Quantifying oscillatory ventilation during exercise in patients with heart failure

Olson, Thomas P.; Johnson, Bruce D.

doi:10.1016/j.resp.2013.09.008

Cited by 14 publications

(10 citation statements)

References 31 publications

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“…However, a recent report recognised this hiatus and presented a new registration method based on Fourier analysis [40]. Although, the EOV signal might be also accurately analysed by other automated methods, since there is no consensus in defining this pattern.…”

Section: Discussionmentioning

confidence: 99%

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

Cornelis

Taeymans

Hens

et al. 2015

International Journal of Cardiology

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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.

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Section: Discussionmentioning

confidence: 99%

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

Cornelis

Taeymans

Hens

et al. 2015

International Journal of Cardiology

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“…Assessment of EOV as a continuous variable, or with more attention to the predictive value of the duration, timing, or size of oscillations, may provide further prognostic information for these patients. Robust 45 Finally, although the results are highly statistically significant, the analysis is based on a relatively small number of events (n=22 for the primary outcome). This limits application of multivariable adjustment; furthermore, validation in an independent sample is needed to support the robustness of our findings.…”

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confidence: 99%

Exercise Oscillatory Ventilation in Patients With Fontan Physiology

Nathan

Loukas

Moko

et al. 2015

Circ: Heart Failure

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Background— Exercise oscillatory ventilation (EOV) refers to regular oscillations in minute ventilation (V E ) during exercise. Its presence correlates with heart failure severity and worse prognosis in adults with acquired heart failure. We evaluated the prevalence and predictive value of EOV in patients with single ventricle Fontan physiology. Methods and Results— We performed a cross-sectional analysis and prospective survival analysis of patients who had undergone a Fontan procedure and subsequent cardiopulmonary exercise test. Data were reviewed for baseline characteristics and incident mortality, heart transplant, or nonelective cardiovascular hospitalization. EOV was defined as regular oscillations for >60% of exercise duration with amplitude >15% of average V E . Survival analysis was performed using Cox regression. Among 253 subjects, EOV was present in 37.5%. Patients with EOV were younger (18.8±9.0 versus 21.7±10.1 years; P =0.02). EOV was associated with higher New York Heart Association functional class ( P =0.02) and V E /V CO 2 slope (36.8±6.9 versus 33.7±5.7; P =0.0002), but not with peak V O 2 (59.7±14.3 versus 61.0±16.0% predicted; P =0.52) or noninvasive measures of cardiac function. The presence of EOV was associated with slightly lower mean cardiac index but other invasive hemodynamic variables were similar. During a median follow-up of 5.5 years, 22 patients underwent transplant or died (n=19 primary deaths, 3 transplants with 2 subsequent deaths). EOV was associated with increased risk of death or transplant (hazard ratio, 3.9; 95% confidence interval, 1.5–10.0; P =0.002) and also predicted the combined outcome of death, transplant, or nonelective cardiovascular hospitalization after adjusting for New York Heart Association functional class, peak V O 2 , and other covariates (multivariable hazard ratio, 2.0; 95% confidence interval, 1.2–3.6; P =0.01). Conclusions— EOV is common in the Fontan population and strongly predicts lower transplant-free survival.

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“…While this measure has been used as a study outcome (27–30), it has not been developed to identify EOV nor quantify total ventilatory dispersion during exercise. Olson and colleagues (31) reported several mathematical methods to quantify the amplitude and periodicity of ventilatory oscillations. They concluded that their methods might be combined in an algorithm to identify EOV.…”

Section: Discussionmentioning

confidence: 99%