This Article Figures Only Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in Web of Science Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Web of Science (10) Citing Articles via Google Scholar Google Scholar Articles by Guazzi, M. Articles by Pedretti, R. Search for Related Content PubMed PubMed Citation Articles by Guazzi, M. Articles by Pedretti, R. Related Collections Related Article

CLINICAL RESEARCH: HEART FAILURE

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

Marco Guazzi, MD, PhD, FACC^_*,_*, Rosa Raimondo, MD, Marco Vicenzi, MD^_*, Ross Arena, PhD, Chiara Proserpio, MD, Simona Sarzi Braga, MD and Roberto Pedretti, MD

^_* Cardiopulmonary Unit, Cardiology Division, University of Milano, San Paolo Hospital, Milano, Italy
Division of Cardiology, IRCCS Salvatore Maugeri Foundation, Scientific Institute of Tradate, Tradate (VA), Italy
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

Related Article

Inside This Issue of JACC
J. Am. Coll. Cardiol. 2007 50: A23-A24. [Full Text] [PDF]

This article has been cited by other articles:

				U. Corra, A. Giordano, A. Mezzani, M. Gnemmi, M. Pistono, R. Caruso, and P. Giannuzzi Cardiopulmonary exercise testing and prognosis in heart failure due to systolic left ventricular dysfunction: a validation study of the European Society of Cardiology Guidelines and Recommendations (2008) and further developments European Journal of Cardiovascular Prevention & Rehabilitation, February 1, 2012; 19(1): 32 - 40. [Abstract] [Full Text] [PDF]

				M. Guazzi, M. Vicenzi, and R. Arena Phosphodiesterase 5 inhibition with sildenafil reverses exercise oscillatory breathing in chronic heart failure: a long-term cardiopulmonary exercise testing placebo-controlled study Eur J Heart Fail, January 1, 2012; 14(1): 82 - 90. [Abstract] [Full Text] [PDF]

				R. M. Murphy, R. V. Shah, R. Malhotra, P. P. Pappagianopoulos, S. S. Hough, D. M. Systrom, M. J. Semigran, and G. D. Lewis Exercise Oscillatory Ventilation in Systolic Heart Failure: An Indicator of Impaired Hemodynamic Response to Exercise Circulation, September 27, 2011; 124(13): 1442 - 1451. [Abstract] [Full Text] [PDF]

				M. T. Naughton and S. Andreas Sleep apnoea in chronic heart failure Sleep Apnoea, December 1, 2010; 396 - 420. [Abstract] [Fulltext] [PDF]

				G. J. Balady, R. Arena, K. Sietsema, J. Myers, L. Coke, G. F. Fletcher, D. Forman, B. Franklin, M. Guazzi, M. Gulati, et al. Clinician's Guide to Cardiopulmonary Exercise Testing in Adults: A Scientific Statement From the American Heart Association Circulation, July 13, 2010; 122(2): 191 - 225. [Full Text] [PDF]

				X. G. Sun, J. E. Hansen, J. F. Beshai, and K. Wasserman Oscillatory Breathing and Exercise Gas Exchange Abnormalities Prognosticate Early Mortality and Morbidity in Heart Failure J. Am. Coll. Cardiol., April 27, 2010; 55(17): 1814 - 1823. [Abstract] [Full Text] [PDF]

				M. Guazzi, K. Dickstein, M. Vicenzi, and R. Arena Six-Minute Walk Test and Cardiopulmonary Exercise Testing in Patients With Chronic Heart Failure: A Comparative Analysis on Clinical and Prognostic Insights Circ Heart Fail, November 1, 2009; 2(6): 549 - 555. [Abstract] [Full Text] [PDF]

				L. Ingle, A. Isted, K. K. Witte, J. G. F. Cleland, and A. L. Clark Impact of different diagnostic criteria on the prevalence and prognostic significance of exertional oscillatory ventilation in patients with chronic heart failure European Journal of Cardiovascular Prevention & Rehabilitation, August 1, 2009; 16(4): 451 - 456. [Abstract] [Full Text] [PDF]

				J.-P. Schmid, A. Apostolo, L. Antonioli, G. Cattadori, M. Zurek, M. Contini, and P. Agostoni Influence of exertional oscillatory ventilation on exercise performance in heart failure European Journal of Cardiovascular Prevention & Rehabilitation, December 1, 2008; 15(6): 688 - 692. [Abstract] [Full Text] [PDF]

				M. Guazzi, J. Myers, M. A. Peberdy, D. Bensimhon, P. Chase, and R. Arena Exercise oscillatory breathing in diastolic heart failure: prevalence and prognostic insights Eur. Heart J., November 2, 2008; 29(22): 2751 - 2759. [Abstract] [Full Text] [PDF]

				R. Arena, J. Myers, and M. Guazzi The Clinical Significance of Aerobic Exercise Testing and Prescription: From Apparently Healthy to Confirmed Cardiovascular Disease American Journal of Lifestyle Medicine, November 1, 2008; 2(6): 519 - 536. [Abstract] [PDF]

				L. Ingle Prognostic value and diagnostic potential of cardiopulmonary exercise testing in patients with chronic heart failure Eur J Heart Fail, February 1, 2008; 10(2): 112 - 118. [Abstract] [Full Text] [PDF]