Impairment of Ventilatory Efficiency in Heart Failure

Kleber, Franz X.; Vietzke, G.; Wernecke, Klaus D.; Bauer, Ulrike; Opitz, Christian; Wensel, Roland; Sperfeld, AD; Gläser, Sven

doi:10.1161/01.cir.101.24.2803

Cited by 338 publications

(300 citation statements)

References 40 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%

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%

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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“…Many studies have confirmed the prognostic impact of VE/VCO 2 in patients with heart failure, in whom a value >35 has been associated with worse prognosis, and have argued for its superiority over peak VO 2 13, 27. However, the value of VE/VCO 2 in AF is contentious, with some studies showing AF association with a higher VE/VCO 2 23 and others showing no association 9.…”

Section: Discussionmentioning

confidence: 99%

Impact of Atrial Fibrillation on Exercise Capacity and Mortality in Heart Failure With Preserved Ejection Fraction: Insights From Cardiopulmonary Stress Testing

El‐Shazly

Senn²,

et al. 2017

JAHA

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BackgroundAtrial fibrillation (AF) has been objectively associated with exercise intolerance in patients with heart failure with reduced ejection fraction; however, its impact in patients with heart failure with preserved ejection fraction has not been fully scrutinized.Methods and ResultsWe identified 1744 patients with heart failure and ejection fraction ≥50% referred for cardiopulmonary stress testing at the Cleveland Clinic (Cleveland, OH), 239 of whom had AF. We used inverse probability of treatment weighting to balance clinical characteristics between patients with and without AF. A weighted linear regression model, adjusted for unbalanced variables (age, sex, diagnosis, hypertension, and β‐blocker use), was used to compare metabolic stress parameters and 8‐year total mortality (social security index) between both groups. Weighted mean ejection fraction was 58±5.9% in the entire population. After adjusting for unbalanced weighted variables, patients with AF versus those without AF had lower mean peak oxygen consumption (18.5±6.2 versus 20.3±7.1 mL/kg per minute), oxygen pulse (12.4±4.3 versus 12.9±4.7 mL/beat), and circulatory power (2877±1402 versus 3351±1788 mm Hg·mL/kg per minute) (P<0.001 for all comparisons) but similar submaximal exercise capacity (oxygen consumption at anaerobic threshold, 12.0±5.1 versus 12.4±6.0mL/kg per minute; P =0.3). Both groups had similar peak heart rate, whereas mean peak systolic blood pressure was lower in the AF group (150±35 versus 160±51 mm Hg; P<0.001). Moreover, AF was associated with higher total mortality.ConclusionsIn the largest study of its kind, we demonstrate that AF is associated with peak exercise intolerance, impaired contractile reserve, and increased mortality in patients with heart failure with preserved ejection fraction. Whether AF is the primary offender in these patients or merely a bystander to worse diastolic function requires further investigation.

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“…MANCINI et al [225] reported that V9O 2 ,peak .14 mL?min -1 ?kg -1 is associated with 94% survival at 1 yr and 84% survival at 2 yrs; while patients with V9O 2 ,peak f14 mL?min -1 ?kg -1 , who were rejected for transplant for noncardiac reasons, had survival rates at 1 and 2 yrs of 47% and 32%, respectively. KLEBER et al [226] reported a better prognosis at 30 months for patients with V9O 2 ,peak .45% pred. SZLACHCIC et al [227] reported that V9O 2 ,peak ,10 mL?min -1 ?kg -1 is associated with 77% mortality at 1 yr, while in patients with V9O 2 ,peak .10 mL?min -1 ?kg -1 mortality rate at 1 yr is ,20%.…”

Section: V9o 2 Peak and Ventilatory Indicesmentioning

confidence: 94%

“…below the respiratory condensation point). A V9E-V9CO 2 slope .130% pred is associated with a 1-yr mortality rate .40% [226]. In a study of 470 patients, an abnormal elevation in the peak V9E/V9CO 2 o44.7 was the strongest predictor of death during a 1.5-yr follow-up [232].…”

Section: Lactate Thresholdmentioning

confidence: 99%

Recommendations on the use of exercise testing in clinical practice

Palange¹,

Ward²,

Carlsen³

et al. 2006

European Respiratory Journal

537

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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Impairment of Ventilatory Efficiency in Heart Failure

Abstract: The VE versus V(CO(2)) slope is an excellent prognostic parameter. It is easier to obtain than parameters of maximal exercise capacity and is of higher prognostic importance than VO(2)max.

Cited by 338 publications

References 40 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

Impact of Atrial Fibrillation on Exercise Capacity and Mortality in Heart Failure With Preserved Ejection Fraction: Insights From Cardiopulmonary Stress Testing

Recommendations on the use of exercise testing in clinical practice

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