Exertional dyspnoea in chronic heart failure: the role of the lung and respiratory mechanical factors

Dubé, Bruno-Pierre; Agostoni, Piergiuseppe; Laveneziana, Pierantonio

doi:10.1183/16000617.0048-2016

Cited by 61 publications

(51 citation statements)

References 146 publications

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“…A clinical series of articles starting in this issue of the European Respiratory Review [10,11] will therefore focus on the clinical use of CPET to explore and unmask the mechanisms underlying dyspnoea during exercise in an abroad spectrum of cardiorespiratory disorders, covering topics including exertional dyspnoea in COPD, chronic heart failure, asthma, obesity, pulmonary arterial hypertension and interstitial lung diseases.…”

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confidence: 99%

Exertional dyspnoea in cardiorespiratory disorders: the clinical use of cardiopulmonary exercise testing

Laveneziana

Agostoni

2016

Eur Respir Rev

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@ERSpublicationsA series of articles on exertional dyspnoea in cardiorespiratory disorders begins in the European Respiratory Review http://ow.ly/fLT0300uHgwIs dyspnoea worth documenting and accurately assessing? The answer is undoubtedly yes, for at least the following reasons. 1) Activity-related dyspnoea is usually the earliest and most troublesome complaint for which patients with cardiopulmonary diseases seek medical attention. 2) This symptom progresses relentlessly as the underlying disease advances, leading invariably to avoidance of activity with consequent skeletal muscle deconditioning and an impoverished quality of life. 3) It is estimated that up to a quarter of the general population and half of severely ill patients are affected by it. 4) Dyspnoea is also an important predictor of quality of life, exercise tolerance and mortality in various conditions. In patients with chronic obstructive pulmonary disease (COPD), it has been shown to be a better predictor of mortality than forced expiratory volume in 1 s. In patients with heart disease referred for clinical exercise testing, it is a better predictor of mortality than angina. 5) Dyspnoea is also associated with decreased functional status and worse psychological health in older individuals living at home. 6) It is also a factor in the low adherence to exercise training programmes in sedentary adults and in patients with COPD. 7) The effective management of exertional dyspnoea remains a major challenge for caregivers and modern treatment strategies that are based on attempts to reverse the underlying chronic condition are only partially successful [1][2][3][4][5][6][7].The perception of dyspnoea involves the integration of afferent and efferent inputs at a cortical level and is modulated by affective, emotional and behavioural components. The recent statements of the American Thoracic Society (ATS) [8] and European Respiratory Society [1] have underlined the multidimensional nature of dyspnoea which comprises three major dimensions: 1) the sensory-perceptual domain, 2) the affective distress and 3) the symptom impact or burden.Dyspnoea is a complex, multifaceted and highly personalised sensory experience, the source and mechanisms of which are incompletely understood: there is no unique central or peripheral source of this symptom. The definition given by the latest ATS statement ("a subjective experience of breathing discomfort that consists of qualitatively distinct sensations that vary in intensity") highlights the importance of the

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confidence: 99%

Exertional dyspnoea in cardiorespiratory disorders: the clinical use of cardiopulmonary exercise testing

Laveneziana

Agostoni

2016

Eur Respir Rev

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“…However, the pathophysiology of exertional dyspnoea differs from the one during acute HF decompensation. The origin of exertional dyspnoea in HF is complex and consists of (1) muscle ischaemia and activation of chemo-, metabo-and ergoreceptors, (2) ventilatory and peripheral muscle dysfunction, (3) pulmonary circulation dysfunction including futile alveolar ventilation, and (4) decreased lung compliance and increased airway resistance [61]. Otherwise, dyspnoea during HF decompensation is mainly the consequence of pulmonary congestion, leading to lung compliance reduction and lung injury, which activate vagal mechanoreceptors and C-fibres [62].…”

Section: Potential Pitfalls Of Carotid Bodies Deactivationmentioning

confidence: 99%

Human carotid bodies as a therapeutic target: new insights from a clinician’s perspective

Tubek¹,

Niewiński²,

Paleczny³

et al. 2018

Kardiol Pol

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From the physiological point of view, carotid bodies are mainly responsible for the ventilatory response to hypoxia; however, they also take part in the regulation of sympathetic tone. According to preclinical data, these structures likely contribute to the development and progression of sympathetically mediated diseases. Moreover, carotid body deactivation in animal models improved blood pressure control in hypertension and reduced mortality in heart failure, along with reducing sympathetic activity. On this basis, two first-in-man studies have been recently performed to investigate the safety and feasibility of such an approach in humans. In this review we summarise the current knowledge regarding the function of carotid bodies, the prevalence of their abnormalities, and the consequences of their excision in human hypertension and heart failure.

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“…Recent advances, current challenges and future directions J. Alberto Neder 1 , Pierantonio Laveneziana 2,3 , Susan A. Ward 4 and Paolo Palange 5,6,7,8 This introductory chapter aims to answer three key questions germane to the uses of CPET in respiratory practice. 1) In the past 10 years, what have been the specific scenarios in which CPET has advanced the provision of clinical information valuable to decision making?…”

Section: Guest Editorsmentioning

confidence: 99%

“…Investigating exercise intolerance Dyspnoea as a cause of exercise intolerance In respirology practice, CPET is now more commonly requested as part of the work-up for unexplained or disproportionate exertional dyspnoea [5][6][7][8][9][10][11][12][13]. As discussed elsewhere in this Monograph [14], the test is more suited to describing patterns of dysfunction, as different clusters of abnormalities overlap across specific diseases.…”

Section: Introductionmentioning

confidence: 99%

“…The potential for high indices of ventilatory inefficiency (V′E-V′CO 2 or the minimum ventilatory equivalent (V′E/V′CO 2 min)) to trigger uncomfortable respiratory sensations in cardio-respiratory disease has long been recognised [26,27]. More recently, several studies have demonstrated that a high ventilatory inefficiency is an early sign of impaired gas exchange efficiency (increased "wasted" ventilation) and/or excessive afferent stimuli to ventilation (as recently reviewed in [28]) as it is related to a high respiratory neural drive and dyspnoea in symptomatic smokers [29,30] and patients with mild COPD [31,32], heart failure [8], heart failure-COPD [33,34], ILD [35] and pulmonary hypertension (PH) [36,37]. Thus, the use of different indices of the V′E-V′CO 2 relationship has proved useful in the interpretation of CPET responses in patients with unexplained or disproportionate exertional dyspnoea [38].…”

Section: Introductionmentioning

confidence: 99%

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Preface

Bals¹

Clinical Exercise Testing

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CPET is one of the most useful and informative diagnostic approaches in pulmonary medicine. It offers deep insight into the cardiopulmonary network and generates data that can be used in diagnosis, staging and outcome prediction in multiple lung diseases. In the hands of an experienced investigator, exercise testing looks easy and elegant. For the patient, exercise testing focuses on relevant outcomes, such as exercise capacity and dyspnoea. It also has the benefit of being noninvasive. However, for novices in this area, the large amount of information generated and the task of interpreting this data can cause a sense of reluctance. The data that result from exercise testing differ in complexity, ranging from simple one-figure measurements to graphical displays of time curves requiring sophisticated interpretation of. As a result, a comprehensive summary of the methodology of CPET is urgently needed to ensure its more frequent use in clinical practice. This ERS Monograph is therefore timely as it provides the reader with a broad and detailed overview of the various CPET applications. The initial chapters summarise the technologies and standard techniques used. They are followed by sections about individual disease areas and a chapter on lung transplantation. Self-assessment cases have also been included in this book, a first for the ERS Monograph book series. We hope that our readers like this new feature and will find it useful. The Guest Editors Paolo Palange, Pierantonio Laveneziana, J. Alberto Neder and Susan A. Ward have worked very hard on topic selection and to integrate these aspects into a book that summarises current knowledge. Together with the authors, they have produced a practice-guideline publication that comprises both background information and hands-on application. I am sure this comprehensive review will be useful in the clinical practice of a broad range of respiratory physicians, and will improve patient care.

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Exertional dyspnoea in chronic heart failure: the role of the lung and respiratory mechanical factors

Cited by 61 publications

References 146 publications

Exertional dyspnoea in cardiorespiratory disorders: the clinical use of cardiopulmonary exercise testing

Exertional dyspnoea in cardiorespiratory disorders: the clinical use of cardiopulmonary exercise testing

Human carotid bodies as a therapeutic target: new insights from a clinician’s perspective

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