Resolution of exercise oscillatory ventilation with adaptive servoventilation in patients with chronic heart failure and Cheyne-Stokes respiration: preliminary study.
BACKGROUND
Exercise oscillatory ventilation (EOV) is a common pattern of breathing in heart failure (HF) patients, and indicates a poor prognosis.


OBJECTIVE
To investigate the effects of adaptive servoventilation (ASV) on ventilatory response during exercise.


METHODS
We studied 39 HF patients with left ventricular ejection fraction (LVEF) £ 45. Cardiorespiratory polygraphy, cardiopulmonary exercise testing (CPET), echocardiography, and measurement of N-terminal pro-brain natriuretic peptide (NT-proBNP) concentration were performed. Twenty patients with Cheyne-Stokes respiration and apnoea-hypopnoea index (AHI) ≥ 15/h were identified. Of these, 11 patients were successfully titrated on ASV and continued therapy. In the third month of ASV treatment, polygraphy, CPET, echocardiography, and measurement of NT-proBNP concentration were performed again.


RESULTS
The EOV was detected at baseline in 12 (31%) HF patients, including eight (67%) who underwent ASV. The EOV was associated with significantly lower LVEF, peak oxygen uptake (VO(2)), and ventilatory anaerobic threshold (VAT), and a significantly higher left ventricular diastolic diameter (LVDD), slope of ventilatory equivalent for carbon dioxide (VE/VCO(2)), AHI, central AHI and NT-proBNP concentration. In seven patients with EOV, reversal of EOV in the third month of ASV therapy was observed; only in one patient did EOV persist (p = 0.0156).


CONCLUSIONS
The EOV can be reversed with ASV therapy. The EOV in association with central sleep apnoea and Cheyne- -Stokes respiration (CSA/CSR) is prevalent in HF patients and correlates with severity of the disease.
Department of Cardiology and Internal Diseases, Military Institute of Medicine, Warsaw, Poland.
Anna
A
Kazimierczak
Krystian
K
Krzyżanowski
Robert
R
Wierzbowski
Robert
R
Ryczek
Paweł
P
Smurzyński
Dariusz
D
Michałkiewicz
Zbigniew
Z
Orski
Grzegorz
G
Gielerak
D000222:Adaptation, Physiological; D000368:Aged; D001945:Breathing Exercises; D002639:Cheyne-Stokes Respiration / Q000503:physiopathology*; D002908:Chronic Disease; D015444:Exercise / Q000502:physiology; D005080:Exercise Test; D005260:Female; D006333:Heart Failure / Q000150:complications / Q000000981:diagnostic imaging / Q000503:physiopathology* / Q000534:rehabilitation*; D006801:Humans; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000378:metabolism; D012891:Sleep Apnea Syndromes / Q000150:complications / Q000503:physiopathology; D014463:Ultrasonography
D020097:Natriuretic Peptide, Brain