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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

Session Poster Session 3

Speaker Chiara Borrelli

Event : Heart Failure 2019

  • Topic : heart failure
  • Sub-topic : Chronic Heart Failure: Comorbidities
  • Session type : Poster Session

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)

Authors:
C Borrelli1 , F Gentile1 , F Rossari1 , P Sciarrone1 , C Passino2 , G Mirizzi2 , F Bramanti2 , G Iudice2 , M Emdin2 , A Giannoni2 , 1University Hospital of Pisa - Pisa - Italy , 2Fondazione Toscana Gabriele Monasterio - Pisa - Italy ,

Citation:

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.

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