Exercise ventilation inefficiency and cardiovascular mortality in heart failure: the critical independent prognostic value of the arterial CO2 partial pressure

Guazzi, Marco; Reina, Giulio; Guazzi, Maurizio D.

doi:10.1016/j.cardfail.2004.06.303

Cited by 34 publications

(80 citation statements)

References 0 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…It is not surprising then that CPET measures such as peak o 2 , AT, peak oxygen pulse, lowest e / co 2 and e -vs-co 2 slope, and OUES are good measures of cardiovascular performance and predictive of survival in patients with HF. [3][4][5][6][7][8][9][10] Another measurement, perhaps even more useful, is the OUEP. Surprisingly, to the best of our knowledge, the measurements of OUEP (or lowest e / o 2 or highest o 2 / e ), either for a fraction of a minute or longer durations, have not been carefully analyzed or reported for prognosis or severity of disease in the past.…”

Section: Discussionmentioning

confidence: 99%

“…[1][2][3] We postulated that management of such patients could be improved by adding more sensitive predictors, further refi ning well-known predictors, or by combining predictors. Currently, in such patients, gas exchange measurements during incremental cardiopulmonary exercise testing (CPET) such as peak oxygen uptake (peak o 2 ) at standard conditions of 0ºC, 760 mm Hg, dry (STPD); anaerobic threshold (AT); peak oxygen pulse; lowest ratio of minute ventilation ( e) at body temperature, ambient atmospheric pressure, saturated with water vapor to minute CO 2 output ( co 2 ) STPD; e -vs-co 2 slope; oscillatory breathing (OB) pattern [3][4][5][6][7][8][9][10] ; and the slope of o 2 to log e (oxygen uptake effi ciency slope [OUES]) [11][12][13][14][15][16][17][18][19][20][21] have been found to be useful in predicting mortality and morbidity and guiding therapy. [3][4][5][6][7][8][9][10] However, the full exercise response pattern of oxygen uptake effi ciency (OUE) ( o 2 / e , mL/L) and specifi cally the measurement of its highest average plateau (OUEP) (mL/L) have not been evaluated.…”

mentioning

confidence: 99%

See 1 more Smart Citation

Oxygen Uptake Efficiency Plateau Best Predicts Early Death in Heart Failure

Sun

Hansen

Stringer

2012

Chest

View full text Add to dashboard Cite

Despite recent improvements in therapy, chronic left heart failure (HF) frequently requires hospitalization or is lethal. [1][2][3] We postulated that management of such patients could be improved by adding more sensitive predictors, further refi ning well-known predictors, or by combining predictors. Currently, in such patients, gas exchange measurements during incremental cardiopulmonary exercise testing (CPET) such as peak oxygen uptake (peak o 2 ) at standard conditions of 0ºC, 760 mm Hg, dry (STPD); anaerobic threshold (AT); peak oxygen pulse; lowest ratio of minute ventilation ( e) at body temperature, ambient atmospheric pressure, saturated with water vapor to minute CO 2 output ( co 2 ) STPD; e -vs-co 2 slope; oscillatory breathing (OB) pattern [3][4][5][6][7][8][9][10] ; and the slope of o 2 to log e (oxygen uptake effi ciency slope [OUES]) [11][12][13][14][15][16][17][18][19][20][21] have been found to be useful in predicting mortality and morbidity and guiding therapy. 3-10 However, the full exercise response pattern of oxygen uptake effi ciency (OUE) ( o 2 / e , mL/L) and specifi cally the measurement of its highest average plateau (OUEP) (mL/L) have not been evaluated.As the CPET core laboratory for two St. Jude Medical multicenter studies 3,22,23 involving 508 patientsBackground: The responses of oxygen uptake effi ciency (ie, oxygen uptake/ventilation 5 O 2 / E ) and its highest plateau (OUEP) during incremental cardiopulmonary exercise testing (CPET) in patients with chronic left heart failure (HF) have not been previously reported. We planned to test the hypothesis that OUEP during CPET is the best single predictor of early death in HF. Methods: We evaluated OUEP, slope of O 2 to log( E) ( oxygen uptake effi ciency slope ) , oscillatory breathing, and all usual resting and CPET measurements in 508 patients with low-ejectionfraction ( , 35%) HF. Each had further evaluations at other sites, including cardiac catheterization. Outcomes were 6-month all-reason mortality and morbidity (death or . 24 h cardiac hospitalization). Statistical analyses included area under curve of receiver operating characteristics, ORs, univariate and multivariate Cox regression, and Kaplan-Meier plots. Results: OUEP, which requires only moderate exercise, was often reduced in patients with HF. A low % predicted OUEP was the single best predictor of mortality ( P , .0001), with an OR of 13.0 ( P , .001). When combined with oscillatory breathing, the OR increased to 56.3, superior to all other resting or exercise parameters or combinations of parameters. Other statistical analyses and morbidity analysis confi rmed those fi ndings. Conclusions: OUEP is often reduced in patients with HF. Low % predicted OUEP ( , 65% predicted) is the single best predictor of early death, better than any other CPET or other cardiovascular measurement. Paired with oscillatory breathing, it is even more powerful.

show abstract

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Oxygen Uptake Efficiency Plateau Best Predicts Early Death in Heart Failure

Sun

Hansen

Stringer

2012

Chest

View full text Add to dashboard Cite

show abstract

“…Dm at rest and relative changes on exertion correlate with O2 uptake at peak exercise 51 . The correlation, however, is even greater between Dm and the excessive ventilatory requirement to carbon dioxide (CO2) output, which is typical in these patients 52 .…”

mentioning

confidence: 99%

Endothelial Dysfunction and Lung Capillary Injury in Cardiovascular Diseases

Guazzi¹,

Phillips²,

Arena³

et al. 2015

Progress in Cardiovascular Diseases

Self Cite

View full text Add to dashboard Cite

Cardiac dysfunction of both systolic and diastolic origin leads to increased left atrial pressure, lung capillary injury and increased resistance to gas transfer. Acutely, pressure-induced trauma disrupts the endothelial and alveolar anatomical configuration and definitively causes an impairment of cellular pathways involved in fluid-flux regulation and gas exchange efficiency, a process well identified as stress failure of the alveolarcapillary membrane. In chronic heart failure (HF), additional stimuli other than pressure may trigger the true remodeling process of capillaries and small arteries characterized by endothelial dysfunction, proliferation of myofibroblasts, fibrosis and extracellular matrix deposition. In parallel there is a loss of alveolar gas diffusion properties due to the increased path from air to blood (thickening of extracellular matrix) and loss of fine molecular mechanism involved in fluid reabsorption and clearance. Deleterious changes in gas transfer not only reflect the underlying lung tissue damage but also portend independent prognostic information and may play a role in the pathogenesis of exercise limitations and ventilatory abnormalities observed in these patients. Few currently approved treatments for chronic HF have the potential to positively affect structural remodeling of the lung capillary network; angiotensin-converting enzyme inhibitors are one of the few currently established options. Recently, more attention has been paid to novel therapies specifically targeting the nitric oxide pathway as a suitable target to improve endothelial function and permeability as well as alveolar gas exchange properties.

show abstract

“…Difference addition, many of these measures may be more reproducible than maximal values since they are not effort dependent [5,6,22].…”

Section: Averagementioning

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

View full text Add to dashboard Cite

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.

show abstract

Exercise ventilation inefficiency and cardiovascular mortality in heart failure: the critical independent prognostic value of the arterial CO2 partial pressure

Cited by 34 publications

References 0 publications

Oxygen Uptake Efficiency Plateau Best Predicts Early Death in Heart Failure

Oxygen Uptake Efficiency Plateau Best Predicts Early Death in Heart Failure

Endothelial Dysfunction and Lung Capillary Injury in Cardiovascular Diseases

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

Contact Info

Product

Resources

About