Chest
Volume 121, Issue 5, May 2002, Pages 1572-1580
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Clinical Investigations
Cardiology
Oscillatory Ventilation During Exercise in Patients With Chronic Heart Failure: Clinical Correlates and Prognostic Implications

https://doi.org/10.1378/chest.121.5.1572Get rights and content

Study objectives

Although breathing disorders are often found in patients with chronic heart failure, exertional oscillatory ventilation (EOV) has been occasionally described. The aim of this study was to determine the prevalence, clinical characteristics, and outcome of patients with chronic heart failure and EOV.

Setting

Cardiology division at tertiary-care hospital.

Study population

We studied 323 patients with chronic heart failure and left ventricular ejection fraction (LVEF) ≤ 40%.

Measurements and results

All patients performed a symptom-limited cardiopulmonary exercise test and were followed up for 22 ± 11 months (mean ± SD). EOV was defined as cyclic fluctuations in minute ventilation (V˙e) at rest that persist during effort lasting ≥ 60% of the exercise duration, with an amplitude ≥ 15% of the average resting value. Patients with EOV (12%), as compared to those without, showed higher New York Heart Association (NYHA) class (p < 0.05) and lower LVEF (p < 0.0001) and peak oxygen consumption (V˙o2) [p < 0.0001]. During the follow-up period, 53 patients died or underwent urgent cardiac transplantation; this group showed higher NYHA class (p < 0.05) and V˙e/V˙co2 slope (p < 0.0001) and lower LVEF (p < 0.0001), mitral Doppler early deceleration time (p < 0.01), and peak V˙o2 (p < 0.0001). EOV was more frequent in nonsurvivors than in survivors (28% vs 9%, p < 0.01). Multivariate analysis revealed peak V˙o22, 51.5; p < 0.0001), EOV (χ2, 45.4; p < 0.0001), and LVEF (χ2, 20.6; p < 0.0001) as independent predictors of major cardiac events.

Conclusions

EOV is not unusual in patients with chronic heart failure, and is associated with worse clinical status, cardiac function, and exercise capacity. EOV is a powerful predictor of poor prognosis and, consequently, it may be considered a valuable guide in the management of patients with chronic heart failure and should suggest a more aggressive medical treatment policy when detected.

Section snippets

Study Population

We studied 390 patients with chronic heart failure due to ischemic or idiopathic dilated cardiomyopathy referred for cardiopulmonary exercise testing as part of a comprehensive heart failure evaluation between January 1996 and November 1998. All patients had a history of at least one unequivocal clinical episode of heart failure. All had been receiving stable medical optimized treatment for at least 1 month at the time of the study. Eligibility criteria were: (1) echocardiographic left

Results

Sixty-seven patients were excluded from the study: 37 patients were unable to reach a peak RER ≥ 1.05; 26 patients were not limited by fatigue and/or dyspnea; and in 4 patients, the presence of artifacts rendered the breath-by-breath gas exchange data uninterpretable. Among proscribed patients, three patients had EOV, but their data were not included in subsequent analysis. Thus, 323 patients met the inclusion criteria and form the basis of this report. Patients' demographics and clinical

Discussion

Although oscillatory ventilation as a mild form of Cheyne-Stokes respiration has been described some 200 years ago,19,20 breathing disorders in patients with chronic heart failure detected during wakefulness, sleep, or exercise are a modern area of study.14,21,22 Oscillatory ventilation during exercise has been occasionally and anecdotally described9,10,11,12,13 and, to our knowledge, this is the first study evaluating the clinical and prognostic value of oscillatory ventilation during exercise

Conclusion

Oscillatory ventilation during exercise is not unusual in patients with chronic heart failure, and is associated with a more advanced clinical status, cardiac functional impairment, and reduced exercise capacity, and may reflect a more severe derangement of the ventilatory control system, perhaps as an important feature of neuroautonomic instability. The presence of EOV can be used as an additional index of clinical instability and hemodynamic deterioration that has independent and additional

ACKNOWLEDGMENT

The authors thank Alfio Agazzone and Elena Bonanomi for technical support, Fabio Comazzi for statistical analysis, and Rosemary Allpress for revision of the English-language manuscript.

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