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Exercise oscillatory ventilation: Mechanisms and prognostic significance
Bishnu P Dhakal1, Gregory D Lewis1
1Bishnu P Dhakal, Cardiology Division, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, United States.
World Journal of Cardiology
|March 30, 2016
Summary
Exercise oscillatory ventilation (EOV), a breathing pattern in advanced heart failure (HF), indicates poor prognosis. Recognizing EOV in heart failure patients is crucial for understanding disease severity and potential outcomes.
Area of Science:
- Cardiology
- Pulmonary Medicine
- Respiratory Physiology
Background:
- Cyclic breathing pattern alterations, specifically periodic breathing (PB), are long-recognized in advanced heart failure (HF).
- Exercise oscillatory ventilation (EOV), a form of PB during exercise, is characterized by hyperpnea and hypopnea without apnea.
Purpose of the Study:
- To review the mechanistic basis of periodic breathing during exercise in heart failure patients.
- To discuss the clinical implications of recognizing exercise oscillatory ventilation in heart failure.
Main Methods:
- Non-invasive detection of EOV during submaximal cardiopulmonary exercise testing.
- Review of proposed mechanisms including circulatory delay, chemosensitivity, and pulmonary congestion.
Main Results:
- EOV presence signifies impaired hemodynamic parameters and is an independent risk factor for poor prognosis in HF patients.
- Mechanisms proposed include circulatory delay, increased chemosensitivity, pulmonary congestion, and ergoreflex signaling.
Conclusions:
- EOV is a significant indicator of advanced heart failure and poor prognosis, regardless of ejection fraction or gas exchange variables.
- While no definitive treatment exists, small studies suggest potential reversal with phosphodiesterase inhibitors, exercise training, and acetazolamide.
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