Oscillatory ventilation during exercise in patients with chronic heart failure: Clinical correlates and prognostic implications

Ugo Corrà, Andrea Giordano, Enzo Bosimini, Alessandro Mezzani, Massimo Piepoli, Andrew J S Coats, Pantaleo Giannuzzi

Research output: Contribution to journalArticle

131 Citations (Scopus)

Abstract

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 V̇O2 (X2, 51.5; p <0.0001), EOV (X2, 45.4; p <0.0001), and LVEF (X2, 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.

Original languageEnglish
Pages (from-to)1572-1580
Number of pages9
JournalChest
Volume121
Issue number5
DOIs
Publication statusPublished - 2002

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Ventilation
Heart Failure
Exercise
Stroke Volume
Deceleration
Tertiary Healthcare
Heart Transplantation
Cardiology
Exercise Test
Tertiary Care Centers
Oxygen Consumption
Survivors
Respiration
Multivariate Analysis
Population

Keywords

  • Exertional oscillatory ventilation
  • Heart failure
  • Prognosis

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine

Cite this

Oscillatory ventilation during exercise in patients with chronic heart failure : Clinical correlates and prognostic implications. / Corrà, Ugo; Giordano, Andrea; Bosimini, Enzo; Mezzani, Alessandro; Piepoli, Massimo; Coats, Andrew J S; Giannuzzi, Pantaleo.

In: Chest, Vol. 121, No. 5, 2002, p. 1572-1580.

Research output: Contribution to journalArticle

Corrà, Ugo ; Giordano, Andrea ; Bosimini, Enzo ; Mezzani, Alessandro ; Piepoli, Massimo ; Coats, Andrew J S ; Giannuzzi, Pantaleo. / Oscillatory ventilation during exercise in patients with chronic heart failure : Clinical correlates and prognostic implications. In: Chest. 2002 ; Vol. 121, No. 5. pp. 1572-1580.
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abstract = "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 V̇O2 (X2, 51.5; p <0.0001), EOV (X2, 45.4; p <0.0001), and LVEF (X2, 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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T1 - Oscillatory ventilation during exercise in patients with chronic heart failure

T2 - Clinical correlates and prognostic implications

AU - Corrà, Ugo

AU - Giordano, Andrea

AU - Bosimini, Enzo

AU - Mezzani, Alessandro

AU - Piepoli, Massimo

AU - Coats, Andrew J S

AU - Giannuzzi, Pantaleo

PY - 2002

Y1 - 2002

N2 - 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 V̇O2 (X2, 51.5; p <0.0001), EOV (X2, 45.4; p <0.0001), and LVEF (X2, 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.

AB - 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 V̇O2 (X2, 51.5; p <0.0001), EOV (X2, 45.4; p <0.0001), and LVEF (X2, 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.

KW - Exertional oscillatory ventilation

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