Prognostic Value of Nocturnal Cheyne-Stokes Respiration in Chronic Heart Failure

Author:

Lanfranchi Paola A.1,Braghiroli Alberto1,Bosimini Enzo1,Mazzuero Giorgio1,Colombo Roberto1,Donner Claudio F.1,Giannuzzi Pantaleo1

Affiliation:

1. From the Division of Cardiology (P.A.L., E.B., G.M., P.G.), Division of Pulmonary Disease (A.B., C.F.D.), and Department of Bioengineering (R.C.), Salvatore Maugeri Foundation, IRCCS, Veruno, Italy.

Abstract

Background —Nocturnal Cheyne-Stokes respiration (CSR) occurs frequently in patients with chronic heart failure (CHF), and it may be associated with sympathetic activation. The aim of the present study was to evaluate whether CSR could affect prognosis in patients with CHF. Methods and Results —Sixty-two CHF patients with left ventricular ejection fraction ≤35%, in NYHA class II to III, underwent clinical evaluation, Doppler echocardiography, ergospirometry, phenylephrine test, Holter recording, and a sleep study to evaluate the occurrence of CSR, expressed as percentage of periodic breathing, and apnea/hypopnea index (AHI) (ie, the number of apneas and hypopneas per hour of recording). During a mean follow-up of 28±13 months, 15 patients died of cardiac causes. Nonsurvivors were in a higher NYHA functional class than survivors ( P <0.001) and had a more depressed left ventricular ejection fraction ( P <0.03), a shorter deceleration time of early filling ( P <0.05), larger left and right atria ( P <0.05 and P <0.02, respectively) and a lower peak V̇ o 2 ( P <0.05). Nonsurvivors also spent a greater percentage of the night in periodic breathing ( P <0.01) with a greater AHI ( P <0.03) and showed lower values of diurnal baroreflex sensitivity ( P <0.05) and of heart rate variability (sdNN: P <0.01). Multivariate analysis revealed the AHI (χ 2 , 10.4; P <0.01), followed by left atrial area (χ 2 , 5.7; P <0.01), as the only independent and additional predictors of subsequent cardiac death. Patients at very high risk for fatal outcome could be identified by an AHI ≥30/h and left atria ≥25 cm 2 . Conclusions —The AHI is a powerful independent predictor of poor prognosis in clinically stable patients with CHF. The presence of an AHI ≥30/h adds prognostic information compared with other clinical, echocardiographic, and autonomic data and identifies patients at very high risk for subsequent cardiac death.

Publisher

Ovid Technologies (Wolters Kluwer Health)

Subject

Physiology (medical),Cardiology and Cardiovascular Medicine

Reference24 articles.

1. Stokes W. The Diseases of the Heart and the Aorta . Dublin Ireland: Hodges and Smith; 1854:302–340.

2. Effects of nasal CPAP on sympathetic activity in patients with heart failure and central sleep apnea.

3. Review: Sleep in Heart Failure

Cited by 602 articles. 订阅此论文施引文献 订阅此论文施引文献,注册后可以免费订阅5篇论文的施引文献,订阅后可以查看论文全部施引文献

同舟云学术

1.学者识别学者识别

2.学术分析学术分析

3.人才评估人才评估

"同舟云学术"是以全球学者为主线,采集、加工和组织学术论文而形成的新型学术文献查询和分析系统,可以对全球学者进行文献检索和人才价值评估。用户可以通过关注某些学科领域的顶尖人物而持续追踪该领域的学科进展和研究前沿。经过近期的数据扩容,当前同舟云学术共收录了国内外主流学术期刊6万余种,收集的期刊论文及会议论文总量共计约1.5亿篇,并以每天添加12000余篇中外论文的速度递增。我们也可以为用户提供个性化、定制化的学者数据。欢迎来电咨询!咨询电话:010-8811{复制后删除}0370

www.globalauthorid.com

TOP

Copyright © 2019-2024 北京同舟云网络信息技术有限公司
京公网安备11010802033243号  京ICP备18003416号-3