Optimizing the evaluation of excess exercise ventilation for prognosis assessment in pulmonary arterial hypertension

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]

Optimizing the evaluation of excess exercise ventilation for prognosis assessment in pulmonary arterial hypertension

Data

2014-11-01

Autores

Ferreira, Eloara V. M.

Ota-Arakaki, Jaquelina S.

Ramos, Roberta P.

Barbosa, Priscila B.

Almeida, Melline

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Artigo

Resumo

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.

Citação

European Journal of Preventive Cardiology. London: Sage Publications Ltd, v. 21, n. 11, p. 1409-1419, 2014.