS
Julie K.K. Vishram-Nielsen MD, PhD , Fernando Luis Scolari MD, PhD , Chun-Po Steve Fan PhD , Yas Moayedi MD , Heather J. Ross MD, MHSc , Cedric Manlhiot PhD , Melissa A. Allwood MD, PhD , Ana Carolina Alba MD, PhD , Keith R. Brunt PhD , Jeremy A. Simpson PhD , Filio Billia MD, PhD
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引用次数: 0

Abstract

Background

Diaphragm atrophy can contribute to dyspnea in patients with heart failure (HF) with its link to central neurohormonal overactivation. HF medications that cross the blood-brain barrier could act centrally and improve respiratory function, potentially alleviating diaphragmatic atrophy. Therefore, we compared the benefit of central- vs peripheral-acting HF drugs on respiratory function, as assessed by a single cardiopulmonary exercise test (CPET) and outcomes in HF patients.

Methods

A retrospective study was conducted of 624 ambulatory adult HF patients (80% male) with reduced left ventricular ejection fraction ≤ 40% and a complete CPET, followed at a single institution between 2001 and 2017. CPET parameters, and the outcomes all-cause death, a composite endpoint (all-cause death, need for left ventricular assist device, heart transplantation), and all-cause and/or HF hospitalizations, were compared in patients receiving central-acting (n = 550) vs peripheral-acting (n = 74) drugs.

Results

Compared to patients who receive peripheral-acting drugs, patients who receive central-acting drugs had better respiratory function (peak breath-by breath oxygen uptake [VO2], P = 0.020; forced expiratory volume in 1 second [FEV1], P = 0.007), and ventilatory efficiency (minute ventilation / carbon dioxide production [VE/VCO2], P < 0.001; end-tidal carbon dioxide tension [PETCO2], P = 0.015; and trend for forced vital capacity [FVC], P = 0.056). Many of the associations between the CPET parameters and drug type remained significant after multivariate adjustment. Moreover, patients receiving central-acting drugs had fewer composite events (P = 0.023), and HF hospitalizations (P = 0.044), although significance after multivariant correction was not achieved, despite the hazard ratio being 0.664 and 0.757, respectively.

Conclusions

Central-acting drugs were associated with better respiratory function as measured by CPET parameters in HF patients. This could extend to clinically meaningful composite outcomes and hospitalizations but required more power to be definitive in linking to drug effect. Central-acting HF drugs show a role in mitigating diaphragm weakness.

Abstract Image

利用中枢作用疗法改善心力衰竭患者的呼吸功能。
背景膈肌萎缩可能导致心力衰竭(HF)患者呼吸困难,这与中枢神经激素过度激活有关。可穿过血脑屏障的高血压药物可发挥中枢作用并改善呼吸功能,从而缓解膈肌萎缩。因此,我们比较了通过单一心肺运动测试(CPET)评估的中枢与外周作用的高血压药物对呼吸功能的益处以及高血压患者的预后。方法我们对 624 名左室射血分数降低≤40% 且有完整 CPET 的卧床成年高血压患者(80% 为男性)进行了回顾性研究,这些患者在 2001 年至 2017 年期间在一家机构接受了随访。比较了接受中枢作用药物(n = 550)与外周作用药物(n = 74)的患者的 CPET 参数、全因死亡、复合终点(全因死亡、需要左室辅助装置、心脏移植)以及全因和/或高血压住院治疗的结果。结果与接受外周作用药物的患者相比,接受中枢作用药物的患者呼吸功能更好(逐次呼吸摄氧量峰值[VO2],P = 0.020;1秒内用力呼气容积[FEV1],P = 0.007)和通气效率(分钟通气量/二氧化碳产生量[VE/VCO2],P <0.001;潮气末二氧化碳张力[PETCO2],P = 0.015;以及用力肺活量[FVC]的趋势,P = 0.056)。经多变量调整后,CPET 参数与药物类型之间的许多关联仍然显著。此外,接受中枢作用药物治疗的患者发生的综合事件(P = 0.023)和心房颤动住院(P = 0.044)较少,尽管危险比分别为 0.664 和 0.757,但经多变量校正后仍未达到显著性。结论中枢作用药物与高血压患者通过 CPET 参数测量的呼吸功能改善有关,这可能会延伸到有临床意义的综合结果和住院治疗,但需要更多的力量才能明确地将药物效应联系起来。中枢作用型高血压药物在缓解膈肌无力方面发挥了作用。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
CJC Open
CJC Open Medicine-Cardiology and Cardiovascular Medicine
CiteScore
3.30
自引率
0.00%
发文量
143
审稿时长
60 days
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