Does Exercise Ventilatory Inefficiency Predict Poor Outcome in Heart Failure Patients With COPD?

Does Exercise Ventilatory Inefficiency Predict Poor Outcome in Heart Failure Patients With COPD?

Author Alencar, Maria Clara Autor UNIFESP Google Scholar
Arbex, Flavio Ferlin Autor UNIFESP Google Scholar
Souza, Aline Autor UNIFESP Google Scholar
Mazzuco, Adriana Google Scholar
Sperandio, Priscila Abreu Autor UNIFESP Google Scholar
Rocha, Alcides Autor UNIFESP Google Scholar
Hirai, Daniel Müller Autor UNIFESP Google Scholar
Mancuso, Frederico Autor UNIFESP Google Scholar
Berton, Danilo C. Google Scholar
Borghi-Silva, Audrey Google Scholar
Almeida, Dirceu Autor UNIFESP Google Scholar
O'Donnel, Denis E. Google Scholar
Neder, Jose Alberto Autor UNIFESP Google Scholar
Abstract PURPOSE: To investigate whether the opposite effects of heart failure (HF) and chronic obstructive pulmonary disease (COPD) on exercise ventilatory inefficiency (minute ventilation [(V) over dot(E)]-carbon dioxide output [(V) over dotCO(2)] relationship) would negatively impact its prognostic relevance. METHODS: After treatment optimization and an incremental cardiopulmonary exercise test, 30 male patients with HF-COPD (forced expiratory volume in 1 second [FEV1] = 57% +/- 17% predicted, ejection fraction = 35% +/- 6%) were prospectively followed up during 412 +/- 261 days for major cardiac events. RESULTS: Fourteen patients (46%) had a negative outcome. Patients who had an event had lower echocardiographically determined right ventricular fractional area change (RVFAC), greater ventilatory inefficiency (higher (V) over dot(E)/(V) over dotCO(2) nadir), and lower end-tidal CO2 (PETCO2) (all P < .05). Multivariate Cox models revealed that (V) over dot(E)/(V) over dotCO(2) nadir > 36, Delta P-ET CO2(PEAK-REST)>= 2 mm Hg, and PETCO2PEAK <= 33 mm Hg added prognostic value to RVFAC <45%. Kaplan-Meyer analyses showed that although 18% of patients with RVFAC > 45% had a major cardiac event after 1 year, no patient with RVFAC > 45% and (V) over dot(E)/ (V) over dotCO(2) nadir = 36 (or PETCO2PEAK>33 mm Hg) had a negative event. Conversely, although 69% of patients with RVFAC <= 45% had a major cardiac event after 1 year, all patients with RVFAC <= 45% and. PETCO2(PEAK-REST)>= 2 mm Hg had a negative event. CONCLUSION: Ventilatory inefficiency remains a powerful prognostic marker in HF despite the presence of mechanical ventilatory constraints induced by COPD. If these preliminary findings are confirmed in larger studies, optimal thresholds for outcome prediction are likely greater than those traditionally recommended for HF patients without COPD.
Keywords cardiopulmonary exercise test
heart failure
lung disease
prognosis
xmlui.dri2xhtml.METS-1.0.item-coverage Philadelphia
Language English
Date 2016
Published in Journal Of Cardiopulmonary Rehabilitation And Prevention. Philadelphia, v. 36, n. 6, p. 454-459, 2016.
ISSN 1932-7501 (Sherpa/Romeo, impact factor)
Publisher Lippincott Williams & Wilkins
Extent 454-459
Origin http://dx.doi.org/10.1097/HCR.0000000000000212
Access rights Closed access
Type Article
Web of Science ID WOS:000387995500008
URI https://repositorio.unifesp.br/handle/11600/56839

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