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(Circulation. 2006;114:e54.)
© 2006 American Heart Association, Inc.

Correspondence

Response to Letter Regarding Article "Sleep and Exertional Periodic Breathing in Chronic Heart Failure: Prognostic Importance and Interdependence"

Ugo Corrà, MD; Massimo Pistono, MD; Alessandro Mezzani, MD; Alberto Braghiroli, MD; Enzo Bosimini, MD; Marco Gnemmi, MD; Pantaleo Giannuzzi, MD

Division of Cardiology, Salvatore Maugeri Foundation, IRCCS, Veruno, Italy

Andrea Giordano, PhD

Bioengineering Department,, Salvatore Maugeri Foundation, IRCCS, Veruno, Italy

Paolo Lanfranchi, MD

Research Center,, Hôpital du Sacré-Cur de Montréal, Montréal, Canada

We thank Dr Guazzi for his interest in our article.¹ In our study, a distinct hierarchical prognostic impact of breathing disorders in chronic heart failure patients is evident, and as a unique finding, apnea/hypopnea index (AHI) >30/h alone has a preeminent predictive role in the presence of exercise oscillatory ventilation (EOV), which could be used as an argument for a reinterpretation of previous reports.^2,3 Even so, EOV contributes to a meaningful increase of risk in patients with AHI >30/h, and the fact that there were few EOV-alone patients in our population confirms the strong clinical interdependence between EOV and AHI >30/h. At the same time, as stated in the Limitations section of our article, because of the small number of EOV-alone patients, our study should not be viewed as the final word but rather as an encouragement for other centers to examine the prevalence and cardiovascular risk associated with EOV alone. Moreover, the lower mean E/CO₂ slope value and its reduced prognostic significance are easily explained by the characteristics of the study population: a large number of clinically stable chronic heart failure patients on ß-blockers, who exhibit such features.^4,5 Finally, with regard to the methodological issues raised by Dr Guazzi, in our experience the influence of EOV on E/CO₂ slope is negligible.

In conclusion, we believe that neither of these issues has an impact on the main findings of our article and our conclusions are supported by the evidence provided.

	Acknowledgments

 
Disclosures

None.

	References

Top References

 

1. Corrà U, Pistono M, Mezzani A, Braghiroli A, Giordano A, Lanfranchi P, Bosimini E, Gnemmi M, Giannuzzi P. Sleep and exertional periodic breathing in chronic heart failure: prognostic importance and interdependence. Circulation. 2006; 113: 44–50.[Abstract/Free Full Text]
   
2. Corrà U, Giordano A, Bosimini E, Mezzani A, Piepoli M, Coats AJ, Giannuzzi P. Oscillatory ventilation during exercise in patients with chronic heart failure: clinical correlates and prognostic implications. Chest. 2002; 121: 1572–1580.[CrossRef][Medline] [Order article via Infotrieve]
   
3. Leite JJ, Mansur AJ, de Freitas HFG, Chizola PR, Bocchi EA, Terra-Filho M, Neded JA, Lorenzo-Filho G. Periodic breathing during incremental exercise predicts mortality in patients with chronic heart failure evaluated for cardiac transplantation. J Am Coll Cardiol. 2003; 41: 2175–2181.[Abstract/Free Full Text]
   
4. Agostoni P, Guazzi M, Bussotti M, De Vita S, Palermo P. Carvedilol reduces the inappropriate increase ventilation during exercise in heart failure patients. Chest. 2002; 122: 2062–2067.[CrossRef][Medline] [Order article via Infotrieve]
   
5. Corrà U, Mezzani A, Bosimini E, Scapellato F, Temporelli PL, Eleuteri E, Giannuzzi P. Limited predictive value of cardiopulmonary exercise indexes in patients with chronic heart failure treated with carvedilol. Am Heart J. 2004; 147: 553–560.[CrossRef][Medline] [Order article via Infotrieve]
   

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Corrà, U. Articles by Lanfranchi, P. Search for Related Content PubMed Articles by Corrà, U. Articles by Lanfranchi, P. Related Collections Other heart failure Congestive Autonomic, reflex, and neurohumoral control of circulation Exercise/exercise testing/rehabilitation