Increased chemosensitivity to
hypoxia and
hypercapnia, together with a prolonged circulatory time, are the main determinants of Cheyne-Stokes (C-S) respiration in
heart failure. To evaluate the effect of
acetazolamide, a
carbonic anhydrase inhibitor, on chemosensitivity and respiratory dynamics in patients with
heart failure with C-S respiration, 12 patients (mean age 62 ± 9 years, mean left ventricular ejection fraction 24 ± 9%) and C-S respiration (mean
apnea-hypopnea index 23 ± 13) who underwent 4 consecutive days of oral
acetazolamide treatment (250 mg twice daily) were enrolled in this study. Assessment of chemosensitivity to
hypoxia and
hypercapnia, cardiopulmonary stress testing, 24-hour cardiorespiratory polygraphy, and neurohormonal characterization were performed at baseline and at the end of treatment.
Acetazolamide improved
central apneas (
apnea-hypopnea index 23 ± 13 to 15 ± 9, p = 0.012) and the percentage of time spent below an arterial
oxyhemoglobin saturation of 90% (16 ± 23% to 10 ± 18%, p = 0.005). Chemosensitivity to
hypoxia was blunted (1.03 ± 0.69 to 0.78 ± 0.55 L/min/mm Hg, p = 0.032), while chemosensitivity to
hypercapnia increased after
acetazolamide (1.27 ± 0.71 to 1.54 ± 0.78 L/min/% arterial oxygen saturation, p = 0.023); patients achieved a lower workload (90 ± 30 to 81 ± 30 W, p <0.001), with no differences in peak oxygen consumption, while there was an increment in the regression slope relating minute ventilation to
carbon dioxide output (39 ± 10 to 43 ± 9, p = 0.010). In conclusion, in patients with
heart failure,
acetazolamide diminishes C-S respiration and improves
oxyhemoglobin saturation, likely by decreasing chemosensitivity to
hypoxia. However, it is associated with reduced maximal workload achieved during effort and increased chemosensitivity to
hypercapnia, inducing a reduction in the ventilatory efficiency.