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J Am Coll Cardiol, 2007; 50:299-308, doi:10.1016/j.jacc.2007.03.042
© 2007 by the American College of Cardiology Foundation
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CLINICAL RESEARCH: HEART FAILURE

Exercise Oscillatory Ventilation May Predict Sudden Cardiac Death in Heart Failure Patients

Marco Guazzi, MD, PhD, FACC*,*, Rosa Raimondo, MD{dagger}, Marco Vicenzi, MD*, Ross Arena, PhD§, Chiara Proserpio, MD{ddagger}, Simona Sarzi Braga, MD{dagger} and Roberto Pedretti, MD{dagger}

* Cardiopulmonary Unit, Cardiology Division, University of Milano, San Paolo Hospital, Milano, Italy
{dagger} Division of Cardiology, IRCCS Salvatore Maugeri Foundation, Scientific Institute of Tradate, Tradate (VA), Italy
{ddagger} Division of Cardiology, University of Insubria, Varese, Italy
§ Virginia Commonwealth University, Richmond, Virginia.

Manuscript received January 29, 2007; revised manuscript received February 26, 2007, accepted March 5, 2007.

* Reprint requests and correspondence: Dr. Marco Guazzi, Cardiopulmonary Unit Cardiology Division, University of Milano, San Paolo Hospital, Via A. di Rudinì, 8, 20142 Milano, Italy. (Email: marco.guazzi{at}unimi.it).

Objectives: The purpose of this study was to test the ability of cardiopulmonary exercise testing (CPET)-derived variables as sudden cardiac death (SCD) predictors.

Background: The CPET variables, such as peak oxygen uptake (VO2), ventilatory requirement to carbon dioxide (CO2) production (VE/VCO2) slope, and exercise oscillatory breathing (EOB), are strong predictors of overall mortality in chronic heart failure (CHF) patients. Even though up to 50% of CHF patients die from SCD, it is unknown whether any of these variables predicts SCD.

Methods: One hundred fifty-six CHF patients (mean age: 60.9 ± 9.4 years; mean ejection fraction: 34.9 ± 10.6%) underwent CPET. Subjects were tracked for sudden versus pump-failure cardiac mortality over 27.8 ± 25.2 months.

Results: Seventeen patients died from SCD, and 17 died from cardiac pump failure. Survivors showed significantly higher peak VO2 (16.8 ± 4.5 ml·kg–1·min–1) and lower VE/VCO2 slope (32.8 ± 6.4) and prevalence of EOB (20.3%), compared with subjects who experienced arrhythmic (13.5 ± 3.2 ml·kg–1·min–1; 41.5 ± 11.4; 100%) or nonarrhythmic (14.1 ± 4.7 ml·kg–1·min–1; 38.1 ± 7.3; 47.1%) deaths (p < 0.05). At Cox regression analysis, all variables were significant univariate predictors of both sudden and pump failure death (p < 0.01). Multivariate analysis, including left ventricular (LV) ejection fraction, LV end systolic volume, and LV mass selected EOB, was the strongest predictor of both overall mortality (chi-square: 38.7, p < 0.001) and SCD (chi-square: 44.7, p < 0.001), whereas VE/VCO2 slope was the strongest ventilatory predictor of pump failure death (chi-square: 11.8, p = 0.001).

Conclusions: Exercise oscillatory breathing is an independent predictor of SCD in patients with CHF and might help as an additional marker for prioritization of antiarrhythmic strategies.

Abbreviations and Acronyms
  CI = confidence interval
  CPET = cardiopulmonary exercise test
  EF = ejection fraction
  EOB = exercise oscillatory breathing
  ICD = implantable cardioverter-defibrillator
  LV = left ventricle/ventricular
  RER = respiratory exchange ratio
  ROC = receiver-operating characteristic
  SCD = sudden cardiac death
  VCO2 = carbon dioxide production
  VE = ventilation
  VO2 = oxygen uptake


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