| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
(Circulation. 1997;96:246-252.)
© 1997 American Heart Association, Inc.
Articles |
Abnormal Awake Respiratory Patterns Are Common in Chronic Heart Failure and May Prevent Evaluation of Autonomic Tone by Measures of Heart Rate Variability
From the Division of Cardiology, Centro Medico di Montescano, "S. Maugeri" Foundation, IRCCS, Pavia, Italy, and Department of Cardiovascular Medicine (P.S.), John Radcliffe Hospital, Headington, Oxford, UK.
Correspondence to Andrea Mortara, Division of Cardiology, Centro Medico di Montescano, "S. Maugeri" Foundation, IRCCS, Montescano, Pavia, Italy.
Background Reduced heart rate variability, particularly in the very-low-frequency (VLF) spectral band, has been found to be a marker for poor prognosis in patients after myocardial infarction, but the origin of the VLF oscillations is unclear. In this study, we demonstrate that the power of cardiovascular oscillations in the VLF band in awake patients with mild to severe chronic heart failure is greatly increased by the common occurrence of unrecognized irregularity of breathing, which may confound the use of heart rate variability measures as indexes of autonomic tone or prognosis.
Methods and Results Among 110 consecutive patients referred for consideration of transplantation, 90 were in sinus rhythm, of whom 10 were excluded as unstable. The remaining 80 patients underwent recordings of ECG, beat-to-beat arterial oxygen saturation (SaO2), and respiration during both spontaneous and controlled breathing. During spontaneous awake breathing, 64% showed periodic breathing or Cheyne-Stokes respiration (CSR), which was associated with dominant power in the VLF band of all signals. This VLF power accounted for 55%, 77%, and 87% of heart rate variability, respectively, in patients with normal breathing, periodic breathing, and CSR. It was reduced by 48% and 62%, respectively, during controlled breathing in patients with periodic breathing or CSR. Controlled ventilation also improved oxygen saturation and markedly reduced its variability.
Conclusions Breathing disorders are surprisingly common in awake patients with poor left ventricular function and produce large VLF oscillations in heart rate variability. If measures of heart rate variability are used for prognostic purposes during both short-term and long-term recordings, the confounding effects of variable respiratory patterns should be excluded. Respiratory rehabilitation might help control potentially hazardous surges in sympathetic tone.
Key Words: respiration • heart rate • heart failure • nervous system, autonomic
This article has been cited by other articles:
 |
|
 |
|
  L. J. Olson, A. M. Arruda-Olson, V. K. Somers, C. G. Scott, and B. D. Johnson Exercise Oscillatory Ventilation: Instability of Breathing Control Associated With Advanced Heart Failure Chest, February 1, 2008; 133(2): 474 - 481. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
T. Brack, I. Thuer, C. F. Clarenbach, O. Senn, G. Noll, E. W. Russi, and K. E. Bloch Daytime Cheyne-Stokes Respiration in Ambulatory Patients With Severe Congestive Heart Failure Is Associated With Increased Mortality Chest, November 1, 2007; 132(5): 1463 - 1471. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 A. Radaelli, M. Cazzaniga, A. Viola, G. Balestri, M. B. Janetti, M. G. Signorini, P. Castiglioni, A. Azzellino, G. Mancia, and A. U. Ferrari Enhanced Baroreceptor Control of the Cardiovascular System by Polyunsaturated Fatty Acids in Heart Failure Patients J. Am. Coll. Cardiol., October 17, 2006; 48(8): 1600 - 1606. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 A. Vazir, M. Dayer, P. C. Hastings, H. F. McIntyre, M. Y. Henein, P. A. Poole-Wilson, M. R. Cowie, M. J. Morrell, and A. K. Simonds Can heart rate variation rule out sleep-disordered breathing in heart failure? Eur. Respir. J., March 1, 2006; 27(3): 571 - 577. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
G. D. Pinna, R. Maestri, S. Capomolla, O. Febo, E. Robbi, F. Cobelli, and M. T. La Rovere Applicability and Clinical Relevance of the Transfer Function Method in the Assessment of Baroreflex Sensitivity in Heart Failure Patients J. Am. Coll. Cardiol., October 4, 2005; 46(7): 1314 - 1321. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 S. Guzzetti, M. T. L. Rovere, G. D. Pinna, R. Maestri, E. Borroni, A. Porta, A. Mortara, and A. Malliani Different spectral components of 24 h heart rate variability are related to different modes of death in chronic heart failure Eur. Heart J., February 2, 2005; 26(4): 357 - 362. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 A. Mortara, G. D. Pinna, P. Johnson, H. Dargie, M. T. La Rovere, P. Ponikowski, L. Tavazzi, P. Sleight, and on behalf of HHH Investigators A multi-country randomised trial of the role of a new telemonitoring system in CHF: the HHH study (Home or Hospital in Heart Failure). Rational, study design and protocol Eur. Heart J. Suppl., November 1, 2004; 6(suppl_F): F99 - F102. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 R. S. T. Leung, J. S. Floras, G. Lorenzi-Filho, F. Rankin, P. Picton, and T. D. Bradley Influence of Cheyne-Stokes Respiration on Cardiovascular Oscillations in Heart Failure Am. J. Respir. Crit. Care Med., June 1, 2003; 167(11): 1534 - 1539. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 G. Piccirillo, M. Nocco, A. Moise, M. Lionetti, C. Naso, S. di Carlo, and V. Marigliano Influence of Vitamin C on Baroreflex Sensitivity in Chronic Heart Failure Hypertension, June 1, 2003; 41(6): 1240 - 1245. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 T. D. Bradley and J. S. Floras Sleep Apnea and Heart Failure: Part II: Central Sleep Apnea Circulation, April 8, 2003; 107(13): 1822 - 1826. [Full Text] [PDF]
|
|
|
|
|
|
D. R. Murray What Is "Heart Rate Variability" and Is It Blunted by Tumor Necrosis Factor? Chest, March 1, 2003; 123(3): 664 - 667. [Full Text] [PDF]
|
|
|
|
|
|
M. T. La Rovere, G. D. Pinna, R. Maestri, A. Mortara, S. Capomolla, O. Febo, R. Ferrari, M. Franchini, M. Gnemmi, C. Opasich, et al. Short-Term Heart Rate Variability Strongly Predicts Sudden Cardiac Death in Chronic Heart Failure Patients Circulation, February 4, 2003; 107(4): 565 - 570. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
T. Yamada, T. Shimonagata, M. Fukunami, K. Kumagai, H. Ogita, A. Hirata, M. Asai, N. Makino, H. Kioka, H. Kusuoka, et al. Comparison of the prognostic value of cardiac iodine-123 metaiodobenzylguanidine imaging and heart rate variability in patients with chronic heart failure: A prospective study J. Am. Coll. Cardiol., January 15, 2003; 41(2): 231 - 238. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 T Kohnlein, T Welte, L B Tan, and M W Elliott Central sleep apnoea syndrome in patients with chronic heart disease: a critical review of the current literature Thorax, June 1, 2002; 57(6): 547 - 554. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
U. Corra, A. Giordano, E. Bosimini, A. Mezzani, M. Piepoli, A. J. S. Coats, and P. Giannuzzi Oscillatory Ventilation During Exercise in Patients With Chronic Heart Failure* : Clinical Correlates and Prognostic Implications Chest, May 1, 2002; 121(5): 1572 - 1580. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
H. Nakayama, C. A. Smith, J. R. Rodman, J. B. Skatrud, and J. A. Dempsey Effect of Ventilatory Drive on Carbon Dioxide Sensitivity below Eupnea during Sleep Am. J. Respir. Crit. Care Med., May 1, 2002; 165(9): 1251 - 1260. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R. S. T. LEUNG and T. DOUGLAS BRADLEY Sleep Apnea and Cardiovascular Disease Am. J. Respir. Crit. Care Med., December 15, 2001; 164(12): 2147 - 2165. [Full Text] [PDF]
|
|
|
|
|
|
S. Miyamoto, M. Fujita, H. Sekiguchi, Y. Okano, N. Nagaya, K. Ueda, S.-i. Tamaki, R. Nohara, S. Eiho, and S. Sasayama Effects of posture on cardiac autonomic nervous activity in patients with congestive heart failure J. Am. Coll. Cardiol., June 1, 2001; 37(7): 1788 - 1793. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 C. F. Notarius and J. S. Floras Limitations of the use of spectral analysis of heart rate variability for the estimation of cardiac sympathetic activity in heart failure Europace, January 1, 2001; 3(1): 29 - 38. [Abstract] [PDF]
|
|
|
|
 |
|
 M. El-Omar, A. Kardos, and B. Casadei Mechanisms of respiratory sinus arrhythmia in patients with mild heart failure Am J Physiol Heart Circ Physiol, January 1, 2001; 280(1): H125 - H131. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 G. D. Pinna, R. Maestri, A. Mortara, M. T. L. Rovere, F. Fanfulla, and P. Sleight Periodic breathing in heart failure patients: testing the hypothesis of instability of the chemoreflex loop J Appl Physiol, December 1, 2000; 89(6): 2147 - 2157. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. TRINDER, R. MERSON, J. I. ROSENBERG, F. FITZGERALD, J. KLEIMAN, and T. DOUGLAS BRADLEY Pathophysiological Interactions of Ventilation, Arousals, and Blood Pressure Oscillations during Cheyne-Stokes Respiration in Patients with Heart Failure Am. J. Respir. Crit. Care Med., September 1, 2000; 162(3): 808 - 813. [Abstract] [Full Text]
|
|
|
|
|
|
M Galinier, A Pathak, J Fourcade, C Androdias, D Curnier, S Varnous, S Boveda, P Massabuau, M Fauvel, J.M Senard, et al. Depressed low frequency power of heart rate variability as an independent predictor of sudden death in chronic heart failure Eur. Heart J., March 2, 2000; 21(6): 475 - 482. [Abstract] [PDF]
|
|
|
|
|
|
G. D. Pinna, R. Maestri, A. Mortara, and M. T. L. Rovere Cardiorespiratory interactions during periodic breathing in awake chronic heart failure patients Am J Physiol Heart Circ Physiol, March 1, 2000; 278(3): H932 - H941. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
P. Ponikowski, S. D. Anker, T. P. Chua, D. Francis, W. Banasiak, P. A. Poole-Wilson, A. J. S. Coats, and M. Piepoli Oscillatory Breathing Patterns During Wakefulness in Patients With Chronic Heart Failure : Clinical Implications and Role of Augmented Peripheral Chemosensitivity Circulation, December 14, 1999; 100(24): 2418 - 2424. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
L. Fauchier and D. Babuty Reply J. Am. Coll. Cardiol., December 1, 1999; 34(7): 2148 - 2149. [Full Text] [PDF]
|
|
|
|
|
|
D. P. Francis, L. C. Davies, M. Piepoli, M. Rauchhaus, P. Ponikowski, and A. J. S. Coats Origin of Oscillatory Kinetics of Respiratory Gas Exchange in Chronic Heart Failure Circulation, September 7, 1999; 100(10): 1065 - 1070. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
G. LORENZI-FILHO, F. RANKIN, I. BIES, and T. D. BRADLEY Effects of Inhaled Carbon Dioxide and Oxygen on Cheyne-Stokes Respiration in Patients with Heart Failure Am. J. Respir. Crit. Care Med., May 1, 1999; 159(5): 1490 - 1498. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
L. Fauchier, D. Babuty, P. Cosnay, and J. P. Fauchier Prognostic value of heart rate variability for sudden death and major arrhythmic events in patients with idiopathic dilated cardiomyopathy J. Am. Coll. Cardiol., April 1, 1999; 33(5): 1203 - 1207. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
G. LORENZI-FILHO, H. R. DAJANI, R. S. T. LEUNG, J. S. FLORAS, and T. D. BRADLEY Entrainment of Blood Pressure and Heart Rate Oscillations by Periodic Breathing Am. J. Respir. Crit. Care Med., April 1, 1999; 159(4): 1147 - 1154. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. Nolan, P. D. Batin, R. Andrews, S. J. Lindsay, P. Brooksby, M. Mullen, W. Baig, A. D. Flapan, A. Cowley, R. J. Prescott, et al. Prospective Study of Heart Rate Variability and Mortality in Chronic Heart Failure : Results of the United Kingdom Heart Failure Evaluation and Assessment of Risk Trial (UK-Heart) Circulation, October 13, 1998; 98(15): 1510 - 1516. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
K. Narkiewicz, N. Montano, C. Cogliati, P. J. H. van de Borne, M. E. Dyken, and V. K. Somers Altered Cardiovascular Variability in Obstructive Sleep Apnea Circulation, September 15, 1998; 98(11): 1071 - 1077. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 F LOMBARDI and A MORTARA Heart rate variability and cardiac failure Heart, September 1, 1998; 80(3): 213 - 214. [Full Text]
|
|
|
|
|
|
E. H. Friedman Respiratory Patterns and Chronic Heart Failure Circulation, July 28, 1998; 98(4): 377 - 377. [Full Text] [PDF]
|
|