Excess ventilation during exercise and prognosis in chronic heart failure

American Journal of Respiratory and Critical Care Medicine

Volumn 183, Issue 10, 2011, Pages 1302-1310

  Sue, Darryl Y ^a,b,c  

^a HARBOR UCLA MEDICAL CENTER   (United States)

^b LOS ANGELES BIOMEDICAL RESEARCH INSTITUTE   (United States)

^c UNIVERSITY OF CALIFORNIA   (United States)

Author keywords

Cardiopulmonary exercise test; Chronic heart failure; Heart function tests; Respiratory dead space; Ventilation during exercise

Indexed keywords

CARVEDILOL;

AEROBIC METABOLISM; ARTERIAL CARBON DIOXIDE TENSION; BETA ADRENERGIC RECEPTOR BLOCKING; BICARBONATE BLOOD LEVEL; CARDIOPULMONARY EXERCISE TEST; CHEMORECEPTOR; CHEMOSENSITIVITY; CONTROLLED STUDY; DYSPNEA; HEART FAILURE; HEART LEFT VENTRICLE EJECTION FRACTION; HEART RIGHT VENTRICLE EJECTION FRACTION; HEART TRANSPLANTATION; HIGH RISK PATIENT; HUMAN; HYPERCAPNIA; HYPERVENTILATION; HYPOXIA; LACTIC ACIDOSIS; LUNG CIRCULATION; LUNG DEAD SPACE; LUNG GAS EXCHANGE; LUNG VASCULAR RESISTANCE; LUNG VENTILATION; LUNG VENTILATION PERFUSION RATIO; METABOLIC ACIDOSIS; METABOLIC RATE; MUSCLE SPINDLE; OBESITY; OXYGEN CONSUMPTION; PERIPHERAL OCCLUSIVE ARTERY DISEASE; POSITRON EMISSION TOMOGRAPHY; PRIORITY JOURNAL; PROGNOSIS; REVIEW; SCINTIANGIOGRAPHY; TIDAL VOLUME;

ACIDOSIS, RESPIRATORY; BLOOD GAS ANALYSIS; CARBON DIOXIDE; CHRONIC DISEASE; EXERCISE; EXERCISE TEST; EXERCISE TOLERANCE; HEART FAILURE; HUMANS; OXYGEN CONSUMPTION; PREDICTIVE VALUE OF TESTS; PROGNOSIS; PULMONARY VENTILATION; RESPIRATORY DEAD SPACE;

EID: 79956203802     PISSN: 1073449X     EISSN: 15354970     Source Type: Journal    
DOI: 10.1164/rccm.201006-0965CI     Document Type: Review

References (80)

1. ERS Task Force, Palange P, Ward SA, Carlsen KH, Casaburi R, Gallagher CG, Gosselink R, O'Donnell DE, Puente-Maestu L, Schols AM, Singh S, et al. Recommendations on the use of exercise testing in clinical practice. Eur Respir J 2007;29:185-209. (Pubitemid 46092015)
2. Dickstein K, Cohen-Solal A, Filippatos G, McMurray JJ, Ponikowski P, Poole-Wilson PA, Strömberg A, vanVeldhuisen DJ, Atar D, Hoes AW, et al. ESC guidelines for the diagnosis and treatment of acute and chronic heart failure 2008: the Task Force for the diagnosis and treatment of acute and chronic heart failure 2008 of the European Society of Cardiology. Developed in collaboration with the Heart Failure Association of the ESC (HFA) and endorsed by the European Society of Intensive Care Medicine (ESICM). Eur J Heart Fail 2008;10:933-989.
3. Hunt SA; American College of Cardiology. American Heart Association Task Force on Practice Guidelines (Writing Committee to Update the 2001 Guidelines for the Evaluation and Management of Heart Failure). ACC/AHA 2005 guideline update for the diagnosis and management of chronic heart failure in the adult: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Update the 2001 Guidelines for the Evaluation and Management of Heart Failure). J Am Coll Cardiol 2005;46:e1-e82.
4. Hunt SA, Abraham WT, Chin MH, Feldman AM, Francis GS, Ganiats TG, Jessup M, Konstam MA, Mancini DM, Michl K, et al. 2009 focused update incorporated into the ACC/AHA 2005 Guidelines for the Diagnosis and Management of Heart Failure in Adults: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines: developed in collaboration with the International Society for Heart and Lung Transplantation. Circulation 2009;119:e391-e479.
5. Balady GJ, Arena R, Sietsema K, Myers J, Coke L, Fletcher GF, Forman D, Franklin B, Guazzi M, Gulati M, et al.; American Heart Association Exercise, Cardiac Rehabilitation, and Prevention Committee of the Council on Clinical Cardiology. Council on Epidemiology and Prevention; Council on Peripheral Vascular Disease; Interdisciplinary Council on Quality of Care and Outcomes Research. Clinician's Guide to cardiopulmonary exercise testing in adults: a scientific statement from the American Heart Association. Circulation 2010;122:191-225.
6. Sun XG, Hansen JE, Garatachea N, Storer TW, Wasserman K. Ventilatory efficiency during exercise in healthy subjects. Am J Respir Crit Care Med 2002;166:1443-1448. (Pubitemid 35387293)
7. Neder JA, Nery LE, Peres C, Whipp BJ. Reference values for dynamic responses to incremental cycle ergometry in males and females aged 20 to 80. Am J Respir Crit Care Med 2001;164:1481-1486. (Pubitemid 33124031)
8. Wensel R, Georgiadou P, Francis DP, Bayne S, Scott AC, Genth-Zotz S, Anker SD, Coats AJ, Piepoli MF. Differential contribution of dead space ventilation and low arterial pCO2 to exercise hyperpnea in patients with chronic heart failure secondary to ischemic or idiopathic dilated cardiomyopathy. Am J Cardiol 2004;93:318-323. (Pubitemid 38167428)
9. Witte KK, Clark AL. Why does chronic heart failure cause breathlessness and fatigue? Prog Cardiovasc Dis 2007;49:366-384.
10. Clark AL, Poole-Wilson PA, Coats AJ. Exercise limitation in chronic heart failure: central role of the periphery. J Am Coll Cardiol 1996;28:1092-1102. (Pubitemid 26376979)
11. Guazzi M, Reina G, Tumminello G, Guazzi MD. Exercise ventilation inefficiency and cardiovascular mortality in heart failure: the critical independent prognostic value of the arterial CO2 partial pressure. Eur Heart J 2005;26:472-480. (Pubitemid 40314763)
12. Narkiewicz K, Pesek CA, van de Borne PJ, Kato M, Somers VK. Enhanced sympathetic and ventilatory responses to central chemoreflex activation in heart failure. Circulation 1999;100:262-267. (Pubitemid 29340132)
13. Ponikowski P, Francis DP, Piepoli MF, Davies LC, Chua TP, Davos CH, Florea V, Banasiak W, Poole-Wilson PA, Coats AJ, et al. Enhanced ventilatory response to exercise in patients with chronic heart failure and preserved exercise tolerance: marker of abnormal cardiorespiratory reflex control and predictor of poor prognosis. Circulation 2001;103:967-972. (Pubitemid 32183802)
14. Witte KK, Notarius CF, Ivanov J, Floras JS. Muscle sympathetic nerve activity and ventilation during exercise in subjects with and without chronic heart failure. Can J Cardiol 2008;24:275-278. (Pubitemid 351771461)
15. Houssiere A, Gujic M, Deboeck G, Ciarka A, Naeije R, van de Borne P. Increased metaboreflex activity is related to exercise intolerance in heart transplant patients. Am J Physiol Heart Circ Physiol 2007;293:H3699-H3706. (Pubitemid 350230916)
16. Wasserman K, Zhang YY, Gitt A, Belardinelli R, Koike A, Lubarsky L, Agostoni PG. Lung function and exercise gas exchange in chronic heart failure. Circulation 1997;96:2221-2227. (Pubitemid 27425826)
17. Lewis GD, Shah RV, Pappagianopolas PP, Systrom DM, Semigran MJ. Determinants of ventilatory efficiency in heart failure: the role of right ventricular performance and pulmonary vascular tone. Circ Heart Fail. 2008;1:227-233.
18. Woods PR, Olson TP, Frantz RP, Johnson BD. Causes of breathing inefficiency during exercise in heart failure. J Card Fail 2010;16:835-842.
19. Ukkonen H, Burwash IG, Dafoe W, de Kemp RA, Haddad H, Yoshinaga K, Davies RA, Gannon EK, Dasilva JN, Beanlands RS. Is ventilatory efficiency (VE/VCO(2) slope) associated with right ventricular oxidative metabolism in patients with congestive heart failure? Eur J Heart Fail 2008;10:1117-1122.
20. Clark AL, Swan JW, Laney R, Connelly M, Somerville J, Coats AJ. The role of right and left ventricular function in the ventilatory response to exercise in chronic heart failure. Circulation 1994;89:2062-2069. (Pubitemid 24142782)
21. Sullivan MJ, Higginbotham MB, Cobb FR. Increased exercise ventilation in patients with chronic heart failure: intact ventilatory control despite hemodynamic and pulmonary abnormalities. Circulation 1988;77:552-559. (Pubitemid 18073347)
22. Banning AP, Lewis NP, Northridge DB, Elborn JS, Hendersen AH. Perfusion/ventilation mismatch during exercise in chronic heart failure: an investigation of circulatory determinants. Br Heart J 1995;74:27-33.
23. Buller NP, Poole-Wilson PA. Mechanism of the increased ventilatory response to exercise in patients with chronic heart failure. Br Heart J 1990;63:281-283. (Pubitemid 20187359)
24. Clark AL, Chua TP, Coats AJ. Anatomical dead space, ventilatory pattern, and exercise capacity in chronic heart failure. Br Heart J 1995;74:377-380.
25. Gardin JM, Leifer ES, Fleg JL, Whellan D, Kokkinos P, Leblanc MH, Wolfel E, Kitzman DW. HF-ACTION Investigators. Relationship of Doppler- echocardiographic left ventricular diastolic function to exercise performance in systolic heart failure: the HF-ACTION study. Am Heart J 2009; 158:S45-S52.
26. Szlachcic J, Massie BM, Kramer BL, Topic N, Tubau J. Correlates and prognostic implication of exercise capacity in chronic congestive heart failure. Am J Cardiol 1985;55:1037-1042. (Pubitemid 15085359)
27. Mancini DM, Eisen H, Kussmaul W, Mull R, Edmunds LH Jr, Wilson JR. Value of peak exercise oxygen consumption for optimal timing of cardiac transplantation in ambulatory patients with heart failure. Circulation 1991;83:778-786.
28. Likoff MJ, Chandler SL, Kay HR. Clinical determinants of mortality in chronic congestive heart failure secondary to idiopathic dilated or to ischemic cardiomyopathy. Am J Cardiol 1987;59:634-638. (Pubitemid 17047334)
29. Stelken AM, Younis LT, Jennison SH, Miller DD, Miller LW, Shaw LJ, Kargl D, Chaitman BR. Prognostic value of cardiopulmonary exercise testing using percent achieved of predicted peak oxygen uptake for patients with ischemic and dilated cardiomyopathy. J Am Coll Cardiol 1996;27:345-352. (Pubitemid 26045501)
30. Myers J, Gullestad L, Vagelos R, Do D, Bellin D, Ross H, Fowler MB. Clinical, hemodynamic, and cardiopulmonary exercise test determinants of survival in patients referred for evaluation of heart failure. Ann Intern Med 1998;129:286-293. (Pubitemid 28394573)
31. Lund LH, Mancini DM. Peak VO2 in elderly patients with heart failure. Int J Cardiol 2008;125:166-171.
32. Green P, Lund LH, Mancini D. Comparison of peak exercise oxygen consumption and the Heart Failure Survival Score for predicting prognosis in women versus men. Am J Cardiol 2007;99:399-403. (Pubitemid 46151763)
33. Elmariah S, Goldberg LR, Allen MT, Kao A. Effects of gender on peak oxygen consumption and the timing of cardiac transplantation. J Am Coll Cardiol 2006;47:2237-2242. (Pubitemid 43795069)
34. Lavie CJ, Milani RV, Ventura HO. Obesity and cardiovascular disease: risk factor, paradox, and impact of weight loss. J Am Coll Cardiol 2009;53:1925-1932.
35. Oreopoulos A, Padwal R, Kalantar-Zadeh K, Fonarow GC, Norris CM, McAlister FA. Body mass index and mortality in heart failure: a meta-analysis. Am Heart J 2008;156:13-22. (Pubitemid 351862293)
36. Chase P, Arena R, Myers J, Abella J, Peberdy MA, Guazzi M, Bensimhon D. Relation of the prognostic value of ventilatory efficiency to body mass index in patients with heart failure. Am J Cardiol 2008;101:348-352. (Pubitemid 351162966)
37. Wolfel EE. Exercise testing with concurrent beta-blocker usage: is it useful? What do we learn? Curr Heart Fail Rep 2006;3:81-88.
38. Guazzi M, Agostoni P, Matturri M, Pontone G, Guazzi MD. Pulmonary function, cardiac function, and exercise capacity in a follow-up of patients with congestive heart failure treated with carvedilol. Am Heart J 1999;138:460-467. (Pubitemid 29428768)
39. Corrà U, Mezzani A, Bosimini E, Scapellato F, Temporelli PL, Eleuteri E, Giannuzzi P. Limited predictive value of cardiopulmonary exercise indices in patients with moderate chronic heart failure treated with carvedilol. Am Heart J 2004;147:553-560. (Pubitemid 38880882)
40. Farr MJ, Lang CC, Lamanca JJ, Zile MR, Francis G, Tavazzi L, Gaasch WH, St John Sutton M, Itoh H, Mancini D. MCC-135 GO1 Investigators. Cardiopulmonary exercise variables in diastolic versus systolic heart failure. Am J Cardiol 2008;15:203-206.
41. Guazzi M, Myers J, Arena R. Cardiopulmonary exercise testing in the clinical and prognostic assessment of diastolic heart failure. J Am Coll Cardiol 2005;15:1883-1890. (Pubitemid 41579812)
42. Moore B, Brubaker PH, Stewart KP, Kitzman DW. VE/VCO2 slope in older heart failure patients with normal versus reduced ejection fraction compared with age-matched healthy controls. J Card Fail 2007;13:259-262. (Pubitemid 46756338)
43. Arena R, Myers J, Guazzi M. The clinical and research applications of aerobic capacity and ventilatory efficiency in heart failure: an evidence-based review. Heart Fail Rev 2008;13:245-269.
44. MacGowan GA, Janosko K, Cecchetti A, Murali S. Exercise-related ventilatory abnormalities and survival in congestive heart failure. Am J Cardiol 1997;79:1264-1266. (Pubitemid 27255178)
45. Chua TP, Ponikowski P, Harrington D, Anker SD, Webb-Peploe K, Clark AL, Poole-Wilson PA, Coats AJ. Clinical correlates and prognostic significance of the ventilatory response to exercise in chronic heart failure. J Am Coll Cardiol 1997;29:1585-1590. (Pubitemid 27272454)
46. Robbins M, Francis G, Pashkow FJ, Snader CE, Hoercher K, Young JB, Lauer MS. Ventilatory and heart rate responses to exercise: better predictors of heart failure mortality than peak oxygen consumption. Circulation 1999;100:2411-2417.
47. Francis DP, Shamim W, Davies LC, Piepoli MF, Ponikowski P, Anker SD, Coats AJ. Cardiopulmonary exercise testing for prognosis in chronic heart failure: continuous and independent prognostic value from VE/VCO(2)slope and peak VO(2). Eur Heart J 2000;21:154-161.
48. Corrà U, Mezzani A, Bosimini E, Scapellato F, Imparato A, Giannuzzi P. Ventilatory response to exercise improves risk stratification in patients with chronic heart failure and intermediate functional capacity. Am Heart J 2002;143:418-426. (Pubitemid 34185171)
49. Mejhert M, Linder-Klingsell E, Edner M, Kahan T, Persson H. Ventilatory variables are strong prognostic markers in elderly patients with heart failure. Heart 2002;88:239-243. (Pubitemid 34913503)
50. Gitt AK, Wasserman K, Kilkowski C, Kleemann T, Kilkowski A, Bangert M, Schneider S, Schwarz A, Senges J. Exercise anaerobic threshold and ventilatory efficiency identify heart failure patients for high risk of early death. Circulation 2002;106:3079-3084. (Pubitemid 35440292)
51. Arena R, Myers J, Aslam SS, Varughese EB, Peberdy MA. Peak VO2 and VE/VCO2 slope in patients with heart failure: a prognostic comparison. Am Heart J 2004;147:354-360. (Pubitemid 38176838)
52. Arena R, Myers J, Abella J, Peberdy MA. Influence of heart failure etiology on the prognostic value of peak oxygen consumption and minute ventilation/carbon dioxide production slope. Chest 2005;128:2812-2817. (Pubitemid 41507644)
53. Nanas SN, Nanas JN, Sakellariou DCh, Dimopoulos SK, Drakos SG, Kapsimalakou SG, Mpatziou CA, Papazachou OG, Dalianis AS, Anastasiou-Nana MI, et al. VE/VCO2 slope is associated with abnormal resting haemodynamics and is a predictor of long-term survival in chronic heart failure. Eur J Heart Fail 2006;8:420-427. (Pubitemid 43853088)
54. Guazzi M, Arena R, Myers J. Comparison of the prognostic value of cardiopulmonary exercise testing between male and female patients with heart failure. Int J Cardiol 2006;113:395-400. (Pubitemid 44780771)
55. Tsurugaya H, Adachi H, Kurabayashi M, Ohshima S, Taniguchi K. Prognostic impact of ventilatory efficiency in heart disease patients with preserved exercise tolerance. Circ J 2006;70:1332-1336. (Pubitemid 44453230)
56. Arena R, Myers J, Abella J, Peberdy MA, Bensimhon D, Chase P, Guazzi M. Development of a ventilatory classification system in patients with heart failure. Circulation 2007;115:2410-2417. (Pubitemid 46717963)
57. Arena R, Myers J, Hsu L, Peberdy MA, Pinkstaff S, Bensimhon D, Chase P, Vicenzi M, Guazzi M. The minute ventilation/carbon dioxide production slope is prognostically superior to the oxygen uptake efficiency slope. J Card Fail 2007;13:462-469. (Pubitemid 47176925)
58. Sarullo FM, Fazio G, Brusca I, Fasullo S, Paterna S, Licata P, Novo G, Novo S, Di Pasquale P. Cardiopulmonary exercise testing in patients with chronic heart failure: prognostic comparison from peak VO2 and VE/VCO2 slope. Open Cardiovasc Med J. 2010;4:127-134.
59. Ferreira AM, Tabet JY, Frankenstein L, Metra M, Mendes M, Zugck C, Beauvais F, Cohen-Solal A. Ventilatory efficiency and the selection of patients for heart transplantation. Circ Heart Fail. 2010;3:378-386.
60. Arena R, Myers J, Abella J, Pinkstaff S, Brubaker P, Kitzman D, Peberdy MA, Bensimhon D, Chase P, Forman DE, et al. Defining the optimal prognostic window for cardiopulmonary exercise testing in patients with heart failure. Circ Heart Fail. 2010;3:405-411.
61. Bard RL, Gillespie BW, Clarke NS, Egan TG, Nicklas JM. Determining the best ventilatory efficiency measure to predict mortality in patients with heart failure. J Heart Lung Transplant 2006;25:589-595.
62. Tabet JY, Beauvais F, Thabut G, Tartière JM, Logeart D, Cohen-Solal A. A critical appraisal of the prognostic value of the VE/VCO2 slope in chronic heart failure. Eur J Cardiovasc Prev Rehabil 2003;10:267-272. (Pubitemid 37433491)
63. Jankowska EA, Witkowski T, Ponikowska B, Reczuch K, Borodulin-Nadzieja L, Anker SD, Piepoli MF, Banasiak W, Ponikowski P. Excessive ventilation during early phase of exercise: a new predictor of poor long-term outcome in patients with chronic heart failure. Eur J Heart Fail 2007;9:1024-1031. (Pubitemid 47451807)
64. Myers J, Arena R, Oliveira RB, Bensimhon D, Hsu L, Chase P, Guazzi M, Brubaker P, Moore B, Kitzman D, et al. The lowest VE/VCO2 ratio during exercise as a predictor of outcomes in patients with heart failure. J Card Fail 2009;15:756-762.
65. Arena R, Peberdy MA, Myers J, Guazzi M, Tevald M. Prognostic value of resting end-tidal carbon dioxide in patients with heart failure. Int J Cardiol 2006;109:351-358.
66. Tanabe Y, Hosaka Y, Ito M, Ito E, Suzuki K. Significance of end-tidal P(CO(2)) response to exercise and its relation to functional capacity in patients with chronic heart failure. Chest 2001;119:811-817. (Pubitemid 32197653)
67. Matsumoto A, Itoh H, Eto Y, Kobayashi T, Kato M, Omata M, Watanabe H, Kato K, Momomura S. End-tidal CO2 pressure decreases during exercise in cardiac patients: association with severity of heart failure and cardiac output reserve. J Am Coll Cardiol 2000;36:242-249. (Pubitemid 30466140)
68. Arena R, Myers J, Abella J, Pinkstaff S, Brubaker P, Moore B, Kitzman D, Peberdy MA, Bensimhon D, Chase P, et al. The partial pressure of resting end-tidal carbon dioxide predicts major cardiac events in patients with systolic heart failure. Am Heart J 2008;156:982-988.
69. Myers J, Gujja P, Neelagaru S, Hsu L, Vittorio T, Jackson-Nelson T, Burkhoff D. End-tidal CO2 pressure and cardiac performance during exercise in heart failure. Med Sci Sports Exerc 2009;41:19-25.
70. Hoshimoto-Iwamoto M, Koike A, Nagayama O, Tajima A, Suzuki T, Uejima T, Sawada H, Aizawa T. Prognostic value of end-tidal CO2 pressure during exercise in patients with left ventricular dysfunction. J Physiol Sci 2009;59:49-55.
71. Myers J, Arena R, Dewey F, Bensimhon D, Abella J, Hsu L, Chase P, Guazzi M, Peberdy MA. A cardiopulmonary exercise testing score for predicting outcomes in patients with heart failure. Am Heart J 2008;156:1177-1183.
72. Guazzi M, Arena R, Ascione A, Piepoli M, Guazzi MD. Gruppo di Studio Fisiologia dell'Esercizio, Cardiologia dello Sport e Riabilitazione Cardiovascolare of the Italian Society of Cardiology. Exercise oscillatory breathing and increased ventilation to carbon dioxide production slope in heart failure: an unfavorable combination with high prognostic value. Am Heart J 2007;153:859-867.
73. Sun XG, Hansen JE, Beshai JF, Wasserman K. Oscillatory breathing and exercise gas exchange abnormalities prognosticate early mortality and morbidity in heart failure. J Am Coll Cardiol 2010;55:1814-1823.
74. Arena RA, Guazzi M, Myers J, Abella J. The prognostic value of ventilatory efficiency with beta-blocker therapy in heart failure. Med Sci Sports Exerc 2007;39:213-219. (Pubitemid 46204286)
75. Wolk R, Johnson BD, Somers VK, Allison TG, Squires RW, Gau GT, Olson LJ. Effects of beta-blocker therapy on ventilatory responses to exercise in patients with heart failure. J Card Fail 2005;11:340-342.
76. Agostoni P, Contini M, Magini A, Apostolo A, Cattadori G, Bussotti M, Veglia F, Andreini D, Palermo P. Carvedilol reduces exercise-induced hyperventilation: A benefit in normoxia and a problem with hypoxia. Eur J Heart Fail 2006;8:729-735. (Pubitemid 44637272)
77. Agostoni P, Guazzi M, Bussotti M, De Vita S, Palermo P. Carvedilol reduces the inappropriate increase of ventilation during exercise in heart failure patients. Chest 2002;122:2062-2067. (Pubitemid 36054183)
78. Guimarães GV, Silva MS, d'Avila VM, Ferreira SM, Silva CP, Bocchi EA. Peak VO2 and VE/VCO2 slope in betablockers era in patients with heart failure: a Brazilian experience. Arq Bras Cardiol 2008;91:39-48.
79. Arena R, Myers J, Abella J, Pinkstaff S, Brubaker P, Moore B, Kitzman D, Peberdy MA, Bensimhon D, Chase P, et al. Influence of etiology of heart failure on the obesity paradox. Am J Cardiol 2009;104:1116-1121.
80. Guazzi M, Myers J, Vicenzi M, Bensimhon D, Chase P, Pinkstaff S, Arena R. Cardiopulmonary exercise testing characteristics in heart failure patients with and without concomitant chronic obstructive pulmonary disease. Am Heart J 2010;160:900-905.