Prognostic Impact of Ventilatory Efficiency in Heart Disease Patients With Preserved Exercise Tolerance

Tsurugaya, Hideki; Adachi, Hitoshi; Kurabayashi, Masahiko; Ohshima, Shigeru; Taniguchi, Koichi

doi:10.1253/circj.70.1332

Cited by 32 publications

(27 citation statements)

References 27 publications

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“…• E/V • CO2 slope, which ranges from approximately 24-34 in normal subjects, 16,[25][26][27][28] becomes steeper with the severity of heart failure. 25,27,29 The slope of ∆V…”

Section: Indexes Of Cpx Testingmentioning

confidence: 98%

Influence of Cerebrovascular Arteriosclerosis on Cerebral Oxygenation During Exercise

Nagayama

Koike

Hoshimoto

et al. 2007

Circ J

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“…• E/V • CO2 slope, which ranges from approximately 24-34 in normal subjects, 16,[25][26][27][28] becomes steeper with the severity of heart failure. 25,27,29 The slope of ∆V…”

Section: Indexes Of Cpx Testingmentioning

confidence: 98%

Influence of Cerebrovascular Arteriosclerosis on Cerebral Oxygenation During Exercise

Nagayama

Koike

Hoshimoto

et al. 2007

Circ J

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“…Impaired cardiovascular response in heart failure patients leads to a prolonged time constant (τ on) and the prognosis for patients with abnormal parameters is poor. [20][21][22] CPX parameters related to the severity of heart failure are shown in Table VI. Detecting the state of autonomic function -Heart rate analysis: In heart disease, the state of autonomic nerve function is an important factor for determining the prognosis.…”

Section: )mentioning

confidence: 99%

Cardiopulmonary Exercise Test

Adachi

2017

Int. Heart J.

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SummaryThe cardiopulmonary exercise test (CPX) is an essential examination for detecting pathophysiological derangement and determining treatment policy because it clarifies not only the changes of hemodynamics but also abnormality in the whole body during exercise where heart disease patients often feel symptoms.To utilize CPX effectively, we must understand each parameter, such as peak oxygen uptake (peak !O2), peak !O2/HR, and !E/ !CO2. In addition, comparison of each parameter, for example, peak !O2 and !E/ !CO2, and peak!O2 and peak!O2/HR, is useful to detect the pathophysiological abnormalities.In this article, I will describe how CPX should be used in clinical settings. (Int Heart J 2017; 58: 654-665)

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“…3,4 Besides the classical risk factors such as left ventricular ejection fraction (LVEF), New York Heart Association (NYHA) class IV symptoms and neurohormonal markers, peak oxygen consumption (V • O2) was found to predict survival in patients with CHF. 5,6 Recently, the V• E/V • CO2 slope was shown to be a better prognostic indicator than peak V• O2, [7][8][9] suggesting that improvement in the slope could be used as an indicator of prolonged survival of patients with CHF.Large clinical trials have established that -blockers improve left ventricular function and the survival of patients with CHF. [10][11][12][13] Several studies have compared metoprolol with carvedilol for treating patients with mild to moderate CHF, [14][15][16][17] and some have shown that carvedilol is more efficacious than metoprolol in improving LVEF and hemodynamic parameters.…”

mentioning

confidence: 99%

“…• O2, [7][8][9] suggesting that improvement in the slope could be used as an indicator of prolonged survival of patients with CHF.…”

mentioning

confidence: 99%

Comparison of the Effects of Carvedilol and Metoprolol on Exercise Ventilatory Efficiency in Patients With Congestive Heart Failure

Kataoka

Satoh

Yoshikawa

et al. 2008

Circ J

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he slope of the relationship between ventilation and carbon dioxide production (V • E/V • CO2 slope) is obtained during symptom-limited cardiopulmonary exercise testing, by plotting ventilation (V • E) vs carbon dioxide production (V • CO2). The increase in the V • E/V • CO2 slope reflects reduced ventilatory efficiency of gas exchange, which is associated with increased physiological dead space, as well as a decrease in the partial arterial pressure of carbon dioxide (PaCO2) regulatory set point. 1,2 The V• E/V • CO2 slope is probably the best indicator of decreased pulmonary blood flow and is elevated in most patients with congestive heart failure (CHF). 3,4 Besides the classical risk factors such as left ventricular ejection fraction (LVEF), New York Heart Association (NYHA) class IV symptoms and neurohormonal markers, peak oxygen consumption (V • O2) was found to predict survival in patients with CHF. 5,6 Recently, the V• E/V • CO2 slope was shown to be a better prognostic indicator than peak V• O2, [7][8][9] suggesting that improvement in the slope could be used as an indicator of prolonged survival of patients with CHF.Large clinical trials have established that -blockers improve left ventricular function and the survival of patients with CHF. [10][11][12][13] Several studies have compared metoprolol with carvedilol for treating patients with mild to moderate CHF, [14][15][16][17] and some have shown that carvedilol is more efficacious than metoprolol in improving LVEF and hemodynamic parameters. 15,17 The recently published large-scale Carvedilol or Metoprolol European Trial (COMET) demonstrated that carvedilol reduces total mortality to a greater extent than metoprolol. 18 However, the relationship between the institution of -blocker therapy and the V • E/V • CO2 slope in patients with CHF isstill unknown.Thus, the purposes of this study were (1) to investigate whether administration of -blockers can improve the V • E/V • CO2 slope, and (2) to compare the influence of 2 -blockers, carvedilol and metoprolol, on the V• E/V • CO2 slope in patients with CHF. Methods Study PopulationA total of 58 patients initially participated, but 1 patient was withdrawn because of sudden death. Therefore, a total of 57 patients with NYHA II-III CHF were examined. The etiology was dilated cardiomyopathy, ischemic, and valvular J 2008; 72: 358 -363 (Received March 16, 2007; revised manuscript received October 30, 2007; accepted November 9, 2007 Background The slope of the relationship between ventilation and carbon dioxide production (V • E/V • CO2 slope), obtained during symptom-limited ramp exercise testing, reflects exercise ventilatory efficiency. Importantly, the V Circ• E/V • CO2 slope is related to prognosis in patients with congestive heart failure (CHF). The aim of the present study was to determine the relationship between the institution of -blockers, carvedilol or metoprolol, and the V• E/V • CO2 slope during exercise in patients with CHF. Methods and ResultsFifty-seven patients with New York Heart Association...

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Prognostic Impact of Ventilatory Efficiency in Heart Disease Patients With Preserved Exercise Tolerance

Cited by 32 publications

References 27 publications

Influence of Cerebrovascular Arteriosclerosis on Cerebral Oxygenation During Exercise

Influence of Cerebrovascular Arteriosclerosis on Cerebral Oxygenation During Exercise

Cardiopulmonary Exercise Test

Comparison of the Effects of Carvedilol and Metoprolol on Exercise Ventilatory Efficiency in Patients With Congestive Heart Failure

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