Ventilatory Efficiency and the Selection of Patients for Heart Transplantation

Ferreira, António Miguel; Tabet, Jean-Yves; Frankenstein, Lutz; Metra, Marco; Mendes, Miguel; Zugck, Christian; Beauvais, Florence; Cohen‐Solal, Alain

doi:10.1161/circheartfailure.108.847392

Cited by 48 publications

(25 citation statements)

References 61 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…This aligns with previous studies demonstrating the use of CPET, [13][14][15][16][17][18] and specifically EOV, [6][7][8][19][20][21][22][23][24][25] as a tool to predict outcomes in patients with heart failure. EOV is thought to be due to aberrant respiratory autoregulation, which involves carotid body and medullary chemodetection of arterial P a O 2 , P a CO 2 , and pH.…”

Section: Discussionsupporting

confidence: 90%

See 1 more Smart Citation

Exercise Oscillatory Ventilation in Patients With Fontan Physiology

Nathan

Loukas

Moko

et al. 2015

Circ: Heart Failure

View full text Add to dashboard Cite

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.

show abstract

Section: Discussionsupporting

confidence: 90%

“…15). FVC tended to be inversely associated with the outcome, but this was not statistically significant (per +10% predicted; hazard ratio, 0.9; 95% CI, 0.7-1.0; P=0.08).…”

Section: Survival Analysis Eov As a Predictor Of Death Transplantatmentioning

confidence: 76%

Exercise Oscillatory Ventilation in Patients With Fontan Physiology

Nathan

Loukas

Moko

et al. 2015

Circ: Heart Failure

View full text Add to dashboard Cite

show abstract

“…689 Cardiopulmonary exercise testing helps refine candidate selection. [690][691][692][693][694][695][696] Data suggest acceptable posttransplant outcomes in patients with reversible pulmonary hypertension, 697 hypertrophic cardiomyopathy, 698 peripartum cardiomyopathy, 699 restrictive cardiomyopathy, 700,701 and muscular dystrophy. 702 Selected patients with stage D HF and poor prognosis should be referred to a cardiac transplantation center for evaluation and transplant consideration.…”

Section: Classmentioning

confidence: 99%

2013 ACCF/AHA Guideline for the Management of Heart Failure

et al. 2013

View full text Add to dashboard Cite

“…A detailed discussion of these matters is beyond the scope of this review and readers are referred to [18] for a comprehensive discussion of the issues involved. Nonetheless, VT, assessed by the slope of minute ventilation (VE) versus carbon dioxide production (VCO 2 ), has been recommended as a powerful prognostic marker in patients with chronic heart failure undergoing evaluation for heart transplantation [19,20].…”

Section: Lungsmentioning

confidence: 99%

Exercise and heart failure in the elderly

Kappagoda

Amsterdam

2012

Heart Fail Rev

View full text Add to dashboard Cite

In this review, we will examine the physiological responses to exercise in elderly populations (age > 65 years) with and without evidence of heart failure. Aging per se in both men and women is associated with a ~40% lower maximum oxygen consumption in sedentary subjects. In trained individuals, this value is 25-32% lower. A smaller SV accounts for nearly 50% of these age-related differences, and the remainder is explained by a lower maximal HR and reduced oxygen extraction. Exercise training is also associated with an increase in the arteriovenous O(2) difference in previously sedentary elderly men and women, which probably contributes to the overall beneficial effect of training in the elderly. However, during vigorous exercise (125 W), the cardiac output in the elderly is dependent upon an age-related increase in end-diastolic volume and stroke volume, which "compensates" partially for the age-related decrease in heart rate. Hence, in elderly individuals, the stroke volume during exercise depends upon diastolic filling. The changes that occur in the heart are also associated with an overall reduction in efferent sympathetic nerve activity. Despite this decline, the metaboreflex initiated by receptors in exercising muscles remains the main determinant of sympathetic activation (to maintain blood pressure) during exercise in the elderly. It is recognized that aging is associated with the development of heart failure, particularly in women in whom its prevalence increases >twofold from age 65-69 (6.6%) to age 85 years (14%). Almost half the people presenting with heart failure appear to have normal left ventricular systolic function, a phenomenon that is more common in women. Exercise training in elderly people with and without heart failure appears to have a beneficial effect in terms of enhancing the quality of life and functional capacity. Mortality benefit in the latter has not been established with certainty.

show abstract

Ventilatory Efficiency and the Selection of Patients for Heart Transplantation

Cited by 48 publications

References 61 publications

Exercise Oscillatory Ventilation in Patients With Fontan Physiology

Exercise Oscillatory Ventilation in Patients With Fontan Physiology

2013 ACCF/AHA Guideline for the Management of Heart Failure

Exercise and heart failure in the elderly

Contact Info

Product

Resources

About