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European Heart Journal Advance Access originally published online on November 23, 2006
European Heart Journal 2007 28(6):673-678; doi:10.1093/eurheartj/ehl404
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© The European Society of Cardiology 2006. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org

Exercise ventilation inefficiency in heart failure: pathophysiological and clinical significance

Gabriele Tumminello1, Marco Guazzi1, Patrizio Lancellotti2 and Luc A. Piérard2,*

1 Cardiopulmonary Unit, Cardiology Division, University of Milano, San Paolo Hospital, 20142 Milano, Italy
2 Department of Cardiology, University Hospital Sart Tilman, Boite 35 CHU, B-4000 Liège, Belgium

Received 24 May 2006; revised 8 September 2006; accepted 7 November 2006; online publish-ahead-of-print 23 November 2006.

* Corresponding author. Tel: +32 4 366 71 94; fax: +32 4 366 71 95. E-mail address: lpierard{at}chu.ulg.ac.be

Heart failure (HF) is a complex syndrome characterized by myocardial dysfunction and a poor prognosis. Among multiple markers of severity, an exercise ventilation inefficiency has important clinical and prognostic value. The pathophysiology determining exercise ventilatory inefficiency is complex and not definitively clarified. Three different mechanisms have been identified: (i) increased dead space, (ii) early occurrence of lactic acidosis, and (iii) abnormal chemoreflex and/or metaboreflex activity. Besides its prognostic value, abnormal ventilation can be influenced by pharmacological and non-pharmacological therapies such as ß-blockers, selective cyclic 3'–5' guanosine monosphosphate phosphodiesterase inhibitors, physical training, and nocturnal continuous positive airway pressure. There is an increasing interest for the exercise periodic breathing, which is frequently associated with HF syndrome and has prognostic importance. The precise mechanisms sustaining exercise periodic breathing are not fully defined but ventilatory and metabo-haemodynamic hypotheses have been proposed.

Key Words: Heart failure • Ventilation • Exercise • Periodic breathing


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