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

Piotr Ponikowski, Darrel P. Francis, Massimo F. Piepoli, L. Ceri Davies, Tuan Peng Chua, Constantinos H. Davos, Viorel Florea, Waldemar Banasiak, Philip A. Poole-Wilson, Andrew J.S. Coats, Stefan D. Anker

Research output: Contribution to journalArticlepeer-review

326 Scopus citations

Abstract

Background - In patients with chronic heart failure (CHF) and preserved exercise tolerance, the value of cardiopulmonary exercise testing for risk stratification is not known. Elevated slope of ventilatory response to exercise (V̇E/V̇CO2) predicts poor prognosis in advanced CHF. Derangement of cardiopulmonary reflexes may trigger exercise hyperpnea. We assessed the relationship between cardiopulmonary reflexes and V̇E/V̇CO2 and investigated the prognostic value of V̇E/V̇CO2 in CHF patients with preserved exercise tolerance. Methods and Results - Among 344 consecutive CHF patients, we identified 123 with preserved exercise capacity, defined as a peak oxygen consumption (peak V̇O2) ≥18 mL · kg-1 · min-1 (age 56 years; left ventricular ejection fraction 28%; peak V̇O2 23.5 mL · kg-1 · min-1). Hypoxic and hypercapnic chemosensitivity (n=38), heart rate variability (n=34), baroreflex sensitivity (n=20), and ergoreflex activity (n=20) were also assessed. We identified 40 patients (33%) with high V̇E/V̇CO2 (ie, >34.0). During follow-up (49±22 months, >3 years in all survivors), 34 patients died (3-year survival 81%). High V̇E/V̇CO2 (hazard ratio 4.3, P<0.0001) but not peak V̇O2 (P=0.7) predicted mortality. In patients with high V̇E/V̇CO2, 3-year survival was 57%, compared with 93% in patients with normal V̇E/V̇CO2 (P<0.0001). Patients with high V̇E/V̇CO2 demonstrated impaired reflex control, as evidenced by augmented peripheral (P=0.01) and central (P=0.0006) chemosensitivity, depressed low-frequency component of heart rate variability (P<0.0001) and baroreflex sensitivity (P=0.03), and overactive ergoreceptors (P=0.003) compared with patients with normal V̇E/V̇CO2. Conclusions - In CHF patients with preserved exercise capacity, enhanced ventilatory response to exercise is a simple marker of a widespread derangement of cardiovascular reflex control; it predicts poor prognosis, which peak V̇O2 does not.

Original languageEnglish (US)
Pages (from-to)967-972
Number of pages6
JournalCirculation
Volume103
Issue number7
DOIs
StatePublished - Feb 20 2001

Keywords

  • Heart failure
  • Prognosis
  • Respiration
  • Ventilation

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