title: Origin of oscillatory kinetics of respiratory gas exchange in chronic heart failure.
abstract: BACKGROUND
  Respiratory gas exchange measurements in patients with chronic heart failure (CHF) at rest and during exercise commonly reveal prominent slow oscillations in ventilation (V(E)), measured oxygen uptake (VO(2)), and carbon dioxide production (VCO(2)), whose origin is not clear. Voluntary simulation of periodic breathing (PB) in normals has been reported to generate a different pattern of oscillations in gas exchange from that seen in spontaneous PB. This necessitates hypothesizing that PB is caused by a primary oscillation in tissue metabolism or in cardiac output.
  
  
  RESULTS
  We developed an automated method by which normal controls could be guided to breathe according to a PB pattern. The resultant metabolic oscillations closely matched those seen in spontaneous PB and had several interesting properties. At low workloads (including rest), the oscillations in VO(2) were as prominent as those in V(E) in both spontaneous PB (alpha(VO2)/alpha(VE)=0.92+/-0.04) and voluntary PB (0.93+/-0.07). However, at increased workload, the oscillations in VO(2) because less prominent than those in V(E) in spontaneous PB (intermediate workload 0.63+/-0.05, high workload 0.57+/-0.04; P<0.001) and voluntary PB (intermediate 0.66+/-0.03, high 0.48+/-0.03; P<0.001). There was no difference in the relative size of metabolic oscillations between voluntary and spontaneous PB at matched workloads (P>0.05 at low, intermediate, and high workloads). Furthermore, VO(2) peaked before V(E) in both spontaneous and voluntary PB. This time delay varied from 6.4+/-0.4 s at low ventilation, to 11.3+/-0.9 s at high ventilation (P<0.0001).
  
  
  CONCLUSIONS
  The magnitude and phase pattern of oscillations in gas exchange of spontaneous PB can be obtained by adequately matched voluntary PB. Therefore, the gas exchange features of PB are explicable by primary ventilatory oscillation.
authors.affiliation: National Heart & Lung Institute, Imperial College of Science, Technology and Medicine, London, UK. d.francis@cheerful.com
authors.forename: D P
authors.initials: DP
authors.lastname: Francis
authors.forename: L C
authors.initials: LC
authors.lastname: Davies
authors.forename: M
authors.initials: M
authors.lastname: Piepoli
authors.forename: M
authors.initials: M
authors.lastname: Rauchhaus
authors.forename: P
authors.initials: P
authors.lastname: Ponikowski
authors.forename: A J
authors.initials: AJ
authors.lastname: Coats
mesh_terms: D000328:Adult; D000368:Aged; D002245:Carbon Dioxide / Q000378:metabolism; D002303:Cardiac Output, Low / Q000503:physiopathology*; D002908:Chronic Disease; D006801:Humans; D007700:Kinetics; D008875:Middle Aged; D009991:Oscillometry; D010101:Oxygen Consumption; D011659:Pulmonary Gas Exchange; D013997:Time Factors
chemical_list: D002245:Carbon Dioxide