Does Exercise Ventilatory Inefficiency Predict Poor Outcome in Heart Failure Patients With COPD?

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dc.citation.issue6
dc.citation.volume36
dc.contributor.authorAlencar, Maria Clara Noman de [UNIFESP]
dc.contributor.authorArbex, Flavio Ferlin [UNIFESP]
dc.contributor.authorSouza, Aline [UNIFESP]
dc.contributor.authorMazzuco, Adriana
dc.contributor.authorSperandio, Priscila Abreu [UNIFESP]
dc.contributor.authorRocha, Alcides [UNIFESP]
dc.contributor.authorHirai, Daniel Müller [UNIFESP]
dc.contributor.authorMancuso, Frederico José Neves [UNIFESP]
dc.contributor.authorBerton, Danilo Cortozi [UNIFESP]
dc.contributor.authorBorghi-Silva, Audrey
dc.contributor.authorAlmeida, Dirceu Rodrigues de [UNIFESP]
dc.contributor.authorO'Donnell, Denis Eunan
dc.contributor.authorNeder, Jose Alberto [UNIFESP]
dc.contributor.institutionUniversidade Federal de São Paulo (UNIFESP)
dc.coveragePhiladelphia
dc.date.accessioned2020-07-31T12:47:27Z
dc.date.available2020-07-31T12:47:27Z
dc.date.issued2016
dc.description.abstractPURPOSE: 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.en
dc.description.affiliationUniv Fed Sao Paulo, Div Respirol, Sao Paulo, Brazil
dc.description.affiliationUniv Fed Sao Paulo, Div Cardiol, Sao Paulo, Brazil
dc.description.affiliationQueens Univ, Resp Invest Unit, Kingston, ON, Canada
dc.description.affiliationQueens Univ, Lab Clin Exercise Physiol, Kingston, ON, Canada
dc.description.affiliationKingston Gen Hosp, Kingston, ON, Canada
dc.description.affiliationUniv Fed Sao Carlos, Dept Physiotherapy, BR-13560 Sao Carlos, SP, Brazil
dc.description.affiliationUniv Fed Rio Grande do Sul, Div Respirol, Porto Alegre, RS, Brazil
dc.description.affiliationUnifespDivision of Respirology, Universidade Federal de Sao Paulo, Sao Paulo, Brazil
dc.description.affiliationUnifespDivision of Cardiology, Universidade Federal de Sao Paulo, Sao Paulo, Brazil
dc.description.sourceWeb of Science
dc.format.extent454-459
dc.identifierhttps://dx.doi.org/10.1097/HCR.0000000000000212
dc.identifier.citationJournal Of Cardiopulmonary Rehabilitation And Prevention. Philadelphia, v. 36, n. 6, p. 454-459, 2016.
dc.identifier.doi10.1097/HCR.0000000000000212
dc.identifier.issn1932-7501
dc.identifier.urihttps://repositorio.unifesp.br/handle/11600/56839
dc.identifier.wosWOS:000387995500008
dc.language.isoeng
dc.publisherLippincott Williams & Wilkins
dc.relation.ispartofJournal Of Cardiopulmonary Rehabilitation And Prevention
dc.rightsinfo:eu-repo/semantics/restrictedAccess
dc.subjectCardiopulmonary exercise testen
dc.subjectHeart failureen
dc.subjectLung diseaseen
dc.subjectPrognosisen
dc.titleDoes Exercise Ventilatory Inefficiency Predict Poor Outcome in Heart Failure Patients With COPD?en
dc.typeinfo:eu-repo/semantics/article
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