Key result
Voluntary hyperventilation increased cardiac index by 29% in healthy subjects (p<0.05), compared to a 10% increase in heart failure and 5% in pulmonary arterial hypertension patients.
Why the study?
The effects of hyperventilation and hyperventilation in periodic breathing on sympatho-vagal balance and hemodynamics in conditions like heart failure or pulmonary arterial hypertension are not completely understood.
Does voluntary hyperventilation and simulated periodic breathing alter sympatho-vagal balance and hemodynamics in patients with heart failure or pulmonary arterial hypertension compared to healthy subjects?
Observational (n=60)
Does voluntary hyperventilation and simulated periodic breathing alter sympatho-vagal balance and hemodynamics in patients with heart failure or pulmonary arterial hypertension compared to healthy subjects?
Voluntary hyperventilation and simulated periodic breathing exert blunted hemodynamic and sympatho-vagal effects in patients with heart failure and pulmonary arterial hypertension compared to healthy volunteers.
Answers are grounded in this paper and cite their sources.
Blunted hyperventilation responses in HF/PAH warrant caution during respiratory assessments; leaves open autonomic effects on outcomes and requires prospective validation.
BACKGROUND: The effects of hyperventilation and hyperventilation in the context of periodic breathing (PB) on sympatho-vagal balance (SVB) and hemodynamics in conditions of decreased cardiac output and feedback resetting, such as heart failure (HF) or pulmonary arterial hypertension (PAH), are not completely understood. OBJECTIVES: To investigate the effects of voluntary hyperventilation and simulated PB on hemodynamics and SVB in healthy subjects, in patients with systolic HF and reduced or mid-range ejection fraction (HFrEF and HFmrEF) and in patients with PAH. METHODS: Study participants (n = 20 per group) underwent non-invasive recording of diastolic blood pressure, heart rate variability (HRV), baroreceptor-reflex sensitivity (BRS), total peripheral resistance index (TPRI) and cardiac index (CI). All measurements were performed at baseline, during voluntary hyperventilation and during simulated PB with different length of the hyperventilation phase. RESULTS: In healthy subjects, voluntary hyperventilation led to a 50% decrease in the mean BRS slope and a 29% increase in CI compared to baseline values (p < 0.01 and p < 0.05). Simulated PB did not alter TPRI or CI and showed heterogeneous effects on BRS, but analysis of dPBV revealed decreased sympathetic drive in healthy volunteers depending on PB cycle length (p < 0.05). In HF patients, hyperventilation did not affect BRS and TPRI but increased the CI by 10% (p < 0.05). In HF patients, simulated PB left all of these parameters unaffected. In PAH patients, voluntary hyperventilation led to a 15% decrease in the high-frequency component of HRV (p < 0.05) and a 5% increase in CI (p < 0.05). Simulated PB exerted neutral effects on both SVB and hemodynamic parameters. CONCLUSIONS: Voluntary hyperventilation was associated with sympathetic predominance and CI increase in healthy volunteers, but only with minor hemodynamic and SVB effects in patients with HF and PAH. Simulated PB had positive effects on SVB in healthy volunteers but neutral effects on SVB and hemodynamics in patients with HF or PAH.
No takes yet. Share an insight, caveat, or question.
Spießhoefer et al. (2019) conducted an observational in Heart Failure and Pulmonary Arterial Hypertension (n=60). Voluntary hyperventilation and simulated periodic breathing vs. Baseline was evaluated on Hemodynamics and sympatho-vagal balance (diastolic blood pressure, HRV, BRS, TPRI, and cardiac index). Voluntary hyperventilation increased cardiac index by 29% in healthy subjects (p<0.05), compared to a 10% increase in heart failure and 5% in pulmonary arterial hypertension patients.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: