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Title: Exercise ventilation in copd: influence of systolic heart failure
Authors: Arbex, Flavio F. [UNIFESP]
Alencar, Maria Clara [UNIFESP]
Souza, Aline [UNIFESP]
Mazzuco, Adriana
Sperandio, Priscila A. [UNIFESP]
Rocha, Alcides [UNIFESP]
Hirai, Daniel M. [UNIFESP]
Mancuso, Frederico [UNIFESP]
Berton, Danilo C.
Borghi-Silva, Audrey
Almeida, Dirceu R. [UNIFESP]
O'Donnell, Denis E.
Neder, J. Alberto [UNIFESP]
Keywords: Carbon Dioxide
Cardiopulmonary Exercise Testing
Gas ExchangeObstructive Pulmonary-Disease
Issue Date: 2016
Publisher: Cadernos Saude Publica
Citation: Copd-Journal Of Chronic Obstructive Pulmonary Disease. Philadelphia, v. 13, n. 6, p. 693-699, 2016.
Abstract: Systolic heart failure is a common and disabling co-morbidity of chronic obstructive pulmonary disease (COPD) which may increase exercise ventilation due to heightened neural drive and/or impaired pulmonary gas exchange efficiency. The influence of heart failure on exercise ventilation, however, remains poorly characterized in COPD. In a prospective study, 98 patients with moderate to very severe COPD [41 with coexisting heart failure
'overlap' (left ventricular ejection fraction < 50%)] underwent an incremental cardiopulmonary exercise test (CPET). Compared to COPD, overlap had lower peak exercise capacity despite higher FEV1. Overlap showed lower operating lung volumes, greater ventilatory inefficiency and larger decrements in end-tidal CO2 (PETCO2) (P < 0.05). These results were consistent with those found in FEV1-matched patients. Larger areas under receiver operating characteristic curves to discriminate overlap from COPD were found for ventilation (VE)-CO2 output VCO2) intercept, VE-VCO2 slope, peak. VE/VCO2 ratio and peak PETCO2. Multiple logistic regression analysis revealed that VE-VCO2 intercept <= 3.5 L/minute [odds ratios (95% CI)=7.69 (2.61-22.65), P < 0.001] plus VE-VCO2 slope >= 34 [2.18 (0.73-6.50), P = 0.14] or peak VE/VCO2 ratio >= 37 [5.35 (1.96-14.59), P = 0.001] plus peak PETCO2 <= 31 mmHg [5.73 (1.42-23.15), P = 0.01] were indicative of overlapping. Heart failure increases the ventilatory response to metabolic demand in COPD. Variables reflecting excessive ventilation might prove useful to assist clinical interpretation of CPET responses in COPD patients presenting heart failure as co-morbidity.
ISSN: 1541-2555
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