Association between hemodynamic impairment and Cheyne-Stokes respiration and periodic breathing in chronic stable congestive heart failure secondary to ischemic or idiopathic dilated cardiomyopathy

Irregular breathing occurs Frequently in patients with congestive heart fai lure (CHF) both during daytime and nighttime, Many factors are involved in the genesis of these breathing abnormalities, but the role of the hemodynam ic impairment remains controversial. This study investigated the relation b etween worsening ventricular function and the frequency of respiratory diso rders in patients with mild to severe CHF. One hundred fifty patients with CHF (mean age 53 +/- 8 years, left ventricular (LV) ejection fraction 26 +/ - 7, in New York Heart Association [NYHA] classes II to IV, and who underwe nt stable therapy for greater than or equal to 2 weeks) were studied, Analy sis of instantaneous lung volume signal and arterial oxygen saturation duri ng awake daytime revealed a normal respiratory pattern in 63 patients, wher eas 87 had a persistent alteration of breathing, with a typical Cheyne-Stok es respiration (CSR) in 42 and periodic breathing (PB [oscillation of tidal volumes without apnea]) in 45 patients. Patients with PB and CSR showed a more pronounced hemodynamic impairment with a significantly reduced cardiac index, an increased pulmonary arterial wedge pressure, and a longer lung-t o-ear circulation time (LECT) compared with patients with normal respirator y patterns. In a logistic regression model that included all of the variabl es significantly associated with breaching disorders, cardiac index and LEC T emerged as the major determinants of CSR, In those patients with LECT gre ater than or equal to 30 seconds [upper quartile) and cardiac index less th an or equal to 1.9 L/min/m(2) (lower quartiles), the incidence of CSR was s ignificantly higher (69%) than in patients with lower LECT and higher cardi ac index (14%, p <0.001). In conclusion, abnormalities of: breathing activi ty during daytime are significantly associated with a prolonged circulation time and a more severe impairment of systolic and diastolic LV indexes. (C ) 1999 by Excerpta Medica, Inc.