Russian Heart Failure Journal 2010year The phenomenon of wave-like breathing in patients with heart failure and ways of its correction


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2010/

The phenomenon of wave-like breathing in patients with heart failure and ways of its correction

Lelyavina T. A., Trukshina M. A., Sitnikova M. Y., Shlyakhto E. V., Berezina A. V., Lebedev D. S.
Federal State Budgetary Institution, “North-West Federal Medical Research Center” of the RF Ministry of Health Care, Akkuratova 2, St.-Petersburg 197341

Keywords: pacemaker, CHF, cyclic respiration

DOI: 10.18087/rhfj.2010.6.1413

Urgency. Undulating respiration (UR) accelerates the reduction of systolic myocardial function and is an unfavorable prognostic factor. Severity of UR can be modified by various interventions. Aim. To study the prevalence of UR in patients with CHF III–IV FC allocated to cardiac resynchronization therapy (CRT), main features of patients with UR and its dynamics after implantation of biventricular pacemaker (BVP). Materials and methods. The study included 25 patients with CHF III–IV FC with indications for CRT, mean age was 53±7 years. Indices of ventilation and gas exchange were evaluated at rest and during exercise using equipment "Oxycon Pro" (Jeger, Germany) before and in 3–6 months after CRT. Severity of UR was determined by the magnitude of fluctuations of minute ventilation (VE), the relationship of "dead" space to tidal volume (Vd / Vt), the volume of oxygen uptake (VO2), the end-tidal carbon dioxide tension (PET CO2). Results. The phenomenon of UR was determined in 10 (40 %) patients. At rest and during exercise variations of VE, Vd / Vt, VO2, PET CO2 with an amplitude of 30±12 % (relative to average values) were recorded. These patients were characterized by more severe CHF, and lower left ventricular ejection fraction (LV EF), PET CO2, VO2 peak and exercise tolerability at higher ventilatory equivalents of CO2 in comparence with patients who did not have such respiratory disorders. After 3–6 months of CRT in patients with UR amplitudes of VE, Vd / Vt, VO2, and PET CO2 decreased by 3 times and were 10±7 % (all p<0.05). LV EF in these period was 23±7 % (p<0.05 compared to baseline), VO2 peak – 12±1,5 ml / min / kg (p>0.05 compared to baseline), but the power load significantly increased (p<0.05). In patients with CHF without UR, in 3–6 months after CPT also just a trend toward the positive dynamics of VO2 peak was found. Thus, patients with severe CHF and UR have higher class of CHF with lower LV EF, PET CO2 and VO2 peak, than patients with CHF but without such respiratory disorders. In patients with CHF and UR in 3–6 months after CRT the severity of UR significantly decreased. Improvement of myocardial contractile function, increased exercise capacity and tendency to increase of peak oxygen consumption in 3–6 months after CRT develop regardless the presence of UR in patients with CHF.
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Lelyavina T. A., Trukshina M. A., Sitnikova M. Y. et al. The phenomenon of wave-like breathing in patients with heart failure and ways of its correction. Russian Heart Failure Journal. 2010;11(6):364-367.

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