Clinical Correlates and Prognostic Significance of the Ventilatory Response to Exercise in Chronic Heart Failure

Chua, Tuan Peng; Ponikowski, Piotr; Harrington, Derek; Anker, Stefan D.; Webb-Peploe, Katharine; Clark, Andrew L.; Poole‐Wilson, Philip A.; Coats, Andrew J.S.

doi:10.1016/s0735-1097(97)00078-8

Cited by 503 publications

(410 citation statements)

References 38 publications

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“…These data are in line with previous work describing the prognostic power of VE/VCO 2 slope. 4,20 Moreover, our results are concordant with a recent report from Levy et al describing an incremental prognostic value of VE/VCO 2 slope, when integrated in the SHFM score, in contrast to additional implementation of brain natriuretic peptide levels. 21 Our analysis confirms that the SHFM score can be applied easily and with adequate prognostic accuracy in CHF patients.…”

Section: Comparison Of Shfm Score and Cpet In Mortality Predictionsupporting

confidence: 92%

“…2 Evaluation of peak exercise capacity has important prognostic implications. 3 However, as many chronic heart failure (CHF) patients are not able to perform maximal exercise, parameters obtained during submaximal exercise such as the ratio of ventilation and CO 2 elimination (VE/VCO 2 slope) 4 or oxygen uptake efficiency slope (OUES) 5,6 have been investigated and were shown to improve the accuracy of CPET in evaluating CHF patients. However, several studies yielded conflicting results with respect to the prognostic power of submaximal and maximal exercise parameters.…”

Section: Introductionmentioning

confidence: 99%

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Comparison of the Seattle Heart Failure Model and Cardiopulmonary Exercise Capacity for Prediction of Death in Patients With Chronic Ischemic Heart Failure and Intracoronary Progenitor Cell Application

Honold

Rosa

Spyridopoulos

et al. 2013

Clinical Cardiology

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Background: Despite many therapeutic advances, the prognosis of patients with chronic heart failure (CHF) remains poor. Therefore, reliable identification of high-risk patients with poor prognosis is of utmost importance. Cardiopulmonary exercise testing (CPET) provides important prognostic information by peak O 2 uptake (peak VO 2 ), maximal oxygen pulse (O 2 Pmax), O 2 uptake efficiency slope (OUES), and VE/VCO 2 slope (VE/VCO 2 ). A different approach for prognostic assessment is the Seattle Heart Failure Model (SHFM), which is based on clinical data and calculates the estimated annual mortality. Hypothesis: Comparison of the prognostic value of the Seattle Heart Failure Score and cardiopulmonary excercis testing in patients with chronic heart failure. Methods: One hundred fifty-seven patients with ischemic heart failure and recent intracoronary progenitor cell application were analyzed for mortality during a follow-up of 4 years. CPET (peak VO 2 , O 2 Pmax, OUES, VE/VCO 2 ) was performed in all patients at baseline. The SHFM score was calculated for every patient, with data obtained at the time of CPET. Results: During follow-up, 24 patients died (15.2%). Nonsurvivors had significantly worse initial CPET results and a higher SHFM score compared to survivors. Receiver operating characteristics curve analysis of sensitivity and specificity revealed the largest area under the curve value for the SHFM score, followed by VE/VCO 2 slope. Kaplan Meier analysis using cutoff points of SHFM and VE/VCO 2 slope with highest sensitivity and specificity resulted in significant discrimination of survivors and nonsurvivors. By multivariate analysis, only the SHFM score persisted as independent predictor of mortality in these patients. Conclusions: These data indicate superior prognostic power of the SHFM score compared to CPET in patients with chronic ischemic heart failure. IntroductionHeart failure is associated with high mortality rates, prolonged and repeated hospitalizations, and enormous implications for healthcare systems. Despite novel therapeutic options like revascularization, device therapy, and pharmacotherapy, the prevalence and incidence of chronic heart failure continued to increase over the last decades. 1 The identification of high-risk patients requires objective assessment of mortality risk. Cardiopulmonary exercise

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Section: Comparison Of Shfm Score and Cpet In Mortality Predictionsupporting

confidence: 92%

Section: Introductionmentioning

confidence: 99%

Comparison of the Seattle Heart Failure Model and Cardiopulmonary Exercise Capacity for Prediction of Death in Patients With Chronic Ischemic Heart Failure and Intracoronary Progenitor Cell Application

Honold

Rosa

Spyridopoulos

et al. 2013

Clinical Cardiology

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“…The low values of the EqCO 2 three months after VAD implantation, however, suggest a complete normalisation of the decompensated state of the patients. 18,19 This is further supported by the nearly complete normalisation of plasma BNP levels three months after VAD implantation, as well as the improvement of the severely compromised renal function.…”

Section: Discussionmentioning

confidence: 85%

Left ventricular assist device: a functional comparison with heart transplantation

Pruijsten

Jonge²,

Kirkels³

et al. 2008

NHJL

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Background. A growing number of patients with end-stage heart failure undergo implantation of ventricular assist devices as a bridge to heart transplantation. Objectives. In this study we investigated whether functional and haemodynamic recovery after implantation is sufficient to warrant the use of them as long-term alternative to heart transplantation. Methods. We compared peak VO 2 of a group of patients three months after implantation of a ventricular assist device and three months after heart transplantation. Furthermore, we analysed the degree of haemodynamic recovery, by comparing plasma levels of BNP and creatinine before and after implantation of the device. Results. After implantation of a ventricular assist device, exercise capacity improved considerably; three months after implantation peak VO 2 was 20.0±4.9 ml/kg/min (52% of predicted for age and gender). After heart transplantation exercise capacity improved even further; 24.0±3.9 ml/ kg/min (62% of predicted for age and gender) (p<0.001). In the three months after implantation, BNP plasma levels decreased from 570±307 pmol/l to 31±25 pmol/l and creatinine levels decreased from 191±82 µmol/l to 82±25 µmol/l, indicating significant unloading of the ventricles and haemodynamic recovery. Conclusion. With regard to functional and haemodynamic recovery, the effect of implantation of a ventricular assist device is sufficient to justify its use as an alternative to heart transplantation. (Neth Heart J 2008;16:41-6.)

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“…The lower D _ VO 2 / DWR in non-survivors suggests an insufficient cardiac reserve. The _ VE/ _ VCO 2 slope, which ranges from approximately 24 to 34 in healthy subjects, becomes steeper in cardiac patients, according to the severity of heart failure [3,18]. Theoretically, a steep _ VE/ _ VCO 2 slope is assumed to relate to an increased ratio of pulmonary dead space to tidal volume (VD/VT) or to a decrease in the regulatory set point for PaCO 2 .…”

Section: Parameters Obtained From Cardiopulmonary Exercise Testingmentioning

confidence: 99%

“…Among these, the peak O 2 uptake ( _ VO 2 ) has traditionally been considered a gold standard for identifying patients with a poor prognosis and selecting candidates for cardiac transplantation [2]. The ratio of the increase in ventilation ( _ VE) to the increase in CO 2 output ( _ VCO 2 ) during exercise ( _ VE/ _ VCO 2 slope) also strongly reflects the severity of heart failure and has been found to be an independent prognostic marker in cardiac patients [3].…”

Section: Introductionmentioning

confidence: 99%

Prognostic value of end-tidal CO2 pressure during exercise in patients with left ventricular dysfunction

et al. 2008

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We compared the prognostic power of end-tidal CO 2 pressure (PETCO 2 ) during exercise, an index of arterial CO 2 pressure, with those of established respiratory gas indexes during exercise testing in patients with left ventricular dysfunction. Seventy-eight consecutive patients with a left ventricular ejection fraction (LVEF) B40% were enrolled in the study. All the patients performed a symptom-limited incremental exercise test with respiratory gas measurements. PETCO 2 at peak exercise, peak O 2 uptake ( _ VO 2 ), the ratio of the increase in ventilation to the increase in CO 2 output ( _ VE/ _ VCO 2 slope), and the ratio of the increase in _ VO 2 to the increase in work rate (D _ VO 2 / DWR) were measured. PETCO 2 at peak exercise was significantly correlated with peak _ VO 2 , _ VE/ _ VCO 2 slope and D _ VO 2 /DWR. During a prospective follow-up period of 992 ± 570 days, 14 cardiac deaths occurred. As compared to survivors, non-survivors had a significantly lower LVEF, lower PETCO 2 at peak exercise, lower peak _ VO 2 , lower D _ VO 2 /DWR and a higher _ VE/ _ VCO 2 slope. Among these indexes, only PETCO 2 at peak exercise was found to be an independent predictor for cardiac death. PETCO 2 at peak exercise is useful in predicting poor prognosis in patients with left ventricular systolic dysfunction.

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Clinical Correlates and Prognostic Significance of the Ventilatory Response to Exercise in Chronic Heart Failure

Abstract: A high VE-VCO2 slope selects patients with more severe heart failure and is an independent prognostic marker. The VE-VCO2 slope may be used as a supplementary index in the assessment of patients with chronic heart failure.

Cited by 503 publications

References 38 publications

Comparison of the Seattle Heart Failure Model and Cardiopulmonary Exercise Capacity for Prediction of Death in Patients With Chronic Ischemic Heart Failure and Intracoronary Progenitor Cell Application

Comparison of the Seattle Heart Failure Model and Cardiopulmonary Exercise Capacity for Prediction of Death in Patients With Chronic Ischemic Heart Failure and Intracoronary Progenitor Cell Application

Left ventricular assist device: a functional comparison with heart transplantation

Prognostic value of end-tidal CO2 pressure during exercise in patients with left ventricular dysfunction

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