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Clinical InvestigationsCardiologyOscillatory Ventilation During Exercise in Patients With Chronic Heart Failure: Clinical Correlates and Prognostic Implications
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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