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(Circulation. 1999;100:1065-1070.)
© 1999 American Heart Association, Inc.

Clinical Investigation and Reports

Origin of Oscillatory Kinetics of Respiratory Gas Exchange in Chronic Heart Failure

Darrel P. Francis, MA, MRCP; L. Ceri Davies, BSc, MRCP; Massimo Piepoli, MD, PhD; Mathias Rauchhaus, MD; Piotr Ponikowski, PhD, MRCP; Andrew J. S. Coats, DM, FRCP

From the National Heart & Lung Institute, Imperial College of Science, Technology and Medicine, London, UK; Piacenza Hospital (M.P.), Piacenza, Italy; and Klinik Innere Medizin III/Kardiologie, Martin-Luther-Universität Halle, Germany (M.R.).

Correspondence and reprint requests to Dr D.P. Francis, Heart Failure Unit, Royal Brompton Hospital, National Heart & Lung Institute, Imperial College of Science, Technology and Medicine, Sydney St, London SW3 6NP, UK. E-mail d.francis{at}cheerful.com

Background—Respiratory gas exchange measurements in patients with chronic heart failure (CHF) at rest and during exercise commonly reveal prominent slow oscillations in ventilation (_E), measured oxygen uptake (O₂), and carbon dioxide production (CO₂), whose origin is not clear. Voluntary simulation of periodic breathing (PB) in normals has been reported to generate a different pattern of oscillations in gas exchange from that seen in spontaneous PB. This necessitates hypothesizing that PB is caused by a primary oscillation in tissue metabolism or in cardiac output.

Methods and Results—We developed an automated method by which normal controls could be guided to breathe according to a PB pattern. The resultant metabolic oscillations closely matched those seen in spontaneous PB and had several interesting properties. At low workloads (including rest), the oscillations in O₂ were as prominent as those in _E in both spontaneous PB (_VO2/_VE=0.92±0.04) and voluntary PB (0.93±0.07). However, at increased workload, the oscillations in O₂ because less prominent than those in _E in spontaneous PB (intermediate workload 0.63±0.05, high workload 0.57±0.04; P<0.001) and voluntary PB (intermediate 0.66±0.03, high 0.48±0.03; P<0.001). There was no difference in the relative size of metabolic oscillations between voluntary and spontaneous PB at matched workloads (P>0.05 at low, intermediate, and high workloads). Furthermore, O₂ peaked before _E in both spontaneous and voluntary PB. This time delay varied from 6.4±0.4 s at low ventilation, to 11.3±0.9 s at high ventilation (P<0.0001).

Conclusions—The magnitude and phase pattern of oscillations in gas exchange of spontaneous PB can be obtained by adequately matched voluntary PB. Therefore, the gas exchange features of PB are explicable by primary ventilatory oscillation.

Key Words: heart failure • ventilation • metabolism

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