Carbon dioxide elimination pattern at cardiopulmonary exercise testing in patients with low ejection fraction value

2020 ◽  
Vol 29 (6) ◽  
pp. 647-653
Author(s):  
O. V. Kamenskaya ◽  
I. Yu. Loginova ◽  
A. M. Chernyavskiy ◽  
D. V. Doronin ◽  
V. V. Lomivorotov
Keyword(s):  
Carbon Dioxide ◽  
Ejection Fraction ◽  
Exercise Testing ◽  
Resting State ◽  
Cardiopulmonary Exercise Testing ◽  
Unfavorable Outcome ◽  
Cardiopulmonary Exercise ◽  
Low Ejection Fraction ◽  
Over Time

The objective of this study was to evaluate partial pressure of end tidal carbon dioxide (PetCO2) over time on exertion (E) and its predictive value in evaluation of risk of unfavorable outcome in patients with low ejection fraction (EF) value.Materials and Methods. Patients (n = 53) with pronounced chronic heart failure (CHF), included in heart transplantation waiting list, were enrolled in the prospective study. All patients underwent cardiopulmonary exercise testing (CPET). Mortality or INCOR left ventricle bypass system implantation according to vital indications within 1 year of follow-up were evaluated as an end-point.Results. Patients with CHF and low EF were characterized by low parameters of E tolerance and peak oxygen consumption (10.4 (9.6–11.7) ml/min/kg). The average PetCO2 level by group was 30.4 (28.3–33.0) mm Hg; in 32% of patients this value decreased or did not change in CPET compared with that in resting state. The significant relationship between increased risk of unfavorable outcome within 1 year of follow-up with low baseline PetCO2 value (odds ratio (OR) – 0.22 (0.05–0.87); p = 0.020) and absence of its increment in PE (OR – 0.16 (0.10–0.54); p = 0.009) was observed.Conclusion. The significant predictive factors of unfavorable outcome within 1 year of follow-up in patients with pronounced CHF and low EF include PetCO2 value in resting state, as well as PetCO2 change over time after E challenge.

scholarly journals Revisiting and Implementing the Weber and Ventilatory Functional Classifications in Heart Failure by Cardiopulmonary Imaging Phenotyping

2021 ◽  
Author(s):  
Marco Guazzi ◽  
Barry Borlaug ◽  
Marco Metra ◽  
Maurizio Losito ◽  
Francesco Bandera ◽  
...  
Keyword(s):  
Heart Failure ◽  
Carbon Dioxide ◽  
Oxygen Consumption ◽  
Mitral Regurgitation ◽  
Ejection Fraction ◽  
Exercise Testing ◽  
Cardiopulmonary Exercise Testing ◽  
Carbon Dioxide Production ◽  
Peak Oxygen Consumption ◽  
Cardiopulmonary Exercise

Background In heart failure, the exercise gas exchange Weber (A to D) and ventilatory classifications (VC‐1 to VC‐4) historically define disease severity and prognosis. However, their applications in the modern heart failure population of any left ventricular ejection fraction combined with hemodynamics are undefined. We aimed at revisiting and implementing these classifications by cardiopulmonary exercise testing imaging. Methods and Results 269 patients with heart failure with reduced (n=105), mid‐range (n=88) and preserved (n=76) ejection fraction underwent cardiopulmonary exercise testing imaging, primarily assessing the cardiac output (CO), mitral regurgitation, and mean pulmonary arterial pressure (mPAP)/CO slope. Within both classes, a progressively lower exercise CO, higher mPAP/CO slopes, and mitral regurgitation ( P <0.01 all) were observed. After adjustment for age and sex, Cox proportional hazard regression analyses showed that Weber (hazard ratio [HR], 2.9; 95% CI, 1.8–4.7; P <0.001) and ventilatory classes (HR, 1.4; 95% CI, 1.1–2.0; P =0.017) were independently associated with outcome. The best stratification was observed when combining Weber (A/B or C/D) with severe ventilation inefficiency (VC‐4) (HR, 2.7; 95% CI, 1.6–4.8; P <0.001). At multivariable analysis the best hemodynamic determinants of peak oxygen consumption and ventilation to carbon dioxide production slope were CO (β‐coefficient, 0.72±0.16; P <0.001) and mPAP/CO slope (β‐coefficient, 0.72±0.16; P <0.001), respectively. Conclusions In the contemporary heart failure population, the Weber and ventilatory classifications maintain their prognostic ability, especially when combined. Exercise CO and mPAP/CO slope are the best predictors of peak oxygen consumption and ventilation to carbon dioxide production slope classifications representing the main targets of interventions to impact functional class and, likely, event rate.

Abstract 13745: Severity of Functional Mitral Regurgitation During Maximal Exercise Testing in Heart Failure: Additional Value of Combining Echocardiography with Cardiopulmonary Exercise Testing

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Greta Generati ◽  
Francesco Bandera ◽  
Marta Pellegrino ◽  
Valentina Labate ◽  
Eleonora Alfonzetti ◽  
...  
Keyword(s):  
Heart Failure ◽  
Mitral Regurgitation ◽  
Ejection Fraction ◽  
Exercise Testing ◽  
Cardiopulmonary Exercise Testing ◽  
Functional Mitral Regurgitation ◽  
Peak Exercise ◽  
Cardiopulmonary Exercise ◽  
Pulmonary Hemodynamic ◽  
Increased Risk

Background: In heart failure (HF) patients the severity of mitral regurgitation (MR) at rest has a well established prognostic value and its increase during exercise further adds to an increased risk. Our goal was to define the relationship between the degree of exercise MR severity with cardiopulmonary and echocardiographic related phenotypes in a cohort of HF patients. Methods: 71 HF reduced ejection fraction patients (mean age 67±11; male 72%; ischemic etiology 61%; NYHA class I, II, III and IV 13%, 36%, 39% and 12%, mean ejection fraction 33±9%) underwent cardiopulmonary exercise test (CPET) on tiltable cycle-ergometer combined with echocardiography at rest and during exercise. The population was divided into two groups according to the degree of functional peak MR: no to mild/moderate MR (no MR, MR1+ and MR2+) vs moderate/severe MR (MR3+ and MR4+). Results: A good correlation (ρ coefficient= 0.49) was found between the degree of dynamic MR and PASP at peak exercise. Despite similar echocardiographic profile at rest patients with significant peak MR (MR≥3+) had worse exercise performance (lower peak VO2, O2 pulse and workload) and impaired ventilatory efficiency (higher VE/VCO2 slope). Conclusions: In HF patients the severity of exercise-induced MR is associated with the most unfavorable performance and pulmonary hemodynamic response. A combined approach with CPET and echocardiographic assessment can help to early unmask and target functional MR and its related unfavorable phenotypes.

Abstract 16117: Nonresponders to Cardiac Rehabilitation and Outcomes

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Alban De Schutter ◽  
Carl Lavie ◽  
Eiman Jahangir ◽  
Arthur Menezes ◽  
Homeyar Dinshaw ◽  
...  
Keyword(s):  
Ejection Fraction ◽  
Cardiac Rehabilitation ◽  
Exercise Capacity ◽  
Poor Prognosis ◽  
Cardiopulmonary Exercise Testing ◽  
Significant Risk ◽  
Metabolic Equivalent ◽  
Cardiopulmonary Exercise ◽  
Before And After

Introduction: Studies of coronary heart disease (CHD) and cardiac rehabilitation (CR) have traditionally focused on increasing enrollment in CR. We examine here the prognosis of patients who enrolled and completed CR, but saw no significant improvement in exercise capacity [nonresponders (NR)]. Hypothesis: Nonresponders have a poor prognosis. Methods: 780 CHD patients who completed CR with cardiopulmonary exercise testing (CPX) before and after the intervention were divided according to improvement in exercise tolerance (ET; no change or decline vs improvement in metabolic equivalent). Mortality was tracked post CR for all patients; 1 to 161 months of follow-up (mean 6.4 years). Results: 243 (31%) subjects were NR. After adjustment for body mass index, age, gender, ejection fraction and baseline ET, lack of improvement in exercise capacity was associated with a statistically significant 55% increase in mortality (p=0.03; Figure 1). Higher age (OR 1.02; p 0.05) and baseline ET (OR 1.07; p 0.001) was significantly associated with being a NR, but depression, gender and ejection fraction were not significant risk factors. Conclusions: A substantial proportion of subjects referred to CR have no improvement in ET and comparatively demonstrate a poor prognosis. Further investigation into the identifying characteristics of this population is needed to examine if their prognosis can be altered.

scholarly journals Correlation Between N-Terminal Pro-Brain Natriuretic Peptide Levels and Cardiopulmonary Exercise Testing in Patients With Pre-Capillary Pulmonary Hypertension: A Pilot Study

2020 ◽  
Vol 14 ◽  
pp. 117954842095404
Author(s):  
Sahachat Aueyingsak ◽  
Wilaiwan Khrisanapant ◽  
Upa Kukongviriyapun ◽  
Orapin Pasurivong ◽  
Pailin Ratanawatkul ◽  
...  
Keyword(s):  
Carbon Dioxide ◽  
Pulmonary Hypertension ◽  
Brain Natriuretic Peptide ◽  
Natriuretic Peptide ◽  
Exercise Testing ◽  
Cardiopulmonary Exercise Testing ◽  
Chronic Thromboembolic Pulmonary Hypertension ◽  
Peak Oxygen Uptake ◽  
Cardiopulmonary Exercise ◽  
End Tidal

Background: N-terminal pro-brain natriuretic peptide (NT-proBNP) and cardiopulmonary exercise testing (CPET) are useful for severity assessment in patients with pulmonary hypertension (PH). Correlations between these tests in pre-capillary PH patients is less well studied. Methods: We studied 23 patients with pre-capillary PH: 8 with idiopathic pulmonary arterial hypertension (IPAH), 6 with systemic sclerosis-associated PAH (SSc-PAH), and 9 with chronic thromboembolic pulmonary hypertension (CTEPH). Clinical evaluation, NT-proBNP levels, six-minute walking test (6MWT), spirometry, and CPET were evaluated on the same day. Correlation between NT-proBNP levels and CPET parameters were investigated. Results: In all patients, NT-proBNP levels were significantly correlated with peak oxygen uptake (VO2) ( r = −0.47), peak oxygen pulse ( r = −0.43), peak cardiac output (CO) ( r = −0.57), peak end-tidal partial pressure of carbon dioxide (PETCO2) ( r = −0.74), ventilatory equivalent to carbon dioxide (VE/VCO2) at anaerobic threshold (AT) ( r = 0.73), and VE/VCO2 slope ( r = 0.64). Significant correlations between NT-proBNP levels and peak PETCO2 and VE/VCO2 were found in IPAH and CTEPH subgroups, and a significant correlation between NT-proBNP levels and VO2 at AT was found in the CTEPH subgroup. No significant correlation was found in the SSc-PAH subgroup. Conclusion: NT-proBNP levels were significantly correlated with CPET parameters in patients with IPAH and CTEPH subgroups, but not in SSc-PAH subgroup. A further study with larger population is required to confirm these preliminary findings.

scholarly journals 150 Incremental value of cardiopulmonary exercise testing in intermediate-risk pulmonary arterial hypertension

2021 ◽  
Vol 23 (Supplement_G) ◽  
Author(s):  
Roberto Badagliacca ◽  
Franz Rischard ◽  
Francesco Lo Giudice ◽  
Luke Howard ◽  
Silvia Papa ◽  
...  
Keyword(s):  
Risk Assessment ◽  
Pulmonary Arterial Hypertension ◽  
Arterial Hypertension ◽  
Exercise Testing ◽  
Prognostic Model ◽  
Cardiopulmonary Exercise Testing ◽  
Intermediate Risk ◽  
Cardiopulmonary Exercise ◽  
Pulmonary Arterial

Abstract Aims Risk assessment in pulmonary arterial hypertension (PAH) is essential for prognostication. However, the majority of patients end-up in an intermediate risk status despite targeted-therapy, offering insufficient guidance in clinical practice. The added value of cardiopulmonary exercise testing (CPET) in this setting remains undefined. Methods and results Two independent cohorts with idiopathic PAH at intermediate risk were used to develop (n = 124) and externally validate (n = 143) the prognostic model. Risk assessment was based on the simplified version of the ESC/ERS guidelines score. The same definition of clinical worsening (CW) was used for both cohorts. Discrimination and calibration were assessed. Seventy-four derivation cohort patients experienced CW (51.2%) during a median of 34 months. Stroke volume index (SVI) and 6-min walk-distance (6MWD) were independent predictors of CW. With addition of CPET variables, SVI and VO2 peak independently improved the power of the prognostic model, determined by the integrated discrimination integral (IDI) index. ROC-derived cut-off values for SVI and VO2 peak were 34 and 14 ml/kg/min, respectively. Forty-eight validation cohort patients experienced CW (33.5%) during a median of 27 months follow-up. Different combinations of cut-off values of SVI and VO2 peak defined three meaningful groups showing good discrimination and calibration. The event-free survival rates at 1, 2, and 3 years were, respectively, 96%, 89%, and 89% for high SVI/high VO2 peak combination; 85%, 73%, and 61% for high SVI/low VO2 peak; and 80%, 70%, and 56% for low SVI/low VO2 peak. Conclusions Combinations of VO2 peak and SVI during follow-up is important in the prognostication of intermediate-risk prevalent patients with idiopathic PAH.

scholarly journals Cardiopulmonary exercise testing provides a predictive tool for early and late outcomes in abdominal aortic aneurysm patients

2011 ◽  
Vol 93 (6) ◽  
pp. 474-481 ◽  
Author(s):  
AR Thompson ◽  
N Peters ◽  
RE Lovegrove ◽  
S Ledwidge ◽  
A Kitching ◽  
...  
Keyword(s):  
Abdominal Aortic Aneurysm ◽  
Aortic Aneurysm ◽  
Exercise Testing ◽  
Cardiopulmonary Exercise Testing ◽  
Apache Ii ◽  
Apache Ii Score ◽  
Predictive Tool ◽  
Cardiopulmonary Exercise ◽  
Abdominal Aortic

INTRODUCTION The aim of this study was to determine if cardiopulmonary exercise testing (CPET) predicts 30-day and midterm outcomes when assessing suitability for abdominal aortic aneurysm (AAA) repair. METHODS Since July 2006 consecutive patients from a single centre identified with a large (≥5.5cm) AAA were sent for CPET. Follow-up was completed on 1 August 2009. Univariate logistical regression was used to compare CPET parameters with the Detsky score, the Acute Physiology and Chronic Health Evaluation (APACHE) II score and the Vascular Physiological and Operative Severity Score for the enUmeration of Mortality and morbidity (VPOSSUM) in predicting predefined early and late outcome measures. RESULTS Full data were available for 102 patients (93% male, median age: 75 years, interquartile range (IQR): 70–80 years, median follow up: 28 months, IQR: 18–33 months). Ventilatory equivalents for oxygen and APACHE II predicted postoperative inotrope requirement (p=0.018 and p=0.019 respectively). The Detsky score predicted the length of stay in the intensive care unit (p=0.008). Midterm (30-month) survival was predicted by the anaerobic threshold (p=0.02). CONCLUSIONS CPET provided the only means in this study of predicting both 30-day outcome and 30-month mortality. CPET could therefore become an increasingly important tool in determining the optimum management for AAA patients.

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