Please use this identifier to cite or link to this item: https://repositorio.unifesp.br/handle/11600/56839
Title: Does Exercise Ventilatory Inefficiency Predict Poor Outcome in Heart Failure Patients With COPD?
Authors: Alencar, Maria Clara [UNIFESP]
Arbex, Flavio Ferlin [UNIFESP]
Souza, Aline [UNIFESP]
Mazzuco, Adriana
Sperandio, Priscila Abreu [UNIFESP]
Rocha, Alcides [UNIFESP]
Hirai, Daniel Müller [UNIFESP]
Mancuso, Frederico [UNIFESP]
Berton, Danilo C.
Borghi-Silva, Audrey
Almeida, Dirceu [UNIFESP]
O'Donnel, Denis E.
Neder, Jose Alberto [UNIFESP]
Keywords: cardiopulmonary exercise test
heart failure
lung disease
prognosis
Issue Date: 2016
Publisher: Lippincott Williams & Wilkins
Citation: Journal Of Cardiopulmonary Rehabilitation And Prevention. Philadelphia, v. 36, n. 6, p. 454-459, 2016.
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.
URI: https://repositorio.unifesp.br/handle/11600/56839
ISSN: 1932-7501
Other Identifiers: http://dx.doi.org/10.1097/HCR.0000000000000212
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