Exercise oscillatory ventilation: Mechanisms and prognostic significance

Table 1 Prevalence and clinical significance of exercise oscillatory ventilation in heart failure patients

Ref.	No. of patients	NYHA class, LVEF	Prevalence of PB	Clinical and prognostic significance of EOV	Significant mortality predictors
Corrà et al[10], (2002)	323	NYHA 2.2 ± 0.9 LVEF 24 ± 8	12%	EOV present in 28% of nonsurvivors vs 9% survivors, follow-up period 22 ± 11 mo	NYHA class, LVEF, peak VO2
Leite et al[15], (2003)	84	NYHA 2-4 LVEF 35 ± 7	30%	EOV independently increased the risk of death by 2.97 fold, median follow-up period of 11.3 mo	Peak VO2, NYHA class, VE/VCO2 slope
Corrà et al[13], (2006)	133	NYHA 2.3 ± 0.7 LVEF 23 ± 7	21%	42% mortality in EOV patients vs 15% in non EOV, follow-up period 39 ± 11 mo	NYHA class, peak VO2, VE/VCO2 slope, AHI, LVEF, lower rate of beta blocker use, peak HR
Guazzi et al[9], (2007)	156	NYHA 1-4 LVEF 35 ± 11	33%	EOV was the strongest predictor of overall and SCD mortality. EOV present in 100% arrhythmic and 47% nonarrhythmic deaths, follow-up period 28 ± 25 mo	LV mass, LVESV. VE/VCO2 slope maintained a predictive value as to overall cardiac mortality and pump failure death outperforming EOV as predictor of pump failure mortality
Guazzi et al[18], (2008)	556 (405 HFrEF, 151 HFpEF)	NYHA 2.4 ± 0.8 in HFrEF, 2.0 ± 0.9 in HFpEF	35% in HFrEF, 31% in HFpEF	EOV was strongest predictor of mortality in HFpEF compared to HFrEF in multivariate models; EOV was similar predictor of mortality in both HFrEF and HFpEF without LVAD or transplant	VE/VCO2 slope in multivariate model, peak VO2 in univariate model
Arena et al[16], (2008)	154	NYHA 2.2 LVEF 30 ± 14	36%	Event (death, transplant or LVAD) free survival 55% in EOV vs 82% in non EOV patients, follow-up period 3 yr	VE/VCO2 slope, LVEF
Bard et al[17], (2008)	44	LVEF 19 ± 7	13%	Death or transplant rate 68% in patients with PB vs 52% without PB	Resting ventilatory variation more powerful predictor of mortality than peak VO2 and VE/VCO2 slope
Olson et al[29], (2008)	47	NYHA 2.6 ± 0.8 LVEF 37 ± 17	7%	EOV associated with higher VE/VCO2 slope, VD/VT, lower PETCO2, higher NYHA class
Ingle et al[28], (2009)	240	LVEF 34 ± 6	31% by Leite and 25% by Corrá Criteria	50% of patients diagnosed with EOV by Corrá criteria and 58% diagnosed by Leite criteria died within 1 yr
Sun et al[24], (2010)	580	NYHA 2-4 LVEF 26 ± 7	51%	EOV combined with elevated VE/VCO2 (≥155% predicted) resulted in an OR of 39 for 6 mo mortality	Peak VO2, AT, peak oxygen pulse significantly worse in nonsurvivors
Ueshima et al[68], (2010)	50	NYHA 1-3	28%	EOV associated with lower peak VO2 and higher VD/VT
Murphy et al[8], (2011)	56	NYHA 2-4 LVEF 30 ± 6	45%	EOV related to ↓exercise cardiac output and ↑cardiac filling pressures
Scardovi et al[31], (2012)	370	NYHA 1-3 LVEF 41% (range 34%-50%)	58%	EOV, VE/VCO2 slope and its ratio to peak VO2 predicted all-cause mortality independent of LVEF	Hemoglobin level, creatinine, BMI, HF admissions in the previous year
Matsuki et al[30], 2013	46	NYHA 3 LVEF 41 ± 16	44%	EOV patients had ↑cardiac filling pressures, higher NT-proBNP value, ↑VE/VCO2 slope, low PETCO2 and greater Borg dyspnea score
Nathan et al[27], (2015)	253	NYHA 1-3	38%	5 yr rate of death or transplant 14.1% in Fontan patients with EOV vs 4.1% of those without EOV	NYHA class, peak HR

LVEF and follow-up periods are in mean ± SD. NYHA: New York Heart Association; VO₂: Oxygen uptake; V_E: Ventilator efficiency; AHI: Apnea-hyponea index; AT: Anaerobic threshold; HR: Heart rate; LVEF: Left ventricular ejection fraction; HFrEF: HF and reduced ejection fraction; HFpEF: HF and preserved ejection fraction; HF: Heart failure; OR: Odds ratio; SCD: Sudden cardiac death; LVAD: Left ventricular assist device; LVESV: Left ventricular end systolic volume; PETCO₂: End tidal partial pressure of carbon dioxide; V_D/V_T: Ratio of physiologic dead space over tidal volume; BMI: Body mass index; NT-proBNP: N terminal pro brain natriuretic peptide.