Prediction of severe cardiovascular events by VE/Vco2 slope versus peak Vo2 in systolic heart failure: A meta-analysis of the published literature

Poggio, Rosana; Arazi, Hernán Cohen; Giorgi, Mariano; Miriuka, Santiago Gabriel

doi:10.1016/j.ahj.2010.08.037

Cited by 89 publications

(78 citation statements)

References 37 publications

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“…Arena et al 11 and others 7,8,15 have demonstrated the relatively greater use of the VE/Vco 2 slope over peak Vo 2 to gauge HF pathophysiology and prognosis. The VE/Vco 2 slope is thought to better reflect the complex interplay of pulmonary, cardiac, and peripheral manifestations of the disease.…”

Section: Discussionmentioning

confidence: 99%

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Ventilatory Power

Forman

Guazzi

Myers

et al. 2012

Circ: Heart Failure

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Background-Minute ventilation/CO 2 production (VE/Vco 2 ) slope is an index determined by cardiopulmonary exercise testing, which incorporates pertinent cardiac, pulmonary, and skeletal muscle physiology into a substantive composite assessment. The VE/Vco 2 slope has many applications, including utility as a well-validated prognostic gauge for patients with heart failure (HF). In this study, we combine VE/Vco 2 slope with systolic blood pressure, creating a novel index that we labeled ventilatory power. Ventilatory power links the combined physiology inherent in the VE/Vco 2 slope to peripheral pressure, adding an additional dimension pertinent to HF assessment. Whereas the related concept of circulatory power links peak oxygen consumption with peak systolic blood pressure as a prognostic index, we hypothesized that ventilatory power would provide greater prognostic discrimination than VE/Vco 2 slope, peak oxygen consumption, and circulatory power for patients with systolic HF. Methods and Results-Patients with systolic HF (left ventricular ejection fraction ≤35%) underwent symptom-limited cardiopulmonary exercise testing as part of routine management and were followed for up to 4 years for major cardiac events (mortality, left ventricular assist device implantation, and heart transplantation). Eight hundred seventy-five patients with HF (left ventricular ejection fraction, 26±9%; mean age, 55±14) were studied. Cardiopulmonary exercise testing indices peak oxygen consumption, VE/Vco 2 slope, circulatory power, and ventilatory power were all predictive of cardiac events (P<0.001). Multivariate analysis demonstrated that ventilatory power was the strongest indicator of prognosis. Conclusions-Although circulatory power and traditional cardiopulmonary exercise testing parameters can be used to predict prognosis among patients with HF, ventilatory power provides relatively greater prognostic discrimination and may constitute a relatively more useful composite tool. (Circ Heart Fail. 2012;5:621-626.)

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Section: Discussionmentioning

confidence: 99%

“…[1][2][3][4][5][6][7][8]11 It is novel in its reliance on the VE/Vco 2 slope, in combination with hemodynamics as a pivotal gauge of HF prognosis. Combining hemodynamics into the assessment is important because it incorporates manifestations of peripheral perfusion physiology into a composite quantification.…”

Section: Discussionmentioning

confidence: 99%

Ventilatory Power

Forman

Guazzi

Myers

et al. 2012

Circ: Heart Failure

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“…VD/VT at exercise is strongly correlated with DLCO in IPF [55]. It is not known whether direct or indirect measures of VD/VT at rest and exercise provide additional information in comparison with resting measurements of gas diffusion in the lung, although experience acquired in the context of pulmonary hypertension (PH) [72] or heart failure [73] suggests this may be so.…”

Section: Dead Space Ventilationmentioning

confidence: 99%

Physiology of the lung in idiopathic pulmonary fibrosis

et al. 2018

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The clinical expression of idiopathic pulmonary fibrosis (IPF) is directly related to multiple alterations in lung function. These alterations derive from a complex disease process affecting all compartments of the lower respiratory system, from the conducting airways to the lung vasculature. In this article we review the profound alterations in lung mechanics (reduced lung compliance and lung volumes), pulmonary gas exchange (reduced diffusing capacity, increased dead space ventilation, chronic arterial hypoxaemia) and airway physiology (increased cough reflex and increased airway volume), as well as pulmonary haemodynamics related to IPF. The relative contribution of these alterations to exertional limitation and dyspnoea in IPF is discussed.

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“…During a maximum Cardiopulmonary Exercise Testing (CPET), different ventilatory data are obtained with clinical, diagnostic and/or prognostic implications 1 , such as maximum oxygen consumption (VO 2 max) -an objective measure of cardiorespiratory function 2,3 -the maximum oxygen pulse, both absolute and relative to body weight 4,5 , the anaerobic threshold (AT) 6 , the ventilatory equivalent for carbon dioxide (VE/VCO2) 7 and the curve generated by the oxygen uptake efficiency slope (OUES) 8 . However, there are several limitations with the measurement of these variables, such as low reproducibility 9 , different manners of calculation or identification 10 , and the fact that to obtain most of these, it is necessary to perform a truly maximum test 11,12 , which usually depends the motivations of the evaluator and the evaluated.…”

Section: Introductionmentioning

confidence: 99%