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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, 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

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