Exercise oscillatory breathing in diastolic heart failure: prevalence and prognostic insights

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 > or =50%, and a Doppler early (E) mitral to early mitral annulus ratio (E') > or =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 VO(2) and higher E/E' ratio (all P < 0.01). Univariate Cox regression analysis demonstrated that peak VO(2), VE/VCO(2) 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.