International Journal of Cardiology 185 (2015) 55
Contents lists available at ScienceDirect
International Journal of Cardiology journal homepage: www.elsevier.com/locate/ijcard
Letter to the Editor
Exercise oscillatory ventilation: Ventilation–perfusion abnormality in heart failure Tomohiko Kisaka a,b,⁎, Harry B. Rossiter a,1, Karlman Wasserman a,2, Yasuki Kihara b,3 a b
Division of Respiratory and Critical Care, Physiology and Medicine, Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, UCLA School of Medicine, Torrance, CA, USA Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
a r t i c l e
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Article history: Received 29 January 2015 Accepted 7 March 2015 Available online 10 March 2015 Keywords: Heart failure Exercise oscillatory ventilation Periodic breathing
etiology for EOV in non-ischemic HF (52.5%). Recognizing that all HF patients are at risk of developing EOV increases its value as a prognostic marker. Indeed, the data of Cornelis et al. [1] support that EOV is associated with HF, independent of the etiology, or whether ejection fraction is preserved or not. Given the recent emphasis on EOV in the literature, the finding that EOV combines with other cardiopulmonary exercise testing variables to dramatically increase the relative risk of cardiovascular events is perhaps not surprising, and it supports the call to have EOV included in the battery used to assess the severity or worsening of the syndrome [3]. However, as yet, the pathogenesis and pathophysiology of EOV are not well understood [4], and therefore it remains to be determined whether EOV will provide an important therapeutic target.
Dear Editor:
Conflict of interest
We were interested to read the recent systematic review by Cornelis et al. emphasizing the significant prognostic value to be gained by including exercise oscillatory ventilation (EOV) in the assessment of patients with heart failure (HF) [1]. In their article, Cornelis et al. [1] did not emphasize the influence of myocardial ischemia on the incidence of EOV in their systematic review, but we feel that it is important to recognize that EOV is associated with both ischemic and non-ischemic etiologies of HF. In fact, Cornelis et al. [1] incorrectly assigned the 46 patients in the population investigated by Matsuki et al. [2] as “ischemic” rather than “non-ischemic”. Their value for “Etiology ischemic (%)” in Table 3 should be given as 0%, instead of 100% in relation to the data of Matsuki et al. [2]. This work intentionally set out to investigate whether ischemia was involved in the pathophysiology of EOV. Although the small change to the data set has no major influence over the key conclusions of their review, it lowers the median percentage of subjects with an ischemic etiology positive for EOV to 54.1%, which is very similar to the percentage
Tomohiko Kisaka received unrestricted funding of research grant from Fukuda Foundation for Medical Technology, Tokyo, Japan (FY2013/1H). The other authors report that there are no conflicts of interest.
⁎ Corresponding author at: 1124 West Carson Street, RB-2, Torrance, CA 90502, USA. E-mail addresses: [email protected] (T. Kisaka), [email protected] (H.B. Rossiter), [email protected] (K. Wasserman), [email protected] (Y. Kihara). 1 1124 West Carson Street, CDCRC-Building, Torrance, CA 90502, USA. 2 1124 West Carson Street, RB-2, Torrance, CA 90502, USA. 3 1-2-3 Kasumi, Minami-ku, Hiroshima 734-0037, Japan.
http://dx.doi.org/10.1016/j.ijcard.2015.03.123 0167-5273/© 2015 Elsevier Ireland Ltd. All rights reserved.
References [1] J. Cornelis, J. Taeymans, W. Hens, P. Beckers, C. Vrints, D. Vissers, Prognostic respiratory parameters in heart failure patients with and without exercise oscillatory ventilation — a systematic review and descriptive meta-analysis, Int. J. Cardiol. 182 (2015) 476–486. [2] R. Matsuki, T. Kisaka, R. Ozono, H. Kinoshita, Y. Sada, N. Oda, et al., Characteristics of patients with severe heart failure exhibiting exercise oscillatory ventilation, Clin. Exp. Hypertens. 35 (2013) 267–272. [3] R. Arena, M. Guazzi, L.P. Cahalin, J. Myers, Revisiting cardiopulmonary exercise testing applications in heart failure: aligning evidence with clinical practice, Exerc. Sport Sci. Rev. 42 (2014) 153–160. [4] Y. Tomita, T. Kasai, T. Kisaka, H.B. Rossiter, Y. Kihara, K. Wasserman, et al., Altered breathing syndrome in heart failure: newer insights and treatment options, Curr. Heart Fail. Rep. 12 (2015) 158–165.
Contents lists available at ScienceDirect
International Journal of Cardiology journal homepage: www.elsevier.com/locate/ijcard
Letter to the Editor
Exercise oscillatory ventilation: Ventilation–perfusion abnormality in heart failure Tomohiko Kisaka a,b,⁎, Harry B. Rossiter a,1, Karlman Wasserman a,2, Yasuki Kihara b,3 a b
Division of Respiratory and Critical Care, Physiology and Medicine, Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, UCLA School of Medicine, Torrance, CA, USA Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
a r t i c l e
i n f o
Article history: Received 29 January 2015 Accepted 7 March 2015 Available online 10 March 2015 Keywords: Heart failure Exercise oscillatory ventilation Periodic breathing
etiology for EOV in non-ischemic HF (52.5%). Recognizing that all HF patients are at risk of developing EOV increases its value as a prognostic marker. Indeed, the data of Cornelis et al. [1] support that EOV is associated with HF, independent of the etiology, or whether ejection fraction is preserved or not. Given the recent emphasis on EOV in the literature, the finding that EOV combines with other cardiopulmonary exercise testing variables to dramatically increase the relative risk of cardiovascular events is perhaps not surprising, and it supports the call to have EOV included in the battery used to assess the severity or worsening of the syndrome [3]. However, as yet, the pathogenesis and pathophysiology of EOV are not well understood [4], and therefore it remains to be determined whether EOV will provide an important therapeutic target.
Dear Editor:
Conflict of interest
We were interested to read the recent systematic review by Cornelis et al. emphasizing the significant prognostic value to be gained by including exercise oscillatory ventilation (EOV) in the assessment of patients with heart failure (HF) [1]. In their article, Cornelis et al. [1] did not emphasize the influence of myocardial ischemia on the incidence of EOV in their systematic review, but we feel that it is important to recognize that EOV is associated with both ischemic and non-ischemic etiologies of HF. In fact, Cornelis et al. [1] incorrectly assigned the 46 patients in the population investigated by Matsuki et al. [2] as “ischemic” rather than “non-ischemic”. Their value for “Etiology ischemic (%)” in Table 3 should be given as 0%, instead of 100% in relation to the data of Matsuki et al. [2]. This work intentionally set out to investigate whether ischemia was involved in the pathophysiology of EOV. Although the small change to the data set has no major influence over the key conclusions of their review, it lowers the median percentage of subjects with an ischemic etiology positive for EOV to 54.1%, which is very similar to the percentage
Tomohiko Kisaka received unrestricted funding of research grant from Fukuda Foundation for Medical Technology, Tokyo, Japan (FY2013/1H). The other authors report that there are no conflicts of interest.
⁎ Corresponding author at: 1124 West Carson Street, RB-2, Torrance, CA 90502, USA. E-mail addresses: [email protected] (T. Kisaka), [email protected] (H.B. Rossiter), [email protected] (K. Wasserman), [email protected] (Y. Kihara). 1 1124 West Carson Street, CDCRC-Building, Torrance, CA 90502, USA. 2 1124 West Carson Street, RB-2, Torrance, CA 90502, USA. 3 1-2-3 Kasumi, Minami-ku, Hiroshima 734-0037, Japan.
http://dx.doi.org/10.1016/j.ijcard.2015.03.123 0167-5273/© 2015 Elsevier Ireland Ltd. All rights reserved.
References [1] J. Cornelis, J. Taeymans, W. Hens, P. Beckers, C. Vrints, D. Vissers, Prognostic respiratory parameters in heart failure patients with and without exercise oscillatory ventilation — a systematic review and descriptive meta-analysis, Int. J. Cardiol. 182 (2015) 476–486. [2] R. Matsuki, T. Kisaka, R. Ozono, H. Kinoshita, Y. Sada, N. Oda, et al., Characteristics of patients with severe heart failure exhibiting exercise oscillatory ventilation, Clin. Exp. Hypertens. 35 (2013) 267–272. [3] R. Arena, M. Guazzi, L.P. Cahalin, J. Myers, Revisiting cardiopulmonary exercise testing applications in heart failure: aligning evidence with clinical practice, Exerc. Sport Sci. Rev. 42 (2014) 153–160. [4] Y. Tomita, T. Kasai, T. Kisaka, H.B. Rossiter, Y. Kihara, K. Wasserman, et al., Altered breathing syndrome in heart failure: newer insights and treatment options, Curr. Heart Fail. Rep. 12 (2015) 158–165.
