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Title: Optimizing the evaluation of excess exercise ventilation for prognosis assessment in pulmonary arterial hypertension
Authors: Ferreira, Eloara V. M. [UNIFESP]
Ota-Arakaki, Jaquelina S. [UNIFESP]
Ramos, Roberta P. [UNIFESP]
Barbosa, Priscila B. [UNIFESP]
Almeida, Melline [UNIFESP]
Treptow, Erika C. [UNIFESP]
Valois, Fabricio M. [UNIFESP]
Nery, Luiz E. [UNIFESP]
Neder, J. Alberto [UNIFESP]
Universidade Federal de São Paulo (UNIFESP)
Queens Univ
Keywords: Exertion
pulmonary hypertension
exercise testing
Issue Date: 1-Nov-2014
Publisher: Sage Publications Ltd
Citation: European Journal of Preventive Cardiology. London: Sage Publications Ltd, v. 21, n. 11, p. 1409-1419, 2014.
Abstract: Background Increased ventilatory ((V) over dotE) response to carbon dioxide output ((V) over dotCO(2)) is a key finding of incremental cardiopulmonary exercise testing in both heart failure and pulmonary arterial hypertension (PAH). As with heart failure, measures of excessive exercise ventilation considering high-to-peak exercise (V) over dotE-(V) over dotCO(2) might have higher prognostic relevance than those restrained to sub-maximal exercise in PAH.Design Cross-sectional and observational study on a tertiary center.Methods Eighty-four patients (36 idiopathic and 48 with associated conditions) were followed up for up to five years. Excessive exercise ventilation was calculated as a slope (Delta (V) over dotE/Delta (V) over dotCO(2) to the respiratory compensation point ((RCP)) and to exercise cessation ((PEAK))) and as a ratio ((V) over dotE/(V) over dotCO(2) at the anaerobic threshold ((AT)) and at (PEAK)).Results Thirteen patients died and three had atrial septostomy. Multivariable regression analyses revealed that Delta (V) over dotE/Delta(V) over dotCO(2(PEAK)) <55 and (V) over dotE/(V) over dotCO(2(PEAK)) <57 were better related to prognosis than Delta (V) over dotE/Delta (V) over dotCO(2(RCP)) and (V) over dotE/(V) over dotCO(2(AT)) (p<0.01). Delta oxygen uptake ((V) over dotO(2))/ work rate >5.5ml/min per W was the only other independent prognostic index. According to a Kaplan-Meier survival analysis, 96.9% (90.8% to 100%) of patients showing (V) over dotE/ (V) over dotCO(2(PEAK)) <55 and (V) over dotO(2/) work rate >5.5ml/min per W were free from a PAH-related event. in contrast, 74.7% (70.1% to 78.2%) with both parameters outside these ranges had a negative outcome.Conclusion Measurements of excessive exercise ventilation which consider all data points maximize the usefulness of incremental cardiopulmonary exercise testing in the prognosis evaluation of PAH.
ISSN: 2047-4873
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