Exercise hyperpnea in chronic heart failure: relationships  to lung stiffness and expiratory flow limitation

Agostoni, Piergiuseppe; Pellegrino, Riccardo; Conca, Cristina; Rodarte, Joseph R.; Brusasco, Vito

doi:10.1152/japplphysiol.00724.2001

Cited by 90 publications

(94 citation statements)

References 31 publications

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“…A few studies have measured respiratory mechanics during exercise in CHF [157,158] Reduced static lung compliance has been described at rest, even in oedema-free patients [159]. Increased airways resistance and hyperresponsiveness have also been reported, even in nonsmokers, which may reflect mucosal oedema [160].…”

Section: Ventilatory Abnormalitiesmentioning

confidence: 99%

“…Recent data from the literature suggest that, despite breathing reserve usually being normal, CHF patients may develop expiratory airflow limitation at peak exercise and that this is the cause of exertional dyspnoea [158]. Patients who have resting expiratory flow limitation have been shown to demonstrate significant dynamic hyperinflation in exercise when ventilatory demands are increased [157]. The tachypnoeic breathing pattern responses may also reflect inspiratory muscle weakness, although the role of the latter in CHF remains conjectural.…”

Section: Ventilatory Abnormalitiesmentioning

confidence: 99%

See 1 more Smart Citation

Recommendations on the use of exercise testing in clinical practice

Palange¹,

Ward²,

Carlsen³

et al. 2006

European Respiratory Journal

549

390

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Evidence-based recommendations on the clinical use of cardiopulmonary exercise testing (CPET) in lung and heart disease are presented, with reference to the assessment of exercise intolerance, prognostic assessment and the evaluation of therapeutic interventions (e.g. drugs, supplemental oxygen, exercise training). A commonly used grading system for recommendations in evidence-based guidelines was applied, with the grade of recommendation ranging from A, the highest, to D, the lowest.For symptom-limited incremental exercise, CPET indices, such as peak O 2 uptake (V9O 2 ), V9O 2 at lactate threshold, the slope of the ventilation-CO 2 output relationship and the presence of arterial O 2 desaturation, have all been shown to have power in prognostic evaluation. In addition, for assessment of interventions, the tolerable duration of symptom-limited high-intensity constant-load exercise often provides greater sensitivity to discriminate change than the classical incremental test. Field-testing paradigms (e.g. timed and shuttle walking tests) also prove valuable.In turn, these considerations allow the resolution of practical questions that often confront the clinician, such as: 1) ''When should an evaluation of exercise intolerance be sought?''; 2) ''Which particular form of test should be asked for?''; and 3) ''What cluster of variables should be selected when evaluating prognosis for a particular disease or the effect of a particular intervention?''

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Section: Ventilatory Abnormalitiesmentioning

confidence: 99%

Section: Ventilatory Abnormalitiesmentioning

confidence: 99%

Recommendations on the use of exercise testing in clinical practice

Palange¹,

Ward²,

Carlsen³

et al. 2006

European Respiratory Journal

549

390

View full text Add to dashboard Cite

show abstract

“…Major pathogenetic bases for lung stiffening are interstitial lung congestion and heart to lung pathological interaction because of cardiomegaly, vascular engorgement, increased alveolar surface tension, unequal ventilation and activation of contractile elements of the vascular wall [17]. The combination of these factors leads to the development of a typical restrictive lung pattern [18,19]. According to Wasserman, the lung restriction may occur as a function of haemodynamic derangement, suggesting a pathogenetic role of an increased wasted ventilation with those patients with higher VE/VCO 2 slope exhibiting the higher dead space to tidal volume ratio and a premature increase in respiratory rate as a compensatory mechanism.…”

Section: Airways Function Abnormalitiesmentioning

confidence: 99%

Exercise intolerance in chronic heart failure: mechanisms and therapies. Part I

Piepoli

Guazzi

Boriani

et al. 2010

European Journal of Cardiovascular Prevention & Rehabilitat

Self Cite

112

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Muscular fatigue and dyspnoea on exertion are among the most common symptoms in chronic heart failure; however their origin is still poorly understood. Several studies have shown that cardiac dysfunction alone cannot fully explain their origin, but the contribution of the multiorgan failure present in this syndrome must be highlighted. In this study, divided in two parts (see part II: pp. 643-648), we aimed to summarize the existing evidence and the most controversial aspects of the complex interplay of different factors involved in symptom generation. In this first part of the review, six key factors are revised: the heart, the lung, the skeletal muscle, the hormonal changes, the O 2 delivery to the periphery, the endothelium. In the second part, the role of the excitatory reflexes and the cardiac cachexia will be presented, and finally, the potential therapeutic implications are discussed. We believe that a better knowledge of the pathophysiology of this syndrome may contribute to the management of the patients and to the improvement in their stress tolerance and quality of life.

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“…The use of non invasive cardiopulmonary gas exchange testing has expanded into a number of clinical areas and is now used frequently to characterize disease status, determine response to therapy and gain perspective on prognosis [1,3,[16][17][18][19][20]. Limitations to further expansion of this testing to other clinical areas include space requirements, adequately trained personnel, the complexity and time for testing as well as the significant costs.…”

Section: Benefits Of Submaximal Cardiopulmonary Exercise Testingmentioning

confidence: 99%

Validation of a Simplified, Portable Cardiopulmonary Gas Exchange System for Submaximal Exercise Testing~!2009-10-25~!2010-01-09~!2010-03-17~!

Miller¹,

Woods²,

Olson³

et al. 2010

TOSMJ

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Shape Medical Systems, Inc. has developed a new miniaturized, simplified system for non-invasive cardiopulmonary gas exchange quantification and has targeted their system for submaximal clinical exercise testing in order to abbreviate testing in an expanding clinical market during a climate of escalating health care costs. The focus of the present study was to compare this new device to a validated, standardized system for measures of cardiopulmonary gas exchange. Eighteen healthy adults (10 male/8 female, age 29±7 yr, BMI 23.8±2.4 kg/m 2 ) were brought to the laboratory and instrumented with both measurement systems via in-series pneumotachs. Additionally, the Shape system included a pulse oximeter for heart rate (HR) and oxygen saturation (SaO 2 ), while the standard system included separate 12-lead ECG and oximetry devices. The protocol included 2-min resting breathing, followed by 3-min at each of 3 workloads (50, 70, 125 watts) on a cycle ergometer. Data were collected breath-by-breath and averaged the last 30-sec of each workload. After a 15-min rest period, the pneumotach order was reversed and the study repeated. Since gas exchange data were similar (p>0.05) within a given metabolic testing system between sessions the data were pooled for comparing the Shape and Standard systems. There were no differences (p>0.05) between the systems for oxygen consumption-VO 2 , carbon dioxide production-VCO 2 , ventilation-V E , end tidal CO 2 -PetCO 2 , tidal volume-V T , respiratory rate-fb, and HR at rest or any work load. SaO 2 was slightly, but significantly lower using the Shape embedded oximeter (p<0.05, averaging ~1% across workloads). There were significant correlation coefficients (p<0.001) between the systems for VO 2 (r=0.991), VCO 2 (r=0.986), V E (r=0.995) and PetCO 2 (r=0.953). Bland Altman plots indicated good agreement between systems for the same gas exchange measures, independent of workload. The Shape system was sensitive to small increases in work (50 to 70 watts) and there were no differences in gas exchange measures in a subgroup of subjects (n=4) using a tight fitting mask instead of a mouthpiece (p>0.05). These data suggest that the new, simplified metabolic system developed by Shape Medical Systems, Inc. accurately quantifies key cardiopulmonary variables over a range of workloads, has a coefficient of variation similar to a well validated system and can be used with mouthpiece or mask.

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Exercise hyperpnea in chronic heart failure: relationships to lung stiffness and expiratory flow limitation

Abstract: Agostoni, PierGiuseppe, Riccardo Pellegrino, Cristina Conca, Joseph R. Rodarte, and Vito Brusasco. Exercise hyperpnea in chronic heart failure: relationships to lung stiffness and expiratory flow limitation.

Cited by 90 publications

References 31 publications

Recommendations on the use of exercise testing in clinical practice

Recommendations on the use of exercise testing in clinical practice

Exercise intolerance in chronic heart failure: mechanisms and therapies. Part I

Validation of a Simplified, Portable Cardiopulmonary Gas Exchange System for Submaximal Exercise Testing~!2009-10-25~!2010-01-09~!2010-03-17~!

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