| Sleep and exertional periodic breathing in chronic heart failure: prognostic importance and interdependence. | |
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MedLine Citation:
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PMID: 16380551 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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BACKGROUND: Sleep and exertional periodic breathing are proverbial in chronic heart failure (CHF), and each alone indicates poor prognosis. Whether these conditions are associated and whether excess risk may be attributed to respiratory disorders in general, rather than specifically during sleep or exercise, is unknown. METHODS AND RESULTS: We studied 133 CHF patients with left ventricular ejection fraction (LVEF) < or =40%. During 1170+/-631 days of follow-up, 31 patients (23%) died. Nonsurvivors had higher New York Heart Association class, ventilatory response (ve/vco2 slope), and apnea-hypopnea index (AHI) and lower peak vo2 (all P<0.01); lower LVEF and prescription of beta-blockers, and shorter transmitral deceleration time (all P<0.05). Exertional oscillatory ventilation (EOV), established by cyclic fluctuations in minute ventilation that persisted for > or =60% of exercise duration with an amplitude > or =15% of the average resting value, was significantly more frequent in nonsurvivors (42% versus 15%, P<0.01). Multivariable analysis selected AHI (hazard ratio [HR] 5.66, 95% CI 2.3 to 19.9, P<0.01), peak vo2 (HR 0.93, 95% CI 0.90 to 0.97, P<0.01), and beta-blocker prescription (HR 0.34, 95% CI 0.13 to 0.87, P<0.05) as predictors of cardiac events. The best cutoff for AHI was >30/h. EOV was significantly related to AHI >30/h (chi2 14.6, P<0.01): 78% of EOV patients showed AHI >30/h. Multivariable analysis, including breathing disorders alone (EOV, AHI >30/h) or in combination (EOV plus AHI >30/h), selected combined disorders as the strongest predictor of events (HR 6.65, 95% CI 2.6 to 17.1, P<0.01). CONCLUSIONS: In CHF, EOV is significantly associated with AHI >30/h. Although each breathing disorder alone is linked to total mortality, their combination has a crucial prognostic burden. |
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Authors:
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Ugo Corrà; Massimo Pistono; Alessandro Mezzani; Alberto Braghiroli; Andrea Giordano; Paola Lanfranchi; Enzo Bosimini; Marco Gnemmi; Pantaleo Giannuzzi |
Publication Detail:
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Type: Journal Article Date: 2005-12-27 |
Journal Detail:
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Title: Circulation Volume: 113 ISSN: 1524-4539 ISO Abbreviation: Circulation Publication Date: 2006 Jan |
Date Detail:
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Created Date: 2006-01-04 Completed Date: 2006-02-22 Revised Date: 2008-11-21 |
Medline Journal Info:
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Nlm Unique ID: 0147763 Medline TA: Circulation Country: United States |
Other Details:
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Languages: eng Pagination: 44-50 Citation Subset: AIM; IM |
Affiliation:
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Divisione di Cardiologia, Salvatore Maugeri Foundation, IRCCS, Veruno, Italy. ucorra@fsm.it |
Export Citation:
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APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
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Aged Exercise Test Female Heart Failure / complications*, mortality Humans Male Middle Aged Oxygen Consumption Periodicity Physical Exertion Prognosis Prospective Studies Respiration* Sleep Apnea Syndromes / diagnosis, etiology*, mortality Survival Rate Survivors |
| Comments/Corrections | |
Comment In:
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Circulation. 2006 Jan 3;113(1):9-10
[PMID:
16391166
]
Circulation. 2006 Jul 18;114(3):e53; author reply e54 [PMID: 16847160 ] |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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