TY - JOUR
T1 - Enhanced ventilatory response to exercise in patients with chronic heart failure and preserved exercise tolerance
T2 - Marker of abnormal cardiorespiratory reflex control and predictor of poor prognosis
AU - Ponikowski, Piotr
AU - Francis, Darrel P.
AU - Piepoli, Massimo F.
AU - Davies, L. Ceri
AU - Chua, Tuan Peng
AU - Davos, Constantinos H.
AU - Florea, Viorel
AU - Banasiak, Waldemar
AU - Poole-Wilson, Philip A.
AU - Coats, Andrew J.S.
AU - Anker, Stefan D.
PY - 2001/2/20
Y1 - 2001/2/20
N2 - 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.
AB - 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.
KW - Heart failure
KW - Prognosis
KW - Respiration
KW - Ventilation
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U2 - 10.1161/01.CIR.103.7.967
DO - 10.1161/01.CIR.103.7.967
M3 - Article
C2 - 11181471
AN - SCOPUS:0035916265
SN - 0009-7322
VL - 103
SP - 967
EP - 972
JO - Circulation
JF - Circulation
IS - 7
ER -