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Review
. 2020 Dec;27(2_suppl):19-26.
doi: 10.1177/2047487320952029.

Roles of periodic breathing and isocapnic buffering period during exercise in heart failure

Piergiuseppe Agostoni  1   2 , Michele Emdin  3   4 , Fabiana De Martino  1 , Anna Apostolo  1 , Marco Masè  5 , Mauro Contini  1 , Cosimo Carriere  5 , Carlo Vignati  1   2 , Gianfranco Sinagra  5
Affiliations
Review

Roles of periodic breathing and isocapnic buffering period during exercise in heart failure

Piergiuseppe Agostoni et al. Eur J Prev Cardiol. 2020 Dec.

Abstract

In heart failure, exercise - induced periodic breathing and end tidal carbon dioxide pressure value during the isocapnic buffering period are two features identified at cardiopulmonary exercise testing strictly related to sympathetic activation. In the present review we analysed the physiology behind periodic breathing and the isocapnic buffering period and present the relevant prognostic value of both periodic breathing and the presence/absence of the identifiable isocapnic buffering period.

Keywords: Heart failure; anaerobic threshold; end tidal CO2 pressure; exercise; periodic breathing; prognosis; respiratory compensation point.

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Conflict of interest statement

Declaration of conflicting interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

Figure 1.
Figure 1.
Ventilation, oxygen consumption (VO2) and minute ventilation (VE)/carbon dioxide production (VCO2) and derived parameter changes during exercise. The isocapnic buffering period is identified between the anaerobic threshold (AT) and the respiratory compensation point (RCP). Reproduced from Carriere et al. with permission.
Figure 2.
Figure 2.
Measurements of near infrared spectroscopy (NIRS) data at rest in a patient with periodic breathing at rest. Fluctuation of oxygenated haemoglobin (HBO2), de-oxygenated haemoglobin (HB) and total haemoglobin (tHB) are reported. The cycle length is approximately 130 seconds.
Figure 3.
Figure 3.
Survival and presence of exercise oscillatory ventilation in patients with heart failure with reduced ejection fraction (HFrEF) and in patients with heart failure with mid-range ejection fraction (HFmrEF). Kaplan–Meier survival curves of study endpoint (cardiovascular death, urgent heart transplant or left ventricular assist device (LVAD) implantation) stratified according to the presence or absence of exercise oscillatory ventilation (EOV+ and EOV–) in patients with HFrEF and in patients with HFmrEF. Comparison among the groups (HFmrEF EOV– vs. HFmrEF EOV+: P = 0.020, χ2 = 5.4; HFmrEF EOV– vs. HFrEF EOV–: P = 0.000, χ2 = 31.1; HFmrEF EOV– vs. HFrEF EOV+: P = 0.000; χ2 = 75.9; HFmrEF EOV+ vs. HFrEF EOV–: P = 0.280, χ2 = 1.17; HFmrEF EOV+ vs. HFrEF EOV+: P = 0.000, χ2 = 29.7; HFrEF EOV– vs. HFrEF EOV+: P = 0.000; χ2 = 9.9). Reproduced from Rovai et al. with permission.
Figure 4.
Figure 4.
Five-year survival, assessed by the composite of cardiovascular death, urgent heart transplantation (HT) and left ventricular assist device (LVAD) in groups 1 (neither anaerobic threshold (AT) nor respiratory compensation point (RCP) detectable), 2 (detectable AT but no RCP) and 3 (both AT and RCP detectable), respectively. Reproduced from Carriere et al. with permission.
See this image and copyright information in PMC

References

    1. Agostoni P, Valentini M, Magri D, et al. Disappearance of isocapnic buffering period during increasing work rate exercise at high altitude. Eur J Cardiovasc Prev Rehabil 2008; 15: 354–358. - PubMed
    1. Whipp BJ, Davis JA, Wasserman K. Ventilatory control of the ‘isocapnic buffering' region in rapidly incremental exercise. Respir Physiol 1989; 76: 357–367. - PubMed
    1. Weatherald J, Farina S, Bruno N, et al. Cardiopulmonary exercise testing in pulmonary hypertension. Ann Am Thorac Soc 2017; 14: S84–S92. - PubMed
    1. He S, Hu X, Cao Y, et al. How to relieve breathing difficulties in high-temperature conditions for heart disease patients. Eur J Prev Cardiol 2018; 25: 976. - PubMed
    1. Cornelis J, Beckers P, Vanroy C, et al. An overview of the applied definitions and diagnostic methods to assess exercise oscillatory ventilation – a systematic review. Int J Cardiol 2015; 190: 161–169. - PubMed