Cundrle Ivan, Johnson Bruce D, Rea Robert F, Scott Christopher G, Somers Virend K, Olson Lyle J
Department of Anesthesiology and Intensive Care, St. Anne's University Hospital, Brno, Czech Republic; Faculty of Medicine, Masaryk University, Brno, Czech Republic; International Clinical Research Center, St. Anne's University Hospital, Brno, Czech Republic.
Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA.
J Card Fail. 2020 Oct;26(10):832-840. doi: 10.1016/j.cardfail.2020.03.006. Epub 2020 Mar 20.
Exercise oscillatory ventilation (EOV) is a consequence of ventilatory control system instability and is commonly observed in patients with advanced heart failure (HF); it is associated with adverse prognosis. The goal of this study was to evaluate the effects of cardiac resynchronization therapy (CRT) on oscillatory ventilation as quantified by a proposed EOV score.
Consecutive patients with HF (N = 35) who underwent clinically indicated CRT, cardiopulmonary exercise testing and carbon dioxide (CO) chemosensitivity by rebreathe before and 4-6 months after CRT were included in this post hoc analysis. With CRT, EOV scores improved in 22 patients (63%). In these patients, left ventricular ejection fraction, left atrial volume, brain natriuretic peptide concentration, and CO chemosensitivity significantly improved after CRT (P < 0.05). Furthermore, minute ventilation per unit CO production significantly decreased, and end-tidal CO increased at rest and at peak exercise post-CRT. Multiple regression analysis showed only the change of CO chemosensitivity to be significantly associated with the improvement of the EOV score (b = 0.64; F = 11.3; P = 0.004). In the group without EOV score improvement (n = 13), though left ventricular ejection fraction significantly increased with CRT (P = 0.015), no significant changes in ventilation or gas exchange were observed.
The EOV score was mitigated by CRT and was associated with decreased CO chemosensitivity.
运动性振荡通气（EOV）是通气控制系统不稳定的结果，在晚期心力衰竭（HF）患者中很常见；它与不良预后相关。本研究的目的是评估心脏再同步治疗（CRT）对振荡通气的影响，该影响通过拟议的EOV评分进行量化。
本事后分析纳入了35例接受临床指征CRT的HF患者，在CRT前及CRT后4 - 6个月进行心肺运动试验和通过重复呼吸测定二氧化碳（CO）化学敏感性。接受CRT后，22例患者（63%）的EOV评分有所改善。在这些患者中，CRT后左心室射血分数、左心房容积、脑钠肽浓度和CO化学敏感性显著改善（P < 0.05）。此外，单位CO产生的分钟通气量显著降低，CRT后静息和运动峰值时的呼气末CO增加。多元回归分析显示，只有CO化学敏感性的变化与EOV评分的改善显著相关（b = 0.64；F = 11.3；P = 0.004）。在EOV评分未改善的组（n = 13）中，尽管CRT使左心室射血分数显著增加（P = 0.015），但未观察到通气或气体交换有显著变化。
CRT可减轻EOV评分，且与CO化学敏感性降低相关。
