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Excessive ventilation during early phase of exercise: A new predictor of poor long‐term outcome in patients with chronic heart failure
Author(s) -
Jankowska Ewa A.,
Witkowski Tomasz,
Ponikowska Beata,
Reczuch Krzysztof,
BorodulinNadzieja Ludmila,
Anker Stefan D.,
Piepoli Massimo F.,
Banasiak Waldemar,
Ponikowski Piotr
Publication year - 2007
Publication title -
european journal of heart failure
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 5.149
H-Index - 133
eISSN - 1879-0844
pISSN - 1388-9842
DOI - 10.1016/j.ejheart.2007.07.001
Subject(s) - medicine , cardiology , heart failure , ejection fraction , respiratory minute volume , cardiopulmonary exercise test , ventilation (architecture) , anaerobic exercise , area under the curve , vo2 max , respiratory system , physical therapy , heart rate , blood pressure , mechanical engineering , engineering
Background: Studies demonstrating prognostic value of excessive exercise ventilation in chronic heart failure (CHF) have focused on data derived from the whole cardiopulmonary exercise test (CPET). Whether ventilatory response to early phase of exercise is useful for risk stratification in CHF is unknown. Methods and results: We evaluated 216 patients with systolic CHF who underwent CPET (age: 60±11 years, NYHA class [I/II/III/IV]: 18/104/77/17). Ventilatory response to exercise (slope of regression line relating ventilation to carbon dioxide production) was calculated from the whole exercise test (VE‐VCO 2 ‐all) and from the first 3min of exercise (early phase — VE‐VCO 2 ‐3min). During follow‐up (mean: 40± 20months, >3years in survivors), 89 (41%) CHF patients died. High VE‐VCO 2 ‐all and VE‐VCO 2 ‐3min predicted poor outcome in single predictor analyses, and in multivariable models when adjusted for prognosticators (age, NYHA class, ejection fraction, peak VO 2 ) ( P <0.0001). In receiver operating characteristic curve analysis, areas under curve for 3‐year follow‐up were similar for VE‐VCO 2 ‐all and VE‐VCO 2 ‐3min. VE‐VCO 2 ‐3min maintained its prognostic value in patients taking β‐blockers ( P <0.0001) and those unable to perform maximal CPET ( P =0.0009). Conclusions: In CHF patients, excessive ventilation assessed over the first 3min predicts poor outcome. Assessment of ventilatory response to exercise for prognostic stratification may be extended to patients unable to perform maximal CPET.