Chest
Volume 133, Issue 2, February 2008, Pages 474-481
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Original Research
Control of Breathing
Exercise Oscillatory Ventilation: Instability of Breathing Control Associated With Advanced Heart Failure

https://doi.org/10.1378/chest.07-2146Get rights and content

Background

Instability of breathing control due to heart failure (HF) manifests as exercise oscillatory ventilation (EOV). Prior descriptions of patients with EOV have not been controlled and have been limited to subjects with left ventricular ejection fraction (LVEF) of ≤ 0.40. The aim of this study was to compare clinical characteristics including ventilatory responses of subjects with EOV to those of control subjects with HF matched for LVEF.

Methods

Subjects (n = 47) were retrospectively identified from 1,340 consecutive patients referred for cardiopulmonary exercise testing. Study inclusion required EOV without consideration of LVEF while control subjects (n = 47) were composed of HF patients with no EOV matched for LVEF. Characteristics for each group were summarized and compared.

Results

For EOV subjects, the mean LVEF was 0.37 (range, 0.11 to 0.70), and 19 subjects (41%) had an LVEF of ≥ 0.40. Compared to control subjects, EOV subjects had increased left atrial dimension, mitral E-wave velocity, and right heart pressures as well as decreased exercise tidal volume response, functional capacity, rest and exercise end-tidal carbon dioxide, and increased ventilatory equivalent for carbon dioxide and dead space ventilation (all p < 0.05). Multivariate analysis demonstrated atrial fibrillation (odds ratio, 6.7; p = 0.006), digitalis therapy (odds ratio, 0.27; p = 0.02), New York Heart Association class (odds ratio, 3.5; p = 0.0006), rest end-tidal carbon dioxide (odds ratio, 0.87; p = 0.005), and peak heart rate (odds ratio, 0.98; p = 0.02) were independently associated with EOV.

Conclusions

Patients with EOV have clinical characteristics and exercise ventilatory responses consistent with more advanced HF than patients with comparable LV systolic function; EOV may occur in HF patients with an LVEF of ≥ 0.40.

Section snippets

Materials and Methods

The study was approved by the Mayo Clinic College of Medicine Institutional Review Board. All subjects provided informed consent.

Subject Characteristics

The frequency of EOV for all ambulatory patients without ischemia who had been referred for cardiopulmonary exercise testing was 47 of 1,340 (3.5%) compared to 45 of 646 (7.0%) for those with a referral diagnosis of HF (p < 0.001). The study group (n = 47) and control group (n = 47) were not different with regard to LVEF, body mass index, gender, or therapy with β-blockers, digitalis, and diuretics. On univariate analysis, characteristics that discriminated EOV subjects from control subjects

Discussion

A unique and noteworthy finding of this study was that a substantial proportion of EOV subjects (41%) had an LVEF of ≥ 0.40. Indeed, on average, EOV subjects had normal stroke volume and cardiac index that were not different from control subjects, indicating that severe LV systolic dysfunction is not a prerequisite for EOV. Additional novel observations were that EOV subjects had larger left atrial volume, findings that are consistent with higher estimated left atrial, pulmonary venous and

ACKNOWLEDGMENT

We thank Kathy O'Malley and Angela Heydmann for assistance in data management, and Michelle Small for manuscript preparation.

References (45)

  • KayeDM et al.

    Neurochemical evidence of cardiac sympathetic activation and increased central nervous system norepinephrine turnover in severe congestive heart failure

    J Am Coll Cardiol

    (1994)
  • CorraU et al.

    Sleep and exertional periodic breathing in chronic heart failure

    Circulation

    (2006)
  • HanleyPJ et al.

    Increased mortality associated with Cheyne-Stokes respiration in patients with congestive heart failure

    Am J Respir Crit Care Med

    (1996)
  • MortaraA et al.

    Abnormal awake respiratory patterns are common in chronic heart failure and may prevent evaluation of autonomic tone by measures of heart rate variability

    Circulation

    (1997)
  • LanfranchiPA et al.

    Prognostic value of nocturnal Cheyne-Stokes respiration in chronic heart failure

    Circulation

    (1999)
  • JavaheriS et al.

    Sleep apnea in 81 ambulatory male patients with stable heart failure: types and their prevalences, consequences and presentations

    Circulation

    (1998)
  • BradleyTD et al.

    Sleep apnea and heart failure: part II. Central sleep apnea

    Circulation

    (2003)
  • MolhotraA et al.
  • SolinP et al.

    Influence of pulmonary capillary wedge pressure on central apnea in heart failure

    Circulation

    (1999)
  • WhiteDP et al.

    Central sleep apnea: improvement with acetazolamide therapy

    Arch Intern Med

    (1982)
  • TomcsanyJ et al.

    Disappearance of periodic breathing after heart operations

    J Thorac Cardiovasc Surg

    (1994)
  • Ben-DovI et al.

    Evidence that circulatory oscillations accompany ventilatory oscillations during exercise in patients with heart failure

    Am Rev Respir Dis

    (1992)
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    This study was supported by the Mayo Foundation, and National Heart Lung and Blood Institute grants HL71478, HL71478S1, HL-65176, HL-70302, and HL-73211.

    The authors have reported to the ACCP that no significant conflicts of interest exist with any companies/organizations whose products or services may be discussed in this article.

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