© 2007 European Society of Cardiology
Clinical relevance of short-term day-time breathing disorders in chronic heart failure patients
a Divisione di Cardiologia, Pneumologia e Bioingegneria, Fondazione "Salvatore Maugeri", IRCCS, Istituto Scientifico di Montescano 27040 Montescano, (Pavia), Italy
b Dipartimento di Cardiologia, Policlinico di Monza Monza, Italy
c Cardiovascular Medicine, John Radcliffe Hospital University of Oxford, Oxford, UK
* Corresponding author. Tel.: +39 385 2471; fax: +39 385 61386. Email address: mtlarovere{at}fsm.it
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Abstract |
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Background: Periodic Breathing (PB, waxing and waning of tidal volume in which hyperventilation alternates with periods of apnoea or hypopnoea), is common during sleep and wakefulness in patients with Heart Failure (HF) and may increase mortality.
Aim: To assess the effect of short-term, day-time PB on prognosis, in HF patients.
Methods: We prospectively studied 380 consecutive HF referrals who had a 10 min, supine day-time respiratory recording. We related PB (adjusted for known predictors) to total cardiac mortality, during a median follow-up of 41 months.
Results: Day-time PB occurred in 145/380 patients who had more severe HF and more compromised left ventricular function (p<0.005). Survival curves began to separate after 10 months and diverged steadily over the next 4 years with a cumulative risk of 41% (PB) vs 26% (No-PB), p<0.002. PB was independently predictive of increased cardiac mortality when entered into a clinical prognostic model (including NYHA Class, LVEF, LVEDD, Systolic Arterial Pressure, beta-blocker treatment, peak VO2 and blood urea) with a RR: 1.8, 95% CI 1.20–2.81.
Conclusion: In advanced HF the presence of PB during a short day-time recording adds to known predictors of cardiac mortality. This may have practical implications for trials of HF therapy.
Key Words: Heart failure • Respiration • Prognosis • Sleep • Mortality
Received April 12, 2007; Accepted June 20, 2007
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