Clinical correlates and prognostic significance of the ventilatory response to exercise in chronic heart failure
TP Chua,
P Ponikowski,
D Harrington,
SD Anker,
K Webb-Peploe,
AL Clark,
PA Poole-Wilson,
and
AJ Coats
Royal Brompton Hospital and National Heart and Lung Institute, Imperial College School of Medicine, London, England, United Kingdom.
OBJECTIVES: This study sought to investigate the clinical characteristics of patients with chronic heart failure and an increased ventilatory response to exercise and to examine the prognostic usefulness of this response. BACKGROUND: The ventilatory response to exercise is increased in many patients with chronic heart failure and may be characterized by the regression slope relating minute ventilation to carbon dioxide output (VE-VCO2 slope) during exercise. METHODS: One hundred seventy-three consecutive patients (155 men; mean [+/-SD] age 59.8 +/- 11.5 years; radionuclide left ventricular ejection fraction [LVEF] 28.4 +/- 14.6%) underwent cardiopulmonary exercise testing (peak oxygen consumption 18.5 +/- 7.3 ml/kg per min; VE-CO2 slope 34.8 +/- 10.6) over a 2-year period. Using 1.96 standard deviations above the mean VE-VCO2 slope of 68 healthy age-matched subjects (mean slope 26.3 +/- 4.1), we defined a high ventilatory response to exercise as a slope >34. RESULTS: Eighty-three patients (48%) had an increased VE-VCO2 slope (mean 43.1 +/- 8.9). There was a difference in age (62.2 vs. 57.3 years, p = 0.005), New York Heart Association functional class (2.9 vs. 2.1, p < 0.001), LVEF (24.7 vs. 31.9%, p = 0.0016), peak oxygen consumption (14.9 vs. 21.7 ml/kg per min, p < 0.0001) and radiographic cardiothoracic ratio (0.58 vs. 0.55, p = 0.002) between these patients and those with a normal slope. In the univariate Cox proportional hazards model, the E-VCO2 slope was an important prognostic factor (p < 0.0001). In the multivariate Cox analyses using several variables (age, peak oxygen consumption, VE-VCO2 slope and LVEF), the VE-VCO2 slope gave additional prognostic information (p = 0.018) beyond peak oxygen consumption (p = 0.022). Kaplan-Meier survival curves at 18 months demonstrated a survival rate of 95% in patients with a normal VE-VCO2 slope compared with 69% in those with a high slope (p < 0.0001). CONCLUSIONS: A high VE-VCO2 slope selects patients with more severe heart failure and is an independent prognostic marker. The VE-VCO2 slope may be used as a supplementary index in the assessment of patients with chronic heart failure.
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Limitation of exercise tolerance in chronic heart failure: distinct effects of left Bundle-Branch block and coronary artery disease
J. Am. Coll. Cardiol.,
May 5, 2004;
43(9):
1524 - 1531.
[Abstract]
[Full Text]
[PDF]
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G. Deboeck, G. Niset, M. Lamotte, J-L. Vachiery, and R. Naeije
Exercise testing in pulmonary arterial hypertension and in chronic heart failure
Eur. Respir. J.,
May 1, 2004;
23(5):
747 - 751.
[Abstract]
[Full Text]
[PDF]
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A. Koike, H. Itoh, R. Oohara, M. Hoshimoto, A. Tajima, T. Aizawa, and L. T. Fu
Cerebral Oxygenation During Exercise in Cardiac Patients
Chest,
January 1, 2004;
125(1):
182 - 190.
[Abstract]
[Full Text]
[PDF]
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M. Rauchhaus, A. L. Clark, W. Doehner, C. Davos, A. Bolger, R. Sharma, A. J. S. Coats, and S. D. Anker
The relationship between cholesterol and survival in patients with chronic heart failure
J. Am. Coll. Cardiol.,
December 3, 2003;
42(11):
1933 - 1940.
[Abstract]
[Full Text]
[PDF]
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P. Agostoni, G. Cattadori, M. Bianchi, and K. Wasserman
Exercise-Induced Pulmonary Edema in Heart Failure
Circulation,
November 25, 2003;
108(21):
2666 - 2671.
[Abstract]
[Full Text]
[PDF]
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R. Wolk, B. D. Johnson, and V. K. Somers
Leptin and the ventilatory response to exercise in heart failure
J. Am. Coll. Cardiol.,
November 5, 2003;
42(9):
1644 - 1649.
[Abstract]
[Full Text]
[PDF]
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C. Schalcher, H. Rickli, M. Brehm, D. Weilenmann, E. Oechslin, W. Kiowski, and H. P. Brunner-La Rocca
Prolonged Oxygen Uptake Kinetics During Low-Intensity Exercise Are Related to Poor Prognosis in Patients With Mild-to-Moderate Congestive Heart Failure
Chest,
August 1, 2003;
124(2):
580 - 586.
[Abstract]
[Full Text]
[PDF]
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R. Arena, J. Myers, S. S. Aslam, E. B. Varughese, and M. A. Peberdy
Technical Considerations Related to the Minute Ventilation/Carbon Dioxide Output Slope in Patients With Heart Failure
Chest,
August 1, 2003;
124(2):
720 - 727.
[Abstract]
[Full Text]
[PDF]
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A S Androne, K Hryniewicz, R Goldsmith, A Arwady, and S D Katz
Acetylcholinesterase inhibition with pyridostigmine improves heart rate recovery after maximal exercise in patients with chronic heart failure
Heart,
August 1, 2003;
89(8):
854 - 858.
[Abstract]
[Full Text]
[PDF]
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M. Guazzi, R. Brambilla, G. Reina, G. Tumminello, and M. D. Guazzi
Aspirin-Angiotensin-Converting Enzyme Inhibitor Coadministration and Mortality in Patients With Heart Failure: A Dose-Related Adverse Effect of Aspirin
Arch Intern Med,
July 14, 2003;
163(13):
1574 - 1579.
[Abstract]
[Full Text]
[PDF]
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H. Rickli, W. Kiowski, M. Brehm, D. Weilenmann, C. Schalcher, A. Bernheim, E. Oechslin, and H. P. Brunner-La Rocca
Combining low-intensity and maximal exercise test results improves prognostic prediction in chronic heart failure
J. Am. Coll. Cardiol.,
July 2, 2003;
42(1):
116 - 122.
[Abstract]
[Full Text]
[PDF]
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J. J. Leite, A. J. Mansur, H. F. G. de Freitas, P. R. Chizola, E. A. Bocchi, M. Terra-Filho, J. A. Neder, and G. Lorenzi-Filho
Periodic breathing during incremental exercise predicts mortality in patients with chronic heart failure evaluated for cardiac transplantation
J. Am. Coll. Cardiol.,
June 18, 2003;
41(12):
2175 - 2181.
[Abstract]
[Full Text]
[PDF]
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S Sakurai, H Adachi, A Hasegawa, H Hoshizaki, S Oshima, K Taniguchi, and M Kurabayashi
Brain natriuretic peptide facilitates severity classification of stable chronic heart failure with left ventricular dysfunction
Heart,
June 1, 2003;
89(6):
661 - 662.
[Full Text]
[PDF]
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A. P Bolger, A. J.S Coats, and M. A Gatzoulis
Congenital heart disease: the original heart failure syndrome
Eur. Heart J.,
May 2, 2003;
24(10):
970 - 976.
[Abstract]
[Full Text]
[PDF]
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T Tomita, H Takaki, Y Hara, F Sakamaki, T Satoh, S Takagi, Y Yasumura, N Aihara, Y Goto, and K Sunagawa
Attenuation of hypercapnic carbon dioxide chemosensitivity after postinfarction exercise training: possible contribution to the improvement in exercise hyperventilation
Heart,
April 1, 2003;
89(4):
404 - 410.
[Abstract]
[Full Text]
[PDF]
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C. Varma, S. Sharma, S. Firoozi, W. J. McKenna, J.-C. Daubert, and Multisite Stimulation in Cardiomyopathy (MUSTIC) S
Atriobiventricular pacing improves exercise capacity in patients with heart failure and intraventricular conduction delay
J. Am. Coll. Cardiol.,
February 19, 2003;
41(4):
582 - 588.
[Abstract]
[Full Text]
[PDF]
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A. Koike, N. Shimizu, A. Tajima, T. Aizawa, L. T. Fu, H. Watanabe, and H. Itoh
Relation Between Oscillatory Ventilation at Rest Before Cardiopulmonary Exercise Testing and Prognosis in Patients With Left Ventricular Dysfunction
Chest,
February 1, 2003;
123(2):
372 - 379.
[Abstract]
[Full Text]
[PDF]
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ATS/ACCP Statement on Cardiopulmonary Exercise Testing
Am. J. Respir. Crit. Care Med.,
January 15, 2003;
167(2):
211 - 277.
[Full Text]
[PDF]
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A. K. Gitt, K. Wasserman, C. Kilkowski, T. Kleemann, A. Kilkowski, M. Bangert, S. Schneider, A. Schwarz, and J. Senges
Exercise Anaerobic Threshold and Ventilatory Efficiency Identify Heart Failure Patients for High Risk of Early Death
Circulation,
December 10, 2002;
106(24):
3079 - 3084.
[Abstract]
[Full Text]
[PDF]
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P. Agostoni, M. Guazzi, M. Bussotti, S. De Vita, and P. Palermo
Carvedilol Reduces the Inappropriate Increase of Ventilation During Exercise in Heart Failure Patients
Chest,
December 1, 2002;
122(6):
2062 - 2067.
[Abstract]
[Full Text]
[PDF]
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J. G Lainchbury and A M. Richards
EXERCISE TESTING IN THE ASSESSMENT OF CHRONIC CONGESTIVE HEART FAILURE
Heart,
December 1, 2002;
88(5):
538 - 543.
[Full Text]
[PDF]
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R. Wensel, C. F. Opitz, S. D. Anker, J. Winkler, G. Hoffken, F. X. Kleber, R. Sharma, M. Hummel, R. Hetzer, and R. Ewert
Assessment of Survival in Patients With Primary Pulmonary Hypertension: Importance of Cardiopulmonary Exercise Testing
Circulation,
July 16, 2002;
106(3):
319 - 324.
[Abstract]
[Full Text]
[PDF]
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T Kohnlein, T Welte, L B Tan, and M W Elliott
Central sleep apnoea syndrome in patients with chronic heart disease: a critical review of the current literature
Thorax,
June 1, 2002;
57(6):
547 - 554.
[Abstract]
[Full Text]
[PDF]
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A. Cohen-Solal, J.Y. Tabet, D. Logeart, P. Bourgoin, M. Tokmakova, and M. Dahan
A non-invasively determined surrogate of cardiac power ('circulatory power') at peak exercise is a powerful prognostic factor in chronic heart failure
Eur. Heart J.,
May 2, 2002;
23(10):
806 - 814.
[Abstract]
[Full Text]
[PDF]
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U. Corra, A. Giordano, E. Bosimini, A. Mezzani, M. Piepoli, A. J. S. Coats, and P. Giannuzzi
Oscillatory Ventilation During Exercise in Patients With Chronic Heart Failure* : Clinical Correlates and Prognostic Implications
Chest,
May 1, 2002;
121(5):
1572 - 1580.
[Abstract]
[Full Text]
[PDF]
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A. Koike, H. Itoh, M. Kato, H. Sawada, T. Aizawa, L. T. Fu, and H. Watanabe
Prognostic Power of Ventilatory Responses During Submaximal Exercise in Patients With Chronic Heart Disease*
Chest,
May 1, 2002;
121(5):
1581 - 1588.
[Abstract]
[Full Text]
[PDF]
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M Guazzi, G Pontone, R Brambilla, P Agostoni, and G Reina
Alveolar-capillary membrane gas conductance: a novel prognostic indicator in chronic heart failure
Eur. Heart J.,
March 2, 2002;
23(6):
467 - 476.
[Abstract]
[Full Text]
[PDF]
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S. Nanas, J. Nanas, C. Kassiotis, C. Nikolaou, E. Tsagalou, D. Sakellariou, I. Terovitis, O. Papazachou, S. Drakos, A. Papamichalopoulos, et al.
Early recovery of oxygen kinetics after submaximal exercise test predicts functional capacity in patients with chronic heart failure
Eur J Heart Fail,
December 1, 2001;
3(6):
685 - 692.
[Abstract]
[Full Text]
[PDF]
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A. J S Coats
HEART FAILURE: What causes the symptoms of heart failure?
Heart,
November 1, 2001;
86(5):
574 - 578.
[Full Text]
[PDF]
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T Iwase, N Nagaya, M Ando, T Satoh, F Sakamaki, S Kyotani, H Takaki, Y Goto, Y Ohkita, M Uematsu, et al.
Acute and chronic effects of surgical thromboendarterectomy on exercise capacity and ventilatory efficiency in patients with chronic thromboembolic pulmonary hypertension
Heart,
August 1, 2001;
86(2):
188 - 192.
[Abstract]
[Full Text]
[PDF]
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R. Wensel and S. D. Anker
Lean tissue adjusted peak oxygen consumption in congestive heart failure
J. Am. Coll. Cardiol.,
July 1, 2001;
38(1):
287 - 288.
[Full Text]
[PDF]
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D P Francis, L C Davies, and A J S Coats
Diagnostic exercise physiology in chronic heart failure
Heart,
July 1, 2001;
86(1):
17 - 20.
[Full Text]
[PDF]
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M. Cicoira, L. Zanolla, L. Franceschini, A. Rossi, G. Golia, M. Zamboni, P. Tosoni, and P. Zardini
Skeletal muscle mass independently predicts peak oxygen consumption and ventilatory response during exercise in noncachectic patients with chronic heart failure
J. Am. Coll. Cardiol.,
June 15, 2001;
37(8):
2080 - 2085.
[Abstract]
[Full Text]
[PDF]
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N. de Jonge, H. Kirkels, J. R. Lahpor, C. Klopping, E. J. Hulzebos, A. Brutel de la Riviere, and E. O. Robles de Medina
Exercise performance in patients with end-stage heart failure after implantation of a left ventricular assist device and after heart transplantation: An outlook for permanent assisting?
J. Am. Coll. Cardiol.,
June 1, 2001;
37(7):
1794 - 1799.
[Abstract]
[Full Text]
[PDF]
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A. L. Clark, F. X. Kleber, G. Vietzke, K.-D. Wernecke, U. Bauer, C. Opitz, R. Wensel, A. Sperfeld, and S. Glaser
Impairment of Ventilatory Efficiency in Heart Failure Response
Circulation,
May 8, 2001;
103
(18):
e97 - e97.
[Full Text]
[PDF]
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R. L. Johnson Jr
Gas Exchange Efficiency in Congestive Heart Failure II
Circulation,
February 20, 2001;
103(7):
916 - 918.
[Full Text]
[PDF]
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P. Ponikowski, D. P. Francis, M. F. Piepoli, L. C. Davies, T. P. Chua, C. H. Davos, V. Florea, W. Banasiak, P. A. Poole-Wilson, A. J. S. Coats, et al.
Enhanced Ventilatory Response to Exercise in Patients With Chronic Heart Failure and Preserved Exercise Tolerance : Marker of Abnormal Cardiorespiratory Reflex Control and Predictor of Poor Prognosis
Circulation,
February 20, 2001;
103(7):
967 - 972.
[Abstract]
[Full Text]
[PDF]
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