European Heart Journal Advance Access published online on October 4, 2008
European Heart Journal, doi:10.1093/eurheartj/ehn437
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Exercise oscillatory breathing in diastolic heart failure: prevalence and prognostic insights
1 Cardiopulmonary Unit, University of Milano, San Paolo Hospital, Via A. di Rudinì, 8, 20142 Milano, Italy
2 VA Palo Alto Health Care System, Palo Alto, CA, USA
3 Virginia Commonwealth University, Richmond, VA, USA
4 LeBauer Cardiovascular Research Foundation, Greensboro, NC, USA
Received 24 April 2008; revised 22 August 2008; accepted 12 September 2008.
* Corresponding author. Tel: +39 02 5032 3144, Fax: +39 02 5032 3144, Email: marco.guazzi{at}unimi.it
Aims: Exercise intolerance occurs in both systolic and diastolic heart failure (HF). Exercise oscillatory breathing (EOB) is a powerful predictor of survival in patients with systolic HF. In diastolic HF, EOB prevalence and prognostic impact are unknown.
Methods and results: A total of 556 HF patients (405 with systolic HF and 151 with diastolic HF) underwent cardiopulmonary exercise testing (CPET). Diastolic HF was defined as signs and symptoms of HF, a left ventricular ejection fraction 
50%, and a Doppler early (E) mitral to early mitral annulus ratio (E') 8. CPET responses, EOB prevalence and its ability to predict cardiac-related events were examined. EOB prevalence in systolic and diastolic HF was similar (35 vs. 31%). Compared with the patients without EOB, patients with EOB and either systolic or diastolic HF had a higher New York Heart Association class, lower peak VO2 and higher E/E' ratio (all P < 0.01). Univariate Cox regression analysis demonstrated that peak VO2, VE/VCO2 slope and EOB all were significant predictors of cardiac events in both systolic and diastolic HF. Multivariable analysis revealed that EOB was retained as a prognostic marker in systolic HF and was the strongest predictor of cardiac events in diastolic HF.
Conclusion: EOB occurrence is similar in diastolic and systolic HF and provides relevant clues for the identification of diastolic HF patients at increased risk of adverse events.
Key Words: Diastolic heart failure • Exercise oscillatory breathing
Presented in part at the 80th American Heart Association Scientific Session, Orlando, Florida, November 3–7, 2007.