Association between hemodynamic impairment and cheyne-stokes respiration and periodic breathing in chronic stable congestive heart failure secondary to ischemic or idiopathic dilated cardiomyopathy

Andrea Mortara, Peter Sleight, Gian Domenico Pinna, Roberto Maestri, Soccorso Capomolla, Oreste Febo, Maria Teresa La Rovere, Franco Cobelli

Research output: Contribution to journalArticle

Abstract

Irregular breathing occurs frequently in patients with congestive heart failure (CHF) both during daytime and nighttime. Many factors are involved in the genesis of these breathing abnormalities, but the role of the hemodynamic impairment remains controversial. This study investigated the relation between worsening ventricular function and the frequency of respiratory disorders in patients with mild to severe CHF. One hundred fifty patients with CHF (mean age 53 ± 8 years, left ventricular (LV) ejection fraction 26 ± 7, in New York Heart Association [NYHA] classes II to IV, and who underwent stable therapy for ≥2 weeks) were studied. Analysis of instantaneous lung volume signal and arterial oxygen saturation during awake daytime revealed a normal respiratory pattern in 63 patients, whereas 87 had a persistent alteration of breathing, with a typical Cheyne-Stokes respiration (CSR) in 42 and periodic breathing (PB [oscillation of tidal volumes without apnea]) in 45 patients. Patients with PB and CSR showed a more pronounced hemodynamic impairment with a significantly reduced cardiac index, an increased pulmonary arterial wedge pressure, and a longer lung-to- ear circulation time (LECT) compared with patients with normal respiratory patterns. In a logistic regression model that included all of the variables significantly associated with breathing disorders, cardiac index and LECT emerged as the major determinants of CSR. In those patients with LECT ≥30 seconds (upper quartile) and cardiac index ≤1.9 L/min/m2 (lower quartiles), the incidence of CSR was significantly higher (69%) than in patients with lower LECT and higher cardiac index (14%, p

Original languageEnglish
Pages (from-to)900-904
Number of pages5
JournalThe American Journal of Cardiology
Volume84
Issue number8
DOIs
Publication statusPublished - Oct 15 1999

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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