Assessment of respiratory compensation phase during graded exercise in patients with chronic heart failure.

Clinic of Cardiology, Medical University, Plovdiv, Bulgaria.
Folia medica 01/2007; 49(3-4):26-31.
Source: PubMed

ABSTRACT The VE-VO2 relationship during graded exercise has an inflection point beyond the ventilatory anaerobic threshold (VAT) termed the respiratory compensation point (RCP). Metabolic variables analyzed at the level of VAT and RCP may contribute to the better understanding of such limiting symptoms in chronic heart failure (CHF) patients as dyspnea and early fatigue. The AIM of the present study was to analyze the RCP during symptom limited ramp exercise testing in CHF patients.
Forty six CHF patients (II and III NYHA functional class; age = 51 +/- 9 years, LVEF% = 35% +/- 6%; mean +/- SD) and 20 matched controls performed graded cardiopulmonary exercise test on a cycle ergometer.
The duration and productivity of RCP (delta(x) = peak(x) - VAT(x)) in patients were significantly (p < 0.001) reduced compared to healthy subjects: delta duration = 3.0 +/- 1.2 vs 4.3 +/- 1.5 min, delta watts = 24.3 +/- 11.5 vs. 39.4 +/- 11.5, delta VO2/kg ( x min-1) = 3.8 +/- 1.3 vs 8.8 +/- 2.3. An important characteristic of this phase was the higher subjective cost of physical effort assessed by Borg scale and Watts/Borg ratio (Borg peak = 9.9 +/- 0.4 vs. 6.0 +/- 1.2; p < 0.001, Watts/Borg peak = 9.2 +/- 2.3 vs 23.9 +/- 6.4, p < 0.001). The relative hyperventilation of patients on the basis of the watt exercise can be seen in the values of derivative index V (ml x min-1 x watt-1) 478 +/- 59 vs 568 +/- 118; (p < 0.001) in controls and patients, respectively.
The impaired efficiency of oxygen delivery systems in patients with CHF is what causes the appearance of early limiting symptoms. Duration and productivity of respiratory compensation phase in CHF patients are considerably reduced compared to controls.

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    ABSTRACT: Maximal exercises testing, whether involving cycling- or walking-based protocols, are often not well tolerated in patients with chronic heart failure (CHF). The peak oxygen consumption and the slope of the relation between ventilation (V(E)) and carbon dioxide production (V(CO(2))) are independent predictors of outcome and help risk stratification. The prognostic usefulness of submaximal exercise testing is not clear. The aim of the present study was to assess the prognostic value of the V(E)/V(CO(2)) slope when derived from data acquired from submaximal exercise. 394 patients referred with breathlessness and suspected heart failure (74% male) (mean+/-S.D.) age 60+/-12 years; BMI 27+/-5 performed a CPET to determine peak V(O(2)) and the V(E)/V(CO(2)) slope. The V(E)/V(CO(2)) slope was calculated using least squares regression from data acquired from the first 25% of exercise (mean V(E)/V(CO(2)) slope+/-SD; 30.6+/-5.7), 50% (29.6+/-6.9), below the ventilatory compensation point (sub-VCP) (29.9+/-6.8), and all data points (full slope) (32.1+/-7.8). For each measure, patients were divided into quartiles and Kaplan-Meier curves were constructed to determine probability of death after 24 months. The prognostic value of the different classifications was assessed using the chi(2) statistic from the Mantel-Cox log-rank test. During a mean follow-up period of 41+/-19 months, 48 patients died. For the V(E)/V(CO(2)) slope, the log-rank statistic was greatest for the full slope (chi(2)=53.7; P=0.0001), followed by the sub-VCP (chi(2)=45.5; P=0.0001), 50% (chi(2)=41.9; P=0.0001), and 25% (chi(2)= 26.0; P=0.01). The pair-wise log-rank statistic between the fourth and third quartiles was also greatest using the full slope (chi(2)=25.4; P=0.001) followed in order by the sub-VCP (chi(2)=20.1; P=0.001), 50% (chi(2)=19.7; P=0.001), and 25% (chi(2)=14.2; P=0.05). Using the stratified slope measurements entered into a Cox regression analysis using a forward LR stepwise elimination procedure; only the full slope remained significant (P=0.0001). The V(E)/V(CO(2)) slope should be calculated from all data points to optimise prognostic sensitivity. Data acquired from the first 50% of exercise and below the VCP provide adequate prognostic surrogates in patients who may not be able to perform maximal exercise testing (i.e. in patients with a respiratory exchange ratio<1.10).
    International journal of cardiology 07/2007; 118(3):350-5. · 6.18 Impact Factor