BACKGROUND: Cheyne-Stokes breathing (CSB) is an abnormal cyclical pattern of respiratory fluctuations observed during sleep in congestive heart failure (CHF) of poor prognosis. We examined the clinical usefulness of CSB screening using the heart rate variability (HRV) data from the ambulatory electrocardiogram. METHODS: We monitored ambulatory electrocardiograms and respiration simultaneously in 86 heart disease patients of both sexes, aged 57 +/- 1 years. HRV was analyzed by the maximum entropy method during the sleeping period (11 PM-5 AM). The 43 CHF patients underwent a 1-year follow-up study. RESULTS: In the power spectra of the HRV, peaks were observed within the CSB band (0.005 to 0.03 Hz). Statistically significant differences in HRV were observed between CSB patients and CSB-free patients in very low frequency (VLF) (P = 0.04), VLF/total frequency (TF) (P = 0.02), CSB (P = 0.01), CSB/TF (P = 0.003), and CSB/VLF (P < 0.0001). Cardiac events occurred in 23% of patients, including cardiac death in two, and rehospitalization for aggravated CHF in eight. In a multivariate Cox regression analysis in which age, sex, ejection fraction, NYHA functional class, beta blocker use, and basic heart disease were included, absence of ACE inhibitor use (RR 5.5, 95% CI 1.0-31) and CSB/VLF > or =80% (RR 4.2, 95% CI 1.1-17) remained significant predictors of cardiac events. CONCLUSIONS: HRV can act as an indicator of the presence of CSB in CHF patients, and could therefore be used, under outpatient conditions, to identify a CHF patients with a poor prognosis.
BACKGROUND: Cheyne-Stokes breathing (CSB) is an abnormal cyclical pattern of respiratory fluctuations observed during sleep in congestive heart failure (CHF) of poor prognosis. We examined the clinical usefulness of CSB screening using the heart rate variability (HRV) data from the ambulatory electrocardiogram. METHODS: We monitored ambulatory electrocardiograms and respiration simultaneously in 86 heart diseasepatients of both sexes, aged 57 +/- 1 years. HRV was analyzed by the maximum entropy method during the sleeping period (11 PM-5 AM). The 43 CHFpatients underwent a 1-year follow-up study. RESULTS: In the power spectra of the HRV, peaks were observed within the CSB band (0.005 to 0.03 Hz). Statistically significant differences in HRV were observed between CSBpatients and CSB-freepatients in very low frequency (VLF) (P = 0.04), VLF/total frequency (TF) (P = 0.02), CSB (P = 0.01), CSB/TF (P = 0.003), and CSB/VLF (P < 0.0001). Cardiac events occurred in 23% of patients, including cardiac death in two, and rehospitalization for aggravated CHF in eight. In a multivariate Cox regression analysis in which age, sex, ejection fraction, NYHA functional class, beta blocker use, and basic heart disease were included, absence of ACE inhibitor use (RR 5.5, 95% CI 1.0-31) and CSB/VLF > or =80% (RR 4.2, 95% CI 1.1-17) remained significant predictors of cardiac events. CONCLUSIONS: HRV can act as an indicator of the presence of CSB in CHFpatients, and could therefore be used, under outpatient conditions, to identify a CHFpatients with a poor prognosis.
Authors: M H Crawford; S J Bernstein; P C Deedwania; J P DiMarco; K J Ferrick; A Garson; L A Green; H L Greene; M J Silka; P H Stone; C M Tracy; R J Gibbons; J S Alpert; K A Eagle; T J Gardner; G Gregoratos; R O Russell; T J Ryan; S C Smith Journal: Circulation Date: 1999-08-24 Impact factor: 29.690
Authors: P A Lanfranchi; A Braghiroli; E Bosimini; G Mazzuero; R Colombo; C F Donner; P Giannuzzi Journal: Circulation Date: 1999-03-23 Impact factor: 29.690