Prognostic Value of Cheyne-Stokes Respiration and Nutritional Status in Acute Decompensated Heart Failure

Abstract

Malnutrition frequently coexists with heart failure (HF), leading to series of negative consequences. Cheyne-Stokes respiration (CSR) is predominantly detected in patients with HF. However, the effect of CSR and malnutrition on the long-term prognosis of patients with acute decompensated HF (ADHF) remains unclear. We enrolled 162 patients with ADHF (median age, 62 years; 78.4% men). The presence of CSR was assessed using polysomnography and the controlling nutritional status score was assessed to evaluate the nutritional status. Patients were divided into four groups based on CSR and malnutrition. The primary outcome was all-cause mortality. In total, 44% of patients had CSR and 67% of patients had malnutrition. The all-cause mortality rate was 26 (16%) during the 35.9 months median follow-up period. CSR with malnutrition was associated with lower survival rates (log-rank p < 0.001). Age, hemoglobin, albumin, lymphocyte count, total cholesterol, triglyceride, low-density lipoprotein cholesterol, creatinine, estimated glomerular filtration rate, B-type natriuretic peptide, administration of loop diuretics, apnea-hypopnea index and central apnea-hypopnea index were significantly different among all groups (p < 0.05). CSR with malnutrition was independently associated with all-cause mortality. In conclusion, CSR with malnutrition is associated with a high risk of all-cause mortality in patients with ADHF.

Keywords: Cheyne-Stokes respiration; acute decompensated heart failure; nutritional status.

Figure 1

Flow diagram of the study population. From May 2012 to April 2018, 241 patients with LV systolic dysfunction (defined as LVEF < 50% via echocardiography) due to ADHF were hospitalized at Juntendo University Hospital. Among them, 79 patients were excluded for the following reasons: lacked CONUT score data (albumin, total cholesterol) and raw data of polysomnography. Thus, 162 eligible patients were enrolled in the study. Abbreviations: ADHF, acute decompensated heart failure; CSR, Cheyne-stokes respiration; CONUT, controlling nutritional status; LV, left ventricular.

Figure 2

Polysomnographic recordings of normal breathing pattern and a clear pattern of CSR from patients with ADHF. The upper panel shows normal respiration during stage 2 sleep. The lower panel shows Cheyne-Stokes respiration with central sleep apnea. Note in-phase gradual crescendo and decrescendo of tidal volume during hyperpnea and only minimal O₂ desaturation during hypopnea. EEG, electroencephalogram; EOG, electrooculogram; EMG, electromyogram; ECG, electrocardiogram; HR, heart rate; SO_2, oxygen saturation. Arrows (↓) indicate arousals.

Figure 3

Cumulative survival curves of CSR (A) and malnutrition (B) on all-cause mortality in patients with acute decompensated heart failure. Cumulative survival curves were significantly different (A) between patients with and without CSR and (B) between those with and without malnutrition. CSR, Cheyne-stokes respiration.

Figure 4

Cumulative survival curves across 4 groups including patients with and without CSR or malnutrition. Patients were categorized into four groups on the basis of prevalence or absence of CSR and of presence or absence of malnutrition. Cumulative survival curves across 4 groups were significantly different. Abbreviations: CSR, Cheyne-stokes respiration. * p < 0.05; ** p < 0.01.