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Clinical relevance of short‐term day‐time breathing disorders in chronic heart failure patients
Author(s) -
La Rovere Maria Teresa,
Pinna Gian Domenico,
Maestri Roberto,
Robbi Elena,
Mortara Andrea,
Fanfulla Francesco,
Febo Oreste,
Sleight Peter
Publication year - 2007
Publication title -
european journal of heart failure
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 5.149
H-Index - 133
eISSN - 1879-0844
pISSN - 1388-9842
DOI - 10.1016/j.ejheart.2007.06.009
Subject(s) - medicine , heart failure , hyperventilation , cardiology , ejection fraction , supine position , periodic breathing , blood pressure
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.