Peak Exercise Oxygen Consumption in Chronic Heart Failure: Toward Efficient Use in the Individual Patient

Opasich, Cristina; Pinna, Gian Domenico; Bobbio, Marco; Sisti, M A; Demichelis, Brunella; Febo, Oreste; Forni, Giovanni; Riccardi, Roberto; Riccardi, P.Giorgio; Capomolla, Soccorso; Cobelli, Franco; Tavazzi, Luigi

doi:10.1016/s0735-1097(98)00002-3

Cited by 151 publications

(98 citation statements)

References 31 publications

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“…In moderate and severe CHF, peak V O 2 constitutes an integral part of patients' pretransplant assessment, with some various cutoff values having been proposed for decision-making. [2][3][4]13 The prognostic strength of peak V O 2 measurements, however, lies predominantly in patients with advanced symptoms and at least moderate functional impairment, as previously known from several studies 1,3,4 and confirmed by our supplementary analysis of patients with less-well-preserved exercise tolerance. Yet data from large trials show that death is not rare in patients with mild symptoms: annual mortality ranges from 8% to 10%, and sudden death is not uncommon.…”

Section: Discussionsupporting

confidence: 80%

“…3,4 Considering NYHA functional classification as being fairly subjective, we decided to use peak V O 2 as an objective measure of exercise capacity for selection of our patients. It has been demonstrated that peak V O 2 values Ն18 mL · kg Ϫ1 · min Ϫ1 identify CHF patients who have only mildly impaired or nearly normal exercise capacity and are considered to imply uniformly good outcome.…”

Section: Patientsmentioning

confidence: 99%

“…It has been demonstrated that peak V O 2 values Ն18 mL · kg Ϫ1 · min Ϫ1 identify CHF patients who have only mildly impaired or nearly normal exercise capacity and are considered to imply uniformly good outcome. 3,4 Therefore, this cutoff value was chosen as a selection criterion. Exclusion criteria included significant pulmonary disease and musculoskeletal disorders.…”

Section: Patientsmentioning

confidence: 99%

“…1 Poor exercise capacity, measured objectively by low peak oxygen consumption (peak V O 2 ), predicts an unfavorable outcome independently of other clinical and hemodynamic parameters. [1][2][3][4] Among CHF patients with preserved exercise tolerance, however, the role of cardiopulmonary exercise testing for predicting prognosis has not been evaluated. Despite recent advances in the management of CHF, the annual mortality in this group is still unacceptably high, and risk stratification remains an important clinical challenge.…”

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confidence: 99%

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Enhanced Ventilatory Response to Exercise in Patients With Chronic Heart Failure and Preserved Exercise Tolerance

et al. 2001

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Background-In patients with chronic heart failure (CHF) and preserved exercise tolerance, the value of cardiopulmonary exercise testing for risk stratification is not known. Elevated slope of ventilatory response to exercise (V E/V CO 2 ) predicts poor prognosis in advanced CHF. Derangement of cardiopulmonary reflexes may trigger exercise hyperpnea. We assessed the relationship between cardiopulmonary reflexes and V E/V CO 2 and investigated the prognostic value of V E/V CO 2 in CHF patients with preserved exercise tolerance. Methods and Results-Among 344 consecutive CHF patients, we identified 123 with preserved exercise capacity, defined as a peak oxygen consumption (peak V O 2 ) Ն18 mL · kg Ϫ1 · min Ϫ1 (age 56 years; left ventricular ejection fraction 28%; peak V O 2 23.5 mL · kg Ϫ1 · min Ϫ1 ). Hypoxic and hypercapnic chemosensitivity (nϭ38), heart rate variability (nϭ34), baroreflex sensitivity (nϭ20), and ergoreflex activity (nϭ20) were also assessed. We identified 40 patients (33%) with high V E/V CO 2 (ie, Ͼ34.0). During follow-up (49Ϯ22 months, Ͼ3 years in all survivors), 34 patients died (3-year survival 81%). High V E/V CO 2 (hazard ratio 4.3, PϽ0.0001) but not peak V O 2 (Pϭ0.7) predicted mortality. In patients with high V E/V CO 2 , 3-year survival was 57%, compared with 93% in patients with normal V E/V CO 2 (PϽ0.0001). Patients with high V E/V CO 2 demonstrated impaired reflex control, as evidenced by augmented peripheral (Pϭ0.01) and central (Pϭ0.0006) chemosensitivity, depressed low-frequency component of heart rate variability (PϽ0.0001) and baroreflex sensitivity (Pϭ0.03), and overactive ergoreceptors (Pϭ0.003) compared with patients with normal V E/V CO 2 . Conclusions-In CHF patients with preserved exercise capacity, enhanced ventilatory response to exercise is a simple marker of a widespread derangement of cardiovascular reflex control; it predicts poor prognosis, which peak V O 2 does not. (Circulation. 2001;103:967-972.)

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Section: Discussionsupporting

confidence: 80%

Section: Patientsmentioning

confidence: 99%

Section: Patientsmentioning

confidence: 99%

mentioning

confidence: 99%

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Enhanced Ventilatory Response to Exercise in Patients With Chronic Heart Failure and Preserved Exercise Tolerance

et al. 2001

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“…Previous studies have showed that peak oxygen uptake (VO 2 ) obtained at maximal exercise provides not only an objective measure of functional capacity, but also prognostic information in patients with CHF. [9][10][11][12][13][14] We predict that patients with exercise intolerance are those with higher neurohormonal and cytokine activation, however, the relation between peak VO 2 and multiple neurohormone/cytokine levels has not been clearly elucidated. Thus, we conducted the present study to clarify the relation between neurohormonal/cytokine activation and functional capacity as measured by cardiopulmonary exercise testing in patients with mild to moderate CHF.…”

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confidence: 99%

Neurohormonal Determinants of Peak Oxygen Uptake in Patients with Chronic Heart Failure

et al. 2003

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SUMMARYChronic heart failure (CHF) is characterized by the activation of neurohormones and cytokines. This study determined whether peak oxygen uptake (VO 2 ) can be predicted by the degree of neurohormonal and cytokine activations in CHF. Plasma norepinephrine, epinephrine, renin-angiotensin system activity, ANP, BNP, and serum interleukin-6 (IL-6) and tumor necrosis factor (TNF)-α were measured in 84 CHF patients (age, 59 ± 1 years, LVEF, 36 ± 1%) and 34 controls. Maximal cardiopulmonary exercise testing was performed. Peak VO 2 (Controls vs CHF: 27.8 ± 1.3 vs 18.2 ± 0.5 mL/min/kg, P < 0.0001) was lower in CHF. Patients with CHF had increased plasma norepinephrine (211 ± 11 vs 315 ± 24 pg/mL), renin activity (1.2 ± 0.2 vs 6.2 ± 1.1 ng/mL/hr), ANP (22 ± 3 vs 72 ± 7 pg/mL), and BNP levels (18 ± 3 vs 200 ± 25 pg/mL) (all P < 0.01). Serum IL-6 (1.1 ± 0.1 vs 2.4 ± 0.3 pg/mL) and TNF-α (2.7 ± 0.2 vs 4.0 ± 0.3 pg/mL) levels were higher in CHF (both P < 0.001). Univariate analysis revealed that age (P < 0.001), cardiothoracic ratio (P < 0.001), norepinephrine (P < 0.0001), ANP (P < 0.001), BNP (P < 0.01), and log IL-6 (P < 0.05) were significantly related with peak VO 2 . Stepwise regression analysis indicated that plasma norepinephrine and ANP emerged as significant determinants of peak VO 2 , independent of patient age (overall R = 0.61, P < 0.0001). In summary, patients with CHF exhibited activation of neurohormones and proinflammatory cytokines. Among the elevated hormonal and cytokine markers, plasma norepinephrine and ANP levels were independent predictors of exercise capacity. (Jpn Heart J 2003; 44: 725-734) Key words: Heart failure, Peak oxygen uptake, Neurohormones, Cytokines, Cardiopulmonary exercise test CHRONIC heart failure (CHF) is characterized by the activation of neurohormones and cytokines.1,2) Among the activated neurohormonal systems, the sympathetic nervous and renin-angiotensin systems play a key role in the pathophysiology and progression of this syndrome.3) The natriuretic peptide system is also activated in CHF, and the degree of the activation has been related to

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Management of Advanced Heart Failure

Freudenberger

2010

Management of Heart Failure

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Peak Exercise Oxygen Consumption in Chronic Heart Failure: Toward Efficient Use in the Individual Patient

Cited by 151 publications

References 31 publications

Enhanced Ventilatory Response to Exercise in Patients With Chronic Heart Failure and Preserved Exercise Tolerance

Enhanced Ventilatory Response to Exercise in Patients With Chronic Heart Failure and Preserved Exercise Tolerance

Neurohormonal Determinants of Peak Oxygen Uptake in Patients with Chronic Heart Failure

Management of Advanced Heart Failure

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