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

Figures

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  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.

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  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; SO2, oxygen saturation. Arrows (↓) indicate arousals.

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  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.

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  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.