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Clinical Investigations: CARDIOLOGY |

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

Ugo Corrà, MD; Andrea Giordano, PhD; Enzo Bosimini, MD; Alessandro Mezzani, MD; Massimo Piepoli, MD, PhD; Andrew J. S. Coats, DM; Pantaleo Giannuzzi, MD
Author and Funding Information

*From the Division of Cardiology (Drs. Corrà, Bosimini, Mezzani, and Giannuzzi) and Bioengineering Department (Dr. Giordano), Salvatore Maugeri Foundation, IRCCS, Veruno, Italy; and Department of Cardiac Medicine (Drs. Piepoli and Coats), National Heart and Lung Institute, London, UK.

Correspondence to: Ugo Corrà, MD, Divisione di Cardiologia, Fondazione “S. Maugeri,” Via per Revislate, 13, 28010 Veruno (NO), Italy; e-mail: ucorra@fsm.it



Chest. 2002;121(5):1572-1580. doi:10.1378/chest.121.5.1572
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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 (V̇e) 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 (V̇o2) [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 V̇e/V̇co2 slope (p < 0.0001) and lower LVEF (p < 0.0001), mitral Doppler early deceleration time (p < 0.01), and peak V̇o2 (p < 0.0001). EOV was more frequent in nonsurvivors than in survivors (28% vs 9%, p < 0.01). Multivariate analysis revealed peak V̇o22, 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.

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