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Title: Impact of chronic obstructive pulmonary disease on exercise ventilatory efficiency in heart failure
Authors: Apostolo, Anna
Laveneziana, PierAntonio
Palange, Paolo
Agalbato, Cecilia
Molle, Roberta
Popovic, Dejana
Bussotti, Maurizio
Internullo, Mattia
Sciomer, Susanna
Bonini, Matteo
Alencar, Maria Clara [UNIFESP]
Godinas, Laurent
Arbex, Flavio [UNIFESP]
Garcia, Gilles
Alberto Neder, J. [UNIFESP]
Agostoni, Piergiuseppe
Hopital Univ Bicetre
Univ Paris 06
Grp Hosp Pitie Salpetriere Charles Foix
Univ Roma La Sapienza
Univ Belgrade
Fdn Salvatore Maugeri
La Sapienza
Universidade Federal de São Paulo (UNIFESP)
Univ Paris 11
Queens Univ
Univ Milan
Keywords: Ventilatory efficiency
Dead space
Heart failure
Lung diseases
Issue Date: 15-Jun-2015
Publisher: Elsevier B.V.
Citation: International Journal of Cardiology. Clare: Elsevier B.V., v. 189, p. 134-140, 2015.
Abstract: Background: Heart failure (HF) and chronic obstructive pulmonary disease (COPD) coexistence increases morbidity and mortality. the intercept of ventilation ((V) over dotEint) on the (V) over dotE vs. carbon dioxide production ((V) over dot CO2) relationship during exercise has been found to vary in proportion with dead space (VD) in HF. Considering that increased VD is the key pathophysiological abnormality in COPD but a secondary finding in HF we hypothesized that a high (V) over dotEint would be useful in suggesting COPD as HF co-morbidity. Our aim was to assess whether an elevated (V) over dotEint suggests the presence of COPD in HF.Methods: in a multicenter retrospective study, the (V) over dotE-(V) over dotCO(2) relationship was analyzed both as slope and intercept in HF (n = 108), HF-COPD (n = 106) and COPD (n = 95). Patients with pulmonary arterial hypertension (PAH) (n= 85) and healthy subjects (HF) (n= 56) served as positive and negative controls relative to (V) over dotE-(V) over dotCO(2) abnormalities, respectively.Results: Slope and (V) over dotEint varied in opposite directions in all groups (p < 0.05) being (V) over dotE-(V) over dotCO(2) slope highest and lowest in PAH and healthy subjects, respectively. No slope differences were observed among HF, HF-COPD and COPD (32 +/- 7, 31 +/- 7, and 31 +/- 6, respectively). (V)over dotEint was higher in HF-COPD and COPD compared to HF, PAH and controls (4.8 +/- 2.4 L/min, 5.9 +/- 3.0 L/min, 3.0 +/- 2.6 L/min, 2.3 +/- 3.3 L/min and 3.9 +/- 2.5 L/min, respectively; p < 0.01). A (V) over dotEint >= 4.07 L/min identified patients with high probability of having COPD or HF-COPD (sensitivity of 71.6% and specificity of 72.0%).Conclusion: These data provide novel evidence that a high (V) over dotEint (>= 4.07 L/min) should be valued to suggest coexistent COPD in HF patients. (C) 2015 Elsevier Ireland Ltd. All rights reserved.
ISSN: 0167-5273
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