Background-Sleep and exertional periodic breathing are proverbial in chronic heart failure (CHF), and each alone indicates poor prognosis. Whether these conditions are associated and whether excess risk may be attributed to respiratory disorders in general, rather than specifically during sleep or exercise, is unknown.

chronic heart failure patients is evident, and as a unique finding, apnea/hypopnea index (AHI) Ͼ30/h alone has a preeminent predictive role in the presence of exercise oscillatory ventilation (EOV), which could be used as an argument for a reinterpretation of previous reports. 2,3 Even so, EOV contributes to a meaningful increase of risk in patients with AHI Ͼ30/h, and the fact that there were few EOV-alone patients in our population confirms the strong clinical interdependence between EOV and AHI Ͼ30/h. At the same time, as stated in the Limitations section of our article, because of the small number of EOV-alone patients, our study should not be viewed as the final word but rather as an encouragement for other centers to examine the prevalence and cardiovascular risk associated with EOV alone. Moreover, the lower mean V E/V CO 2 slope value and its reduced prognostic significance are easily explained by the characteristics of the study population: a large number of clinically stable chronic heart failure patients on ␤-blockers, who exhibit such features. 4,5 Finally, with regard to the methodological issues raised by Dr Guazzi, in our experience the influence of EOV on V E/V CO 2 slope is negligible.In conclusion, we believe that neither of these issues has an impact on the main findings of our article and our conclusions are supported by the evidence provided. DisclosuresNone.

Exercise training (ET) and secondary prevention measures in cardiovascular disease aim to stimulate early physical activity and to facilitate recovery and improve health behaviours. ET has also been proposed for heart failure patients with a ventricular assist device (VAD), to help recovery in the patient's functional capacity. However, the existing evidence in support of ET in these patients remains limited. After a review of current knowledge on the causes of the persistence of limitation in exercise capacity in VAD recipients, and concerning the benefit of ET in VAD patients, the Heart Failure Association of the European Society of Cardiology has developed the present document to provide practical advice on implementing ET. This includes appropriate screening to avoid complications and then starting with early mobilisation, ET prescription is individualised to meet the patient's needs. Finally, gaps in our knowledge are discussed.

We evaluated the longest list of CPET prognostic parameters yet studied in HF: ESC-predictors were independent predictors of cardiovascular events, and the ESC prototype showed a convincing predictive capacity, whereas none of 11 S-predictors enhanced the prognostic performance, except peak SBP.

In the present context of an aging population, limited donor heart availability, improved reliability of mechanical cardiac support and improved patient outcomes, ventricular assist device (VAD) options to support end-stage heart failure patients are rapidly expanding. In addition, both the smaller size and lighter weight of the pumps now produced and early evidence that these third generation devices may be associated with lower risk of infection and right ventricular failure will probably lead to greater physician and patient acceptability. This is the first of a two-part review on the role of cardiovascular prevention and rehabilitation in patients with VAD. In this first part, we will discuss the role of exercise therapy in VAD patients, while the second will focus on long-term management. One of the prerequisites for use of a VAD--whether permanent (as destination therapy) or semi-permanent (as an alternative to heart transplantation)--is that exercise capacity, although not normal, must be adequate for daily life activities. An intensive multidisciplinary rehabilitation program has the potential to increase exercise performance and improve the quality of life of VAD patients. Both early progressive mobilization and exercise training may improve the overall condition of VAD patients, and favorably impact their clinical course.