Response of the oxygen uptake efficiency slope to exercise training in patients with chronic heart failure

Laethem, Christophe Van; Veire, Nico Van de; Backer, Guy De; Bihija, Salhi; Seghers, Tony; Cambier, Dirk; Vanderheyden, Marc; Sutter, Johan De

doi:10.1016/j.ejheart.2007.01.007

Cited by 76 publications

(65 citation statements)

References 22 publications

(37 reference statements)

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“…The OUES has also been assessed before and after exercise training [74][75][76][77] and heart transplantation. 78 It has been demonstrated to improve after these interventions, indicating that the OUES has promise as a CPX marker sensitive to clinical change.…”

Section: Oxygen Uptake Efficiency Slopementioning

confidence: 99%

2016 Focused Update: Clinical Recommendations for Cardiopulmonary Exercise Testing Data Assessment in Specific Patient Populations

et al. 2016

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Abstract-In the past several decades, cardiopulmonary exercise testing (CPX) has seen an exponential increase in its evidence base. The growing volume of evidence in support of CPX has precipitated the release of numerous scientific statements by societies and associations. In 2012, the European Association for Cardiovascular Prevention & Rehabilitation and the American Heart Association developed a joint document with the primary intent of redefining CPX analysis and reporting in a way that would streamline test interpretation and increase clinical application. Specifically, the 2012 joint scientific statement on CPX conceptualized an easy-to-use, clinically meaningful analysis based on evidence-vetted variables in color-coded algorithms; single-page algorithms were successfully developed for each proposed test indication. Because of an abundance of new CPX research in recent years and a reassessment of the current algorithms in light of the body of evidence, a focused update to the 2012 scientific statement is now warranted. The purposes of this update are to confirm algorithms included in the initial scientific statement not requiring revision, to propose revisions to algorithms included in the initial scientific statement, to propose new algorithms based on emerging scientific evidence, to further clarify the application of oxygen consumption at ventilatory threshold, to describe CPX variables with an emerging scientific evidence base, to describe the synergistic value of combining CPX with other assessments, to discuss personnel considerations for CPX laboratories, and to provide recommendations for future CPX research. (Circulation. 2016;133:e694-e711.

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Section: Oxygen Uptake Efficiency Slopementioning

confidence: 99%

2016 Focused Update: Clinical Recommendations for Cardiopulmonary Exercise Testing Data Assessment in Specific Patient Populations

et al. 2016

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“…[1][2][3] We postulated that management of such patients could be improved by adding more sensitive predictors, further refi ning well-known predictors, or by combining predictors. Currently, in such patients, gas exchange measurements during incremental cardiopulmonary exercise testing (CPET) such as peak oxygen uptake (peak o 2 ) at standard conditions of 0ºC, 760 mm Hg, dry (STPD); anaerobic threshold (AT); peak oxygen pulse; lowest ratio of minute ventilation ( e) at body temperature, ambient atmospheric pressure, saturated with water vapor to minute CO 2 output ( co 2 ) STPD; e -vs-co 2 slope; oscillatory breathing (OB) pattern [3][4][5][6][7][8][9][10] ; and the slope of o 2 to log e (oxygen uptake effi ciency slope [OUES]) [11][12][13][14][15][16][17][18][19][20][21] have been found to be useful in predicting mortality and morbidity and guiding therapy. [3][4][5][6][7][8][9][10] However, the full exercise response pattern of oxygen uptake effi ciency (OUE) ( o 2 / e , mL/L) and specifi cally the measurement of its highest average plateau (OUEP) (mL/L) have not been evaluated.…”

mentioning

confidence: 99%

Oxygen Uptake Efficiency Plateau Best Predicts Early Death in Heart Failure

Sun

Hansen

Stringer

2012

Chest

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Despite recent improvements in therapy, chronic left heart failure (HF) frequently requires hospitalization or is lethal. [1][2][3] We postulated that management of such patients could be improved by adding more sensitive predictors, further refi ning well-known predictors, or by combining predictors. Currently, in such patients, gas exchange measurements during incremental cardiopulmonary exercise testing (CPET) such as peak oxygen uptake (peak o 2 ) at standard conditions of 0ºC, 760 mm Hg, dry (STPD); anaerobic threshold (AT); peak oxygen pulse; lowest ratio of minute ventilation ( e) at body temperature, ambient atmospheric pressure, saturated with water vapor to minute CO 2 output ( co 2 ) STPD; e -vs-co 2 slope; oscillatory breathing (OB) pattern [3][4][5][6][7][8][9][10] ; and the slope of o 2 to log e (oxygen uptake effi ciency slope [OUES]) [11][12][13][14][15][16][17][18][19][20][21] have been found to be useful in predicting mortality and morbidity and guiding therapy. 3-10 However, the full exercise response pattern of oxygen uptake effi ciency (OUE) ( o 2 / e , mL/L) and specifi cally the measurement of its highest average plateau (OUEP) (mL/L) have not been evaluated.As the CPET core laboratory for two St. Jude Medical multicenter studies 3,22,23 involving 508 patientsBackground: The responses of oxygen uptake effi ciency (ie, oxygen uptake/ventilation 5 O 2 / E ) and its highest plateau (OUEP) during incremental cardiopulmonary exercise testing (CPET) in patients with chronic left heart failure (HF) have not been previously reported. We planned to test the hypothesis that OUEP during CPET is the best single predictor of early death in HF. Methods: We evaluated OUEP, slope of O 2 to log( E) ( oxygen uptake effi ciency slope ) , oscillatory breathing, and all usual resting and CPET measurements in 508 patients with low-ejectionfraction ( , 35%) HF. Each had further evaluations at other sites, including cardiac catheterization. Outcomes were 6-month all-reason mortality and morbidity (death or . 24 h cardiac hospitalization). Statistical analyses included area under curve of receiver operating characteristics, ORs, univariate and multivariate Cox regression, and Kaplan-Meier plots. Results: OUEP, which requires only moderate exercise, was often reduced in patients with HF. A low % predicted OUEP was the single best predictor of mortality ( P , .0001), with an OR of 13.0 ( P , .001). When combined with oscillatory breathing, the OR increased to 56.3, superior to all other resting or exercise parameters or combinations of parameters. Other statistical analyses and morbidity analysis confi rmed those fi ndings. Conclusions: OUEP is often reduced in patients with HF. Low % predicted OUEP ( , 65% predicted) is the single best predictor of early death, better than any other CPET or other cardiovascular measurement. Paired with oscillatory breathing, it is even more powerful.

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“…Similarly, previous studies demonstrated that maximal and submaximal OUES were positively correlated. Van Laethem et al [23] observed a significant correlation between OUES measured until 90% of the incremental test and OUES with maximal data (r = 0.973; p < 0.0001) in 35 male and female patients with chronic heart failure. Williamson et al [24] also observed that full test OUES was significantly correlated with OUES until RER 1.0 was reached (r = 0.90) and with OUES until RER 0.9 was reached (r = 0.79) (p < 0.05) in 100 healthy men.…”

Section: Discussionmentioning

confidence: 99%

Maximal and submaximal oxygen uptake efficiency slope: influence of cardiorespiratory variables and maximal dynamic strength

Pasqua¹,

Damasceno²,

Lima‐Silva³

et al. 2017

Pulm Crit Care Med

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Objective: The purpose of this study was to investigate if the OUES is determined by the same factors when calculated with VO 2 and VE values throughout the incremental test (OUES 100 ) or using values until 80% of the VO 2 max (OUES 80 ).Methods: 116 healthy male individuals performed a maximal incremental test, two constant-speed tests and a maximal dynamic strength test.Results: OUES 100 and OUES 80 were significantly correlated (r = 0.964; P < 0.001). VO 2 max was the main determinant factor for both OUES 100 and OUES 80 . Additionally, maximal heart rate (HRmax) and maximal dynamic strength (1RM) were the other variables selected for the two models as secondary variables. However, the importances of them were inversed, with the HRmax being the second determinant of the OUES 80 , while 1RM the second determinant for OUES 100 . The running economy, ventilatory threshold and respiratory compensation point were not selected for the models (P > 0.05). Conclusions:Our results suggest that the OUES 80 might satisfactorily replace maximal variables in aerobic fitness evaluations without maximal effort requirement. VO 2 max seems to be the main factor determining oxygen uptake efficiency slope, regardless the range (maximal or submaximal) used to determine. Otherwise, the muscle strength plays a more important role to the oxygen uptake efficiency considering maximal intensities, while the cardiovascular system seems to more strongly influence the oxygen uptake efficiency only until submaximal intensities.

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Response of the oxygen uptake efficiency slope to exercise training in patients with chronic heart failure

Cited by 76 publications

References 22 publications

2016 Focused Update: Clinical Recommendations for Cardiopulmonary Exercise Testing Data Assessment in Specific Patient Populations

2016 Focused Update: Clinical Recommendations for Cardiopulmonary Exercise Testing Data Assessment in Specific Patient Populations

Oxygen Uptake Efficiency Plateau Best Predicts Early Death in Heart Failure

Maximal and submaximal oxygen uptake efficiency slope: influence of cardiorespiratory variables and maximal dynamic strength

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