Exercise Oscillatory Ventilation

Olson, Lyle J.; Arruda‐Olson, Adelaide M.; Somers, Virend K.; Scott, Christopher G.; Johnson, Bruce D.

doi:10.1378/chest.07-2146

Cited by 40 publications

(18 citation statements)

References 46 publications

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“…19–30%), 3, 6–8 but it is highly consistent with the prevalence of EOV reported by Sun and colleagues (51%) in a cohort with exercise capacity similar to our HF subjects (peak VO 2 =12 ml/kg/min vs. 12.6 ml/kg/min in our cohort). 5 Like other investigators, we found that EOV was not related to age, gender, or LVEF 7, 29 but was associated with reduced peak VO 2 and a trend toward increased V E /VCO 2 slope. 5, 7, 8 …”

Section: Discussionsupporting

confidence: 83%

“…Ventilatory efficiency (V E /VCO 2 slope) was calculated by previously defined techniques 27 using breath-by-breath data. A subject was considered to have EOV, if they had three or more consecutive, regular oscillations in ventilation (V E ) during exercise, with V E oscillation amplitude ≥ 25% of average V E , 28, 29 persisting for ≥ 60% of exercise duration. 30 Oscillatory cycle length was measured as the average time from nadir-to-nadir for each respective oscillation.…”

Section: Methodsmentioning

confidence: 99%

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Exercise Oscillatory Ventilation in Systolic Heart Failure

et al. 2011

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Background Exercise oscillatory ventilation (EOV) is a non-invasive parameter that potently predicts outcomes in systolic heart failure (HF). However, mechanistic insights into EOV have been limited by the absence of studies relating EOV to invasive hemodynamic measurements and blood gases performed during exercise. Methods and Results 56 patients with systolic HF (age 59±2 years [mean±SEM], left ventricular ejection fraction 30±1%) and 19 age-matched controls were studied with incremental cardiopulmonary exercise testing. Fick cardiac outputs, filling pressures, and arterial blood gases were measured at one-minute intervals during exercise. EOV was detected in 45% of HF (HF+EOV) patients and in none of the controls. The HF+EOV group did not differ from the HF patients without EOV (HF-EOV) in age, gender, BMI, LVEF, or etiology of HF. Univariate predictors of the presence of EOV in HF, among measurements performed during exercise, included higher right atrial pressure and pulmonary capillary wedge pressure and lower cardiac index (CI), but not PaCO2 or PaO2. Multivariate logistic regression identified that low exercise CI is the strongest predictor of EOV (odds ratio 1.39, for each 1.0 L/min/m2 decrement in CI, 95% confidence interval 1.14–1.70, P=0.001). Among HF patients with EOV, exercise CI was inversely related to EOV cycle length (R=−0.71) and amplitude (R=−0.60), both P<0.001. EOV cycle length and amplitude decreased proportionate to increases in CI in 11 HF+EOV subjects treated with 12 weeks of sildenafil. Conclusions EOV is closely related to reduced CI and elevated filling pressures during exercise and may be an important surrogate for exercise-induced hemodynamic impairment in HF patients. Clinical Trials Registration ClinicalTrials.gov number NCT00309790.

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Section: Discussionsupporting

confidence: 83%

Section: Methodsmentioning

confidence: 99%

Exercise Oscillatory Ventilation in Systolic Heart Failure

et al. 2011

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“…patients commonly respond to exercise with a tachypneic hyperventilation and even occasionally cyclic periodic breathing – the severity of which is prognostic of morbidity and mortality in CHF patients [72, 95]. Deadspace ventilation and V̇E/V̇CO 2 are high owing primarily to the increased breathing frequency but so is V̇ A /V̇CO 2 – thus arterial hypocapnia is common [144].…”

Section: Exercise Hyperpnea In Health and Diseasementioning

confidence: 99%

“…Accordingly, intrathecal fentanyl-induced blockade of muscle afferents in human CHF patients resulted in substantial hypoventilation and CO 2 retention over a wide range of exercise intensities as compared to age matched controls [98]. Thirdly, high pulmonary vascular pressures are common in CHF, especially during exercise and in the presence of pulmonary edema this would precipitate pulmonary C fiber stimulation and a tachypneic ventilatory response and would also be expected to contribute to an unstable, periodic breathing [95, 96]. …”

Section: Exercise Hyperpnea In Health and Diseasementioning

confidence: 99%

Pathophysiology of human ventilatory control

2014

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We review the substantial progress recently made in understanding the underlying mechanisms controlling breathing and the applicability of these findings to selected human diseases. Emphasis is placed on the sites of central respiratory rhythm and pattern generation as well as newly described functions of the carotid chemoreceptors and the integrative nature of the central chemoreceptors and the interaction between peripheral and central chemoreception. Recent findings supporting critical contributions from cortical central command and muscle afferent feedback to exercise hyperpnea are also reviewed. These basic principles and the evidence supporting chemoreceptor and ventilatory control system plasticity during and following constant and intermittent hypoxemia and stagnant hypoxia are applied: a) to the pathogenesis, consequences and treatment of obstructive sleep apnea; and b) to exercise hyperpnea and its control and limitations with aging, COPD and CHF.

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“…Exercise oscillatory ventilation is characterized by the regular alternation of hyperpnea and hypopnea during exercise without interposed apnea [1], which distinguished it from other forms of periodic breathing observed in heart failure patients including Cheyne-Stokes respiration or central sleep apnea [2][3][4]. Exercise oscillatory ventilation has been observed in 19-58 % of heart failure patients [5][6][7][8][9][10] and has emerged as a potent independent risk factor for adverse prognosis in heart failure that is additive to traditional echocardiographic and metabolic indices of clinical risk [5,7,[9][10][11][12].…”

Section: Introductionmentioning

confidence: 99%

Effect of a cardiac rehabilitation program on exercise oscillatory ventilation in Japanese patients with heart failure

et al. 2015

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Although exercise oscillatory ventilation has emerged as a potent independent risk factor for adverse prognosis in heart failure, it is not well known whether cardiac rehabilitation can improve oscillatory ventilation. In this study, we investigated the magnitude of oscillations in ventilation before and after cardiac rehabilitation in chronic heart failure patients with exercise oscillatory ventilation. Cardiac rehabilitation (5-month program) was performed in 26 patients with chronic heart failure who showed an oscillatory ventilation pattern during cardiopulmonary exercise testing (CPX). After the 5-month rehabilitation program was completed, the patients again underwent CPX. To determine the magnitude of oscillations in ventilation, the amplitude and cycle length of the oscillations were calculated and compared with several other parameters, including biomarkers that have established prognostic value in heart failure. At baseline before cardiac rehabilitation, both oscillation amplitude (R = 0.625, P < 0.01) and cycle length (R = 0.469, P < 0.05) were positively correlated with the slope of minute ventilation vs. carbon dioxide production. Plasma BNP levels were positively correlated with amplitude (R = 0.615, P < 0.01) but not cycle length (R = 0.371). Cardiac rehabilitation decreased oscillation amplitude (P < 0.01) but failed to change cycle length. The change in amplitude was positively correlated with the change in BNP levels (R = 0.760, P < 0.01). Multiple regression analysis showed that only the change in amplitude was an independent predictor of the change in BNP levels (R = 0.717, P < 0.01). A 5-month cardiac rehabilitation program improves exercise oscillatory ventilation in chronic heart failure patients by reducing the oscillation amplitude. This effect is associated with a reduction of plasma BNP levels, potentially contributing to an improvement of heart failure.

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Exercise Oscillatory Ventilation

Cited by 40 publications

References 46 publications

Exercise Oscillatory Ventilation in Systolic Heart Failure

Exercise Oscillatory Ventilation in Systolic Heart Failure

Pathophysiology of human ventilatory control

Effect of a cardiac rehabilitation program on exercise oscillatory ventilation in Japanese patients with heart failure

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