Cheyne-Stokes respiration in heart failure: friend or foe? Hemodynamic effects of hyperventilation in heart failure patients and healthy volunteers.
OBJECTIVE
In patients with heart failure (HF), Cheyne-Stokes respiration (CSR) is characterized by chronic hyperventilation (HV) with low arterial partial pressure of carbon dioxide (pCO2). It is still unclear whether this HV represents a compensatory response to HF or an independent comorbidity. This study investigated the hemodynamic effects of HV in HF patients and volunteers.


METHODS
A total of 15 volunteers [13 male, 25 ± 4 years, brain natriuretic peptide (BNP) <49 pg/mL, left ventricular rejection fraction (LVEF) >55 %) and 20 HF patients with reduced LVEF (15 male, 67.7 ± 12 years, NYHA class 2.6 ± 0.6, BNP 790 ± 818 pg/mL, LVEF 32.4 ± 7.3 %) were enrolled. Hemodynamics was monitored noninvasively in volunteers (TaskForce Monitor, CNSystems) and invasively in HF patients.


RESULTS
During HV, the transcutaneous CO2 pressure in volunteers decreased from 38.7 ± 2.5 to 28.6 ± 3.3 mmHg (p < 0.001) and pCO2 in HF patients decreased from 33.6 ± 3.7 to 22.2 ± 3.2 mmHg (p < 0.001). There was a significant increase in cardiac output (CO) in both volunteers (6.2 ± 1.3-7.5 ± 1.3 L/min, p < 0.001) and HF patients (4.4 ± 1.3-5.0 ± 1.3 L/min), mainly as a result of an increase in heart rate (67.4 ± 7.6-82.8 ± 10.9/min, p < 0.001; and 77.2 ± 17.7-86.2 ± 22.4/min, p < 0.001, respectively); stroke volume (SV) was unchanged in volunteers (93.7 ± 19.6-93.8 ± 21.4 mL) and only slightly increased in HF patients (64.4 ± 28.7-68.5 ± 23.2 mL).


CONCLUSIONS
CSR with associated HV may be a compensatory mechanism in patients with a failing heart. This compensatory mechanism includes an increase in heart rate, which might be deleterious in the long run.
Department of Cardiology, Heart and Diabetes Center NRW, University Hospital, Ruhr University Bochum, Georgstrasse 11, 32545, Bad Oeynhausen, Germany, ooldenburg@hdz-nrw.de.
Olaf
O
Oldenburg
Jens
J
Spießhöfer
Henrik
H
Fox
Thomas
T
Bitter
Dieter
D
Horstkotte
D000328:Adult; D000368:Aged; D001794:Blood Pressure; D002302:Cardiac Output; D002639:Cheyne-Stokes Respiration / Q000209:etiology / Q000503:physiopathology*; D005260:Female; D006333:Heart Failure / Q000150:complications / Q000503:physiopathology*; D006339:Heart Rate; D006801:Humans; D006985:Hyperventilation / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D012016:Reference Values; D015656:Respiratory Mechanics