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Short term respiratory monitoring during tilt-table testing predicts periodic breathing/Cheyne-Stokes severity in patients with heart failure with reduced ejection fraction
Authors : C Borrelli (Pisa,IT), F Gentile (Pisa,IT), F Rossari (Pisa,IT), P Sciarrone (Pisa,IT), C Passino (Pisa,IT), G Mirizzi (Pisa,IT), F Bramanti (Pisa,IT), G Iudice (Pisa,IT), M Emdin (Pisa,IT), A Giannoni (Pisa,IT)
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1University Hospital of Pisa - Pisa - Italy
2Fondazione Toscana Gabriele Monasterio - Pisa - Italy
Background: In patients with heart failure with reduced ejection fraction (HFrEF), periodic breathing (PB: hyperventilation/hypopneas) and Cheyne-Stokes respiration (CSR: hyperventilation/apneas) are usually thought to occur only at night in supine position.
Aim: We aimed to evaluate whether PB/CSR can be observed in patients with HFrEF in awake and orthostatic conditions.
Methods: A total of 461 patients with HFrEF on optimal guideline-recommended treatment (left ventricular ejection fraction: 29 ± 7%; age: 65 ± 12 years; 81% males) underwent echocardiography, pulmonary function test, 24-h electrocardiographic and respiratory recording and neurohormonal evaluation (natriuretic peptides, plasma norepinephrine, renin activity and aldosterone levels). Each patient also underwent a short term attended respiratory monitoring (SRM) during tilt table testing (10 minutes in clinostatism and 5 minutes in orthostatism).
A score from 0 to 2 for the SRM was created, with 0 being normal respiration, 1 being PB/CSR disappearing in orthostatism and 2 being PB/CSR persisting in orthostatism.
Results: The prevalence of scores 0-1-2 were 50%, 35% and 15%, respectively.
The score was predictive of apnea-hypopnea index (AHI) and central apnea index (CAI) severity at the 24-h recording (all p<0.001) during daytime (from 0 to 2, AHI: 4 IR 1-11 vs 11 IR 4-20 vs 22 IR 13-32 events/h; CAI: 0 IR 0-2 vs 3 IR 0-9 vs 13 IR 5-26, all p<0.001), nighttime (AHI: 12 IR 4-25 vs 23 IR 13-33 vs 36 IR 22-42 events/h; CAI: 1 IR 1-4 vs 6 IR 1-18 vs 16 IR 6-29, all p<0.001) and the 24-hour (AHI: 7 IR 2-17 vs 15 IR 9-25 vs 27 IR 18-36 events/h; CAI: 0 IR 0-4 vs 5 IR 1-14 vs 13 IR 5-26, all p<0.001). SRM score was also predictive of time spent with an oxygen saturation <90% (T90 4.0 IR 1.0-10.3 vs 6.5 IR 3.3-14.8 vs 11.0 IR 6.0-17.0 minutes, p<0.005).
At univariate, logistic multinomial analysis predictors of presence of PB/CSR were left ventricular ejection fraction, moderate to severe mitral regurgitation (MR), left atrial volume, baseline atrial fibrillation (AF), right atrial diameter, systolic pulmonary artery pressure, NT-proBNP and norepinephrine levels, while at multivariate analysis only AF (OR 4.93, CI 1.30-18-57, p=0,019) resulted as independent predictor. At univariate, logistic multinomial analysis only AF was found to be predictor of PB/CSR persistence during orthostatism (OR 2.09; CI 1.16-3.77, p=0.01).
Conclusions: In HFrEF patients, a diurnal short term recording performed during tilt testing can stratify the severity of PB/CSR during daytime, nighttime and the 24-hour. Atrial fibrillation is the only independent predictor of PB/CSR presence and persistence in awake, orthostatic conditions.
ESC 365 is supported by Bayer, Boehringer Ingelheim and Lilly Alliance, Bristol-Myers Squibb and Pfizer Alliance, Novartis Pharma AG and Vifor Pharma in the form of educational grants. The sponsors were not involved in the development of this platform and had no influence on its content.
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