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Cheyne-Stokes respiration in heart failure: friend or foe? Hemodynamic effects of hyperventilation in heart failure patients and healthy volunteers

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Abstract

Objective

In patients with heart failure (HF), Cheyne-Stokes respiration (CSR) is characterized by chronic hyperventilation (HV) with low arterial partial pressure of carbon dioxide (pCO2). It is still unclear whether this HV represents a compensatory response to HF or an independent comorbidity. This study investigated the hemodynamic effects of HV in HF patients and volunteers.

Methods

A total of 15 volunteers [13 male, 25 ± 4 years, brain natriuretic peptide (BNP) <49 pg/mL, left ventricular rejection fraction (LVEF) >55 %) and 20 HF patients with reduced LVEF (15 male, 67.7 ± 12 years, NYHA class 2.6 ± 0.6, BNP 790 ± 818 pg/mL, LVEF 32.4 ± 7.3 %) were enrolled. Hemodynamics was monitored noninvasively in volunteers (TaskForce Monitor, CNSystems) and invasively in HF patients.

Results

During HV, the transcutaneous CO2 pressure in volunteers decreased from 38.7 ± 2.5 to 28.6 ± 3.3 mmHg (p < 0.001) and pCO2 in HF patients decreased from 33.6 ± 3.7 to 22.2 ± 3.2 mmHg (p < 0.001). There was a significant increase in cardiac output (CO) in both volunteers (6.2 ± 1.3–7.5 ± 1.3 L/min, p < 0.001) and HF patients (4.4 ± 1.3–5.0 ± 1.3 L/min), mainly as a result of an increase in heart rate (67.4 ± 7.6–82.8 ± 10.9/min, p < 0.001; and 77.2 ± 17.7–86.2 ± 22.4/min, p < 0.001, respectively); stroke volume (SV) was unchanged in volunteers (93.7 ± 19.6–93.8 ± 21.4 mL) and only slightly increased in HF patients (64.4 ± 28.7–68.5 ± 23.2 mL).

Conclusions

CSR with associated HV may be a compensatory mechanism in patients with a failing heart. This compensatory mechanism includes an increase in heart rate, which might be deleterious in the long run.

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Acknowledgments

English language medical writing assistance was provided by Nicola Ryan, independent medical writer, on behalf of ResMed.

Conflict of interest

There are no conflicts of interest to declare.

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Authors and Affiliations

  1. Department of Cardiology, Heart and Diabetes Center NRW, University Hospital, Ruhr University Bochum, Georgstrasse 11, 32545, Bad Oeynhausen, Germany

    Olaf Oldenburg, Jens Spießhöfer, Henrik Fox, Thomas Bitter & Dieter Horstkotte

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  1. Olaf Oldenburg
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  2. Jens Spießhöfer
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  3. Henrik Fox
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  4. Thomas Bitter
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  5. Dieter Horstkotte
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Correspondence to Olaf Oldenburg.

Additional information

O. Oldenburg and J. Spießhöfer contributed equally.

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Oldenburg, O., Spießhöfer, J., Fox, H. et al. Cheyne-Stokes respiration in heart failure: friend or foe? Hemodynamic effects of hyperventilation in heart failure patients and healthy volunteers. Clin Res Cardiol 104, 328–333 (2015). https://doi.org/10.1007/s00392-014-0784-1

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