Prevalence of exertional oscillatory ventilation in continuous-flow left ventricular assist device recipients

Background Exercise oscillatory ventilation is an ominous outcome sign in heart failure due to reduced left ventricular ejection fraction; currently, the prevalence of exercise oscillatory ventilation is unknown in left ventricular assist device recipients. Methods We studied cardiopulmonary exercise testing in heart failure due to reduced left ventricular ejection fraction or left ventricular assist device patients and exercise oscillatory ventilation was defined according to Kremser's criteria. Results The occurrence of exercise oscillatory ventilation was similar in either heart failure due to reduced left ventricular ejection fraction (192 patients, 8%) or left ventricular assist device patients (85 recipients, 10%), even though the mean peak oxygen consumption and elevated ventilatory response to exercise slope was lower and higher in left ventricular assist device recipients, respectively, but the occurrence of exercise oscillatory ventilation was comparable among heart failure patients due to reduced left ventricular ejection fraction and left ventricular assist device, if those with impaired exercise capacity were considered. Of note, left ventricular assist device recipients with exercise oscillatory ventilation had a higher end-diastolic left ventricular volume and systolic pulmonary artery pressure at rest. Conclusions Using the largest cohort of left ventricular assist device patients performing cardiopulmonary exercise testing, we demonstrated that the occurrence of exercise oscillatory ventilation is similar in heart failure due to reduced left ventricular ejection fraction and left ventricular assist device patients. Recipients with exercise oscillatory ventilation might have haemodynamic and ventilatory dysfunction during exercise, but other factors could play a role, i.e. the duration and severity of heart failure before left ventricular assist device implantation together with the coexistence of morbidity.