Association of right ventricular dysfunction and Cheyne–Stokes respiration in patients with chronic heart failure

Abstract

SUMMAR Y Cheyne-Stokes respiration (CSR) is present in up to 40% of patients with congestive heart failure (CHF) and is an independent risk factor for increased overall mortality. We examined whether CSR is associated with right ventricular (RV) dysfunction in CHF patients. Parameters of RV function were assessed by two-dimensional echocardiography and tissue velocity imaging in 42 patients (aged 23-75 years) with a left ventricular (LV) ejection fraction below 40%. Respiratory polygraphy revealed CSR with an central apnea-hypopnea index (CAHI) >10 h )1 in 13 of the 42 patients (31%). Demographic characteristics did not differ among the patient groups. The velocity of the tricuspid annular systolic motion (TASM), a parameter reflecting systolic RV function, was significantly reduced in CHF patients with CSR (10.5 ± 2.3 cm s )1 ) compared with those without CSR (15.0 ± 5.1 cm s )1 , P ¼ 0.004), and was inversely associated with the CAHI (y ¼ 15.2-0.2x; r ¼ 0.46, P ¼ 0.003). The RV dimensions were significantly increased and the fractional RV area changes significantly reduced in CHF patients with CSR (33 ± 17 versus 48 ± 20%; P ¼ 0.04). Doppler parameters of pulmonary artery flow indicate higher pulmonary artery pressures in CSR patients compared with patients without CSR, which is also reflected by an increased RV free-wall thickness in CSR patients (6.5 ± 1.1 vs. 5.3 ± 1.3 mm; P ¼ 0.05). Parameters of systolic LV function, forced expiratory volume in 1 s (FEV 1 ), and P a O 2 and P a CO 2 were not different among patients with or without CSR. In conclusion, CSR is associated with depressed systolic RV function and increased RV dimensions in CHF patients. Future studies will show whether optimized treatment of CSR will improve RV function.

Brain natriuretic peptide for prediction of Cheyne-Stokes respiration in heart failure patients

“…Since a significant relationship between BNP and LV ejection fraction was found, it is tempting to speculate that a significant relationship between LVEF and CAHI is present reflecting the dependence of CSR on reduced systolic LV function. However, this association is lacking conforming with earlier reports [1,3,10,29]. Thus, it may be hypothesized that diastolic dysfunction is the crucial factor determining the occurrence of CSR.…”

“…37% of our patients with reduced LV ejection fraction displayed a central sleep apnoea, confirming previous reports of the high incidence of this nocturnal breathing disorder in affected patients. A reduced circulation time and an LV ejection fraction below 45% have been proposed as essential factors determining the emergence of CSR, although LV diameters and/or systolic LV function are not different among patients with or without CSR [1,3,10]. Activation of afferent pulmonary receptors is initiated, probably due to diastolic dysfunction [11] triggering hyperventilation.…”

“…Cheyne-Stokes respiration (CSR) is present in up to 50% of patients with chronic heart failure (CHF) and left ventricular (LV) ejection fraction ≤ 45% [1][2][3][4]. Repetitive apnoeas and arousal cycles induce sleep fragmentation followed by fatigue, daytime sleepiness and neurohumoral activation including sympathoadrenergic stimulation [5,6].…”

“…A beneficial impact of nasal CPAP ventilation on outcome has recently been questioned [9]. Increased LV filling pressures due to diastolic dysfunction appear to be crucially involved in this breathing disorder [1,10], since it has been convincingly demonstrated that pulmonary artery pressure and pulmonary capillary wedge pressure are significantly increased in patients with CSR compared to subjects without this breathing disorder [11].…”

Bigger numbers needed!

“…CSR leads to several unfavourable consequences: hypoxia, arousal from sleep, sympathetic activation, blood pressure surges and susceptibility to cardiac arrhythmia [4][5][6]. Pulmonary capillary wedge pressure (PCWP), as a likely cause of CSR [7], and right heart load, as a consequence of CSR [8], are increased in heart failure patients with CSR, as compared to those without CSR, despite a comparable reduction of left ventricular ejection fraction in both groups.…”