Enhanced carotid body chemoreceptors play a central role in the progression of chronic heart failure by contributing to respiratory instability, oscillatory breathing, and cardiorenal dysfunction.
Does carotid body denervation or modulation improve disordered breathing and cardiorenal dysfunction in chronic heart failure?
Carotid body denervation or modulation represents a potential therapeutic target to reduce sympathetic overactivity, disordered breathing, and cardiorenal dysfunction in chronic heart failure.
Oscillatory breathing (OB) patterns are observed in pre-term infants, patients with cardio-renal impairment, and in otherwise healthy humans exposed to high altitude. Enhanced carotid body (CB) chemoreflex sensitivity is common to all of these populations and is thought to contribute to these abnormal patterns by destabilizing the respiratory control system. OB patterns in chronic heart failure (CHF) patients are associated with greater levels of tonic and chemoreflex-evoked sympathetic nerve activity (SNA), which is associated with greater morbidity and poor prognosis. Enhanced chemoreflex drive may contribute to tonic elevations in SNA by strengthening the relationship between respiratory and sympathetic neural outflow. Elimination of CB afferents in experimental models of CHF has been shown to reduce OB, respiratory-sympathetic coupling, and renal SNA, and to improve autonomic balance in the heart. The CB chemoreceptors may play an important role in progression of CHF by contributing to respiratory instability and OB, which in turn further exacerbates tonic and chemoreflex-evoked increases in SNA to the heart and kidney.
Marcus et al. (Mon,) conducted a review in Chronic heart failure. Enhanced carotid body chemoreceptors play a central role in the progression of chronic heart failure by contributing to respiratory instability, oscillatory breathing, and cardiorenal dysfunction.