Prognostic respiratory parameters in heart failure patients with and without exercise oscillatory ventilation — A systematic review and descriptive meta-analysis

Abstract

The purpose of this review was to describe the occurrence of prognostic variables as derived from cardiopulmonary exercise testing (CPET) in patients with heart failure (HF), presenting exercise oscillatory ventilation (EOV) compared to patients without EOV. The effect of EOV on peak oxygen consumption (VO2), minute ventilation/carbon dioxide production (VE/VCO2) slope, oxygen uptake efficiency slope (OUES), rest and peak pulmonary end-tidal carbon dioxide pressure (PETCO2) was meta-analysed. A systematic search strategy was performed in five databases (Pubmed, Cochrane Library, PEDro, Science Direct and Web of Science) assessing 252 articles for eligibility. Nineteen citations met the inclusion criteria totalling 3032 patients with HF (EOV=1111; non-EOV=1921). The risk of bias was assessed by two researchers. Extracted data were pooled using random or fixed effects meta-analysis, if appropriate. The level of significance was set at p≤0.05. Overall, the presentation of EOV significantly indicated aggravated prognostic markers. Subgroup analysis revealed left ventricular ejection fraction (LVEF) and mode of CPET protocol as independent factors, whereas defining EOV significantly influenced the results. A meta-analysis of studies reporting hazard ratios for cardiovascular events demonstrated that HF patients with EOV run a fourfold risk for an adverse event compared to HF patients without EOV. In general, these findings suggest that the presence of EOV in patients with HF is associated with a deterioration of the prognostic CPET parameters. Furthermore, EOV can occur in HF patients with reduced as well as preserved ejection fraction. Further research on defining and assessing EOV in a more accurate and reproducible way is required.

Association of Oscillatory Ventilation during Cardiopulmonary Test to Clinical and Functional Variables of Chronic Heart Failure Patients

“…One study has showed that the presence of the combination EOV and VE/VCO 2 > 34 is particularly more alarming because of the risk for adverse cardiac events [ 18 ] . Otherwise, our results do not agree with the literature when it comes to the worst response of CET variables on EOV population, described as lower peak VO 2 , higher VE/VCO 2 slope, and lower rest and peak P ET CO 2 , when compared to non-EOV population [ 17 ] . Hypotheses for these findings are the heterogeneity of exercise protocols in the literature and the absence of a gold standard to verify the presence of EOV in patients with profile and clinical status similar to our subjects.…”

“…Other CET variables showed similarities between our study and the literature, specifically when it comes to the coexisting presence of EOV and other bad prognostic variables, such as VE/VCO 2 > 34 and peak VO 2 < 14 ml/kg/min [ 17 ] . One study has showed that the presence of the combination EOV and VE/VCO 2 > 34 is particularly more alarming because of the risk for adverse cardiac events [ 18 ] .…”

Safety, Tolerability, and Effects of Sodium Bicarbonate Inhalation in Cystic Fibrosis

“…The Harvard step test is an accepted tool to evaluate tolerability to physical exercise [47]. Higher values of this measure related to a lower incidence of cardiopulmonary disease and better predisposition or physical activity [48,49]. Here, the Harvard step test showed an improvement in oxygen consumption and energy expenditure after the intervention with inhaled NaHCO 3 ( Table 2).…”

Relationship Between Exercise Oscillatory Ventilation Loop and Prognosis of Heart Failure

“…2 A meta-analysis of studies reporting hazard ratios (HRs) for cardiovascular events demonstrated that HF patients with EOV have a 4-fold higher risk for adverse events than HF patients without EOV. 3 EOV is now considered a marker of disease severity and worse prognosis in HF. 3,4 Despite the clear association between EOV and outcomes in HF, there are limited data regarding the mechanistic basis for EOV.…”

“…3 EOV is now considered a marker of disease severity and worse prognosis in HF. 3,4 Despite the clear association between EOV and outcomes in HF, there are limited data regarding the mechanistic basis for EOV. 5 Moreover, only a few studies have evaluated the association between EOV severity and prognosis of HF patients with EOV.…”