Exercise oscillatory ventilation: Instability of breathing control associated with advanced heart failure

Background: Instability of breathing control due to heart failure (HF) manifests as exercise oscillatory ventilation (EOV). Prior descriptions of patients with EOV have not been controlled and have been limited to subjects with left ventricular ejection fraction (LVEF) of ≤ 0.40. The aim of this study was to compare clinical characteristics including ventilatory responses of subjects with EOV to those of control subjects with HF matched for LVEF. Methods: Subjects (n = 47) were retrospectively identified from 1,340 consecutive patients referred for cardiopulmonary exercise testing. Study inclusion required EOV without consideration of LVEF while control subjects (n = 47) were composed of HF patients with no EOV matched for LVEF. Characteristics for each group were summarized and compared. Results: For EOV subjects, the mean LVEF was 0.37 (range, 0.11 to 0.70), and 19 subjects (41%) had an LVEF of ≥ 0.40. Compared to control subjects, EOV subjects had increased left atrial dimension, mitral E-wave velocity, and right heart pressures as well as decreased exercise tidal volume response, functional capacity, rest and exercise end-tidal carbon dioxide, and increased ventilatory equivalent for carbon dioxide and dead space ventilation (all p < 0.05). Multivariate analysis demonstrated atrial fibrillation (odds ratio, 6.7; p = 0.006), digitalis therapy (odds ratio, carbon dioxide (odds ratio, 0.87; p = 0.005), and peak heart rate (odds ratio, 0.98; p = 0.02) were independently associated with EOV. Conclusions: Patients with EOV have clinical characteristics and exercise ventilatory responses consistent with more advanced HF than patients with comparable LV systolic function; EOV may occur in HF patients with an LVEF of ≥ 0.40.