Association between hemodynamic impairment and cheyne-stokes respiration and periodic breathing in chronic stable congestive heart failure secondary to ischemic or idiopathic dilated cardiomyopathy

• Published in: The American journal of cardiology Vol. 84; no. 8; pp. 900 - 904
• Main Authors: Mortara, Andrea, Sleight, Peter, Pinna, Gian Domenico, Maestri, Roberto, Capomolla, Soccorso, Febo, Oreste, La Rovere, Maria Teresa, Cobelli, Franco
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 15-10-1999; Elsevier; Elsevier Limited
• Subjects: Analysis of Variance; Apnea - etiology; Apnea - physiopathology; Biological and medical sciences; Cardiology. Vascular system; Cardiomyopathy, Dilated - complications; Cardiovascular disease; Cheyne-Stokes Respiration - etiology; Cheyne-Stokes Respiration - physiopathology; Chi-Square Distribution; Chronic Disease; Echocardiography, Doppler; Electrocardiography; Female; Heart; Heart failure; Heart Failure - etiology; Heart Failure - physiopathology; Heart failure, cardiogenic pulmonary edema, cardiac enlargement; Hemodynamics; Humans; Logistic Models; Lung Volume Measurements; Male; Medical sciences; Middle Aged; Oxygen - blood; Plethysmography; Pulmonary Circulation; Respiratory system; Studies; Human; Heart failure; Respiratory disease; Pathogenesis; Heart disease; Clinical form; Cardiovascular disease; Hemodynamics; Cheyne Stokes breathing
• ISSN: 0002-9149; 1879-1913
• DOI: 10.1016/S0002-9149(99)00462-2

Irregular breathing occurs frequently in patients with congestive heart failure (CHF) both during daytime and nighttime. Many factors are involved in the genesis of these breathing abnormalities, but the role of the hemodynamic impairment remains controversial. This study investigated the relation between worsening ventricular function and the frequency of respiratory disorders in patients with mild to severe CHF. One hundred fifty patients with CHF (mean age 53 ± 8 years, left ventricular (LV) ejection fraction 26 ± 7, in New York Heart Association [NYHA] classes II to IV, and who underwent stable therapy for ≥2 weeks) were studied. Analysis of instantaneous lung volume signal and arterial oxygen saturation during awake daytime revealed a normal respiratory pattern in 63 patients, whereas 87 had a persistent alteration of breathing, with a typical Cheyne-Stokes respiration (CSR) in 42 and periodic breathing (PB [oscillation of tidal volumes without apnea]) in 45 patients. Patients with PB and CSR showed a more pronounced hemodynamic impairment with a significantly reduced cardiac index, an increased pulmonary arterial wedge pressure, and a longer lung-to-ear circulation time (LECT) compared with patients with normal respiratory patterns. In a logistic regression model that included all of the variables significantly associated with breathing disorders, cardiac index and LECT emerged as the major determinants of CSR. In those patients with LECT ≥30 seconds (upper quartile) and cardiac index ≤1.9 L/min/m
2 (lower quartiles), the incidence of CSR was significantly higher (69%) than in patients with lower LECT and higher cardiac index (14%, p <0.001). In conclusion, abnormalities of breathing activity during daytime are significantly associated with a prolonged circulation time and a more severe impairment of systolic and diastolic LV indexes.