Imperial College London


Faculty of MedicineNational Heart & Lung Institute

Professor of Cardiology



+44 (0)20 7594 3381d.francis Website




Miss Juliet Holmes +44 (0)20 7594 5735




Block B Hammersmith HospitalHammersmith Campus






BibTex format

author = {Giannoni, A and Gentile, F and Navari, A and Borrelli, C and Mirizzi, G and Catapano, G and Vergaro, G and Grotti, F and Betta, M and Piepoli, MF and Francis, DP and Passino, C and Emdin, M},
doi = {10.1161/JAHA.119.012419},
journal = {J Am Heart Assoc},
pages = {e012419--e012419},
title = {Contribution of the Lung to the Genesis of Cheyne-Stokes Respiration in Heart Failure: Plant Gain Beyond Chemoreflex Gain and Circulation Time.},
url = {},
volume = {8},
year = {2019}

RIS format (EndNote, RefMan)

AB - Background The contribution of the lung or the plant gain ( PG ; ie, change in blood gases per unit change in ventilation) to Cheyne-Stokes respiration ( CSR ) in heart failure has only been hypothesized by mathematical models, but never been directly evaluated. Methods and Results Twenty patients with systolic heart failure (age, 72.4±6.4 years; left ventricular ejection fraction, 31.5±5.8%), 10 with relevant CSR (24-hour apnea-hypopnea index [ AHI ] ≥10 events/h) and 10 without ( AHI <10 events/h) at 24-hour cardiorespiratory monitoring underwent evaluation of chemoreflex gain (CG) to hypoxia ([Formula: see text]) and hypercapnia ([Formula: see text]) by rebreathing technique, lung-to-finger circulation time, and PG assessment through a visual system. PG test was feasible and reproducible (intraclass correlation coefficient, 0.98; 95% CI , 0.91-0.99); the best-fitting curve to express the PG was a hyperbola ( R2≥0.98). Patients with CSR showed increased PG , [Formula: see text] (but not [Formula: see text]), and lung-to-finger circulation time, compared with patients without CSR (all P<0.05). PG was the only predictor of the daytime AHI ( R=0.56, P=0.01) and together with the [Formula: see text] also predicted the nighttime AHI ( R=0.81, P=0.0003) and the 24-hour AHI ( R=0.71, P=0.001). Lung-to-finger circulation time was the only predictor of CSR cycle length ( R=0.82, P=0.00006). Conclusions PG is a powerful contributor of CSR and should be evaluated together with the CG and circulation time to individualize treatments aimed at stabilizing breathing in heart failure.
AU - Giannoni,A
AU - Gentile,F
AU - Navari,A
AU - Borrelli,C
AU - Mirizzi,G
AU - Catapano,G
AU - Vergaro,G
AU - Grotti,F
AU - Betta,M
AU - Piepoli,MF
AU - Francis,DP
AU - Passino,C
AU - Emdin,M
DO - 10.1161/JAHA.119.012419
EP - 012419
PY - 2019///
SP - 012419
TI - Contribution of the Lung to the Genesis of Cheyne-Stokes Respiration in Heart Failure: Plant Gain Beyond Chemoreflex Gain and Circulation Time.
T2 - J Am Heart Assoc
UR -
UR -
VL - 8
ER -