Increased Dead Space Ventilation Mediates Reduced Exercise Capacity in Systolic Heart Failure

Kee, Kirk; Stuart-Andrews, Christopher; Ellis, Matthew; Wrobel, Jérémy; Nilsen, Kris; Sharma, Meenal; Thompson, Bruce; Naughton, Matthew T.

doi:10.1164/rccm.201508-1555oc

Cited by 24 publications

(17 citation statements)

References 35 publications

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“…In HFpEF with pulmonary hypertension, without evidence of concomitant pulmonary diseases, impaired D LCO predicted prognosis: patients with a D LCO < 45% of predicted had a 37% survival rate at 3 years compared with an 88% survival rate in patients with D LCO > 45% of predicted . Similarly, in HFrEF, low D LCO was an indicator for high dead‐space ventilation during exercise and resulting dyspnoea …”

Section: Pulmonary Function Tests and Cardiovascular Outcomesmentioning

confidence: 96%

“…In HF, mild to moderate exercise leads to a substantial increase in left ventricular filling pressure . While measures of cardiac function at rest such as cardiac output, stroke volume, and EF poorly correlate with the cardinal symptoms of dyspnoea and reduced exercise capacity in chronic HF patients, a low D LCO at rest was shown to be indicative of high dead space ventilation at maximal exercise during cardiopulmonary exercise testing, which results from ventilation–perfusion mismatching and contributes to inefficient ventilation during exercise …”

Section: Pulmonary Function Testing In Heart Failurementioning

confidence: 99%

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What can we learn from pulmonary function testing in heart failure?

Magnussen

Canepa

Zambito

et al. 2017

European J of Heart Fail

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Pulmonary diseases frequently coexist in heart failure (HF), thus posing diagnostic and therapeutic challenges to cardiologists evaluating patients with overlapping symptoms and implementing recommended HF treatments. There is a growing body of evidence suggesting that pulmonary function testing might provide useful information for the best management of these patients. The availability of portable devices, allowing the measurement of spirometry and lung diffusion capacity for carbon monoxide outside of hospital-based pulmonary lung function laboratories, provides an opportunity for a more widespread use of these measures in the cardiology community, but their interpretation can be challenging. In this work, after a brief review of the methodologies, we discuss the interpretation of pulmonary function testing in patients with HF alone or associated with pulmonary diseases, and its contribution in differentiating cardiac and pulmonary symptoms and preventing acute cardiac decompensation. In addition, we examined recent evidence suggesting how the use of pulmonary function testing may provide independent prognostic information in HF patients with and without pulmonary disorders, and help therapeutic decisions to fill the treatment gap that still exists in HF patients with concomitant pulmonary diseases.

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Section: Pulmonary Function Tests and Cardiovascular Outcomesmentioning

confidence: 96%

Section: Pulmonary Function Testing In Heart Failurementioning

confidence: 99%

What can we learn from pulmonary function testing in heart failure?

Magnussen

Canepa

Zambito

et al. 2017

European J of Heart Fail

View full text Add to dashboard Cite

show abstract

“…Similarly to heart failure [89][90][91], VD/VT worsens as disease severity increases in patients with COPD [88]. Interestingly, however, while the most commonly used parameter of ventilatory efficiency in the clinical literature (the V′E−V′CO 2 slope) increases from mild to severe heart failure [4][5][6][7]10], the V′E−V′CO 2 slope decreases and the V′E intercept increases in severe-to-very-severe COPD compared with milder disease.…”

Section: Ventilatory Efficiency and Exercise Intolerancementioning

confidence: 99%

Physiological and clinical relevance of exercise ventilatory efficiency in COPD

et al. 2017

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Exercise ventilation (') relative to carbon dioxide output (' ) is particularly relevant to patients limited by the respiratory system, those with chronic obstructive pulmonary disease (COPD). High'-' (poor ventilatory efficiency) has been found to be a key physiological abnormality in symptomatic patients with largely preserved forced expiratory volume in 1 s (FEV). Establishing an association between high '-' and exertional dyspnoea in mild COPD provides evidence that exercise intolerance is not a mere consequence of detraining. As the disease evolves, poor ventilatory efficiency might help explaining "out-of-proportion" breathlessness (to FEV impairment). Regardless, disease severity, cardiocirculatory co-morbidities such as heart failure and pulmonary hypertension have been found to increase '-' In fact, a high '-' has been found to be a powerful predictor of poor outcome in lung resection surgery. Moreover, a high '-' has added value to resting lung hyperinflation in predicting all-cause and respiratory mortality across the spectrum of COPD severity. Documenting improved ventilatory efficiency after lung transplantation and lung volume reduction surgery provides objective evidence of treatment efficacy. Considering the usefulness of exercise ventilatory efficiency in different clinical scenarios, the '-' relationship should be valued in the interpretation of cardiopulmonary exercise tests in patients with mild-to-end-stage COPD.

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“…It is known that dynamic hyperinflation in COPD patients may alter the cardiac response to exercise, which in turn affects exercise performance [16]. However, it has been shown that patients with heart failure and low resting lung diffusing capacity increase their dead space ventilation during strenuous exercise, thus leading to enhanced dyspnoea owing to inefficient ventilation-to-perfusion matching [17]. Similarly, patients with pulmonary hypertension, i.e.…”

Section: @Erspublicationsmentioning

confidence: 99%