Optimizing the evaluation of excess exercise ventilation for prognosis assessment in pulmonary arterial hypertension
Background Increased ventilatory ( V · E) response to carbon dioxide output ( V · CO2) is a key finding of incremental cardiopulmonary exercise testing in both heart failure and pulmonary arterial hypertension (PAH). As with heart failure, measures of excessive exercise ventilation considering high-...
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| Veröffentlicht in: | European journal of preventive cardiology 2014-11, Vol.21 (11), p.1409-1419 |
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| creator | Ferreira, Eloara VM Ota-Arakaki, Jaquelina S Ramos, Roberta P Barbosa, Priscila B Almeida, Melline Treptow, Erika C Valois, Fabricio M Nery, Luiz E Neder, J Alberto |
| description | Background
Increased ventilatory (
V
·
E) response to carbon dioxide output (
V
·
CO2) is a key finding of incremental cardiopulmonary exercise testing in both heart failure and pulmonary arterial hypertension (PAH). As with heart failure, measures of excessive exercise ventilation considering high-to-peak exercise
V
·
E–
V
·
CO2 might have higher prognostic relevance than those restrained to sub-maximal exercise in PAH.
Design
Cross-sectional and observational study on a tertiary center.
Methods
Eighty-four patients (36 idiopathic and 48 with associated conditions) were followed up for up to five years. Excessive exercise ventilation was calculated as a slope (Δ
V
·
E/Δ
V
·
CO2 to the respiratory compensation point (RCP) and to exercise cessation (PEAK)) and as a ratio (
V
·
E/
V
·
CO2 at the anaerobic threshold (AT) and at PEAK).
Results
Thirteen patients died and three had atrial septostomy. Multivariable regression analyses revealed that Δ
V
·
E/Δ
V
·
CO2(PEAK) |
| doi_str_mv | 10.1177/2047487313494293 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_1612980609</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sage_id>10.1177_2047487313494293</sage_id><sourcerecordid>1612980609</sourcerecordid><originalsourceid>FETCH-LOGICAL-c409t-a5beb08e9dd3b4a09765d08f15517f3166f672d99f14a6064cfad7555c2031943</originalsourceid><addsrcrecordid>eNp1kE1LxDAQQIMoKurdk-QieKkmTdokRxG_QPCi55JtJ2ukTWqmFfXXG9lVQTCXGTJvZpJHyCFnp5wrdVYyqaRWggtpZGnEBtn9uiqk1nzzJ1dihxwgPrN8alaWWm-TnVIorZRRu2S6Hyc_-A8flnR6Agqvtp_t5GOg0VF4awExB0itR6CvECbfr8ouJjqmuAwRPVKLmMkh16kPdJz7IQab3qlNEyRve_r0PkLOA-befbLlbI9wsI575PHq8uHipri7v769OL8rWsnMVNhqAQumwXSdWEjLjKqrjmnHq4orJ3hdu1qVnTGOS1uzWrbOdqqqqrZkghsp9sjJam5-58sMODWDxxb63gaIMza85qXRWYvJKFuhbYqICVwzJj_kHzScNV-6m7-6c8vRevq8GKD7afiWm4HjNWCxtb1LNmSLv5zWUhjDM1esOLRLaJ7jnEK28v_iTyr1loY</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>1612980609</pqid></control><display><type>article</type><title>Optimizing the evaluation of excess exercise ventilation for prognosis assessment in pulmonary arterial hypertension</title><source>Access via SAGE</source><source>MEDLINE</source><source>Oxford University Press Journals All Titles (1996-Current)</source><source>Alma/SFX Local Collection</source><creator>Ferreira, Eloara VM ; Ota-Arakaki, Jaquelina S ; Ramos, Roberta P ; Barbosa, Priscila B ; Almeida, Melline ; Treptow, Erika C ; Valois, Fabricio M ; Nery, Luiz E ; Neder, J Alberto</creator><creatorcontrib>Ferreira, Eloara VM ; Ota-Arakaki, Jaquelina S ; Ramos, Roberta P ; Barbosa, Priscila B ; Almeida, Melline ; Treptow, Erika C ; Valois, Fabricio M ; Nery, Luiz E ; Neder, J Alberto</creatorcontrib><description>Background
Increased ventilatory (
V
·
E) response to carbon dioxide output (
V
·
CO2) is a key finding of incremental cardiopulmonary exercise testing in both heart failure and pulmonary arterial hypertension (PAH). As with heart failure, measures of excessive exercise ventilation considering high-to-peak exercise
V
·
E–
V
·
CO2 might have higher prognostic relevance than those restrained to sub-maximal exercise in PAH.
Design
Cross-sectional and observational study on a tertiary center.
Methods
Eighty-four patients (36 idiopathic and 48 with associated conditions) were followed up for up to five years. Excessive exercise ventilation was calculated as a slope (Δ
V
·
E/Δ
V
·
CO2 to the respiratory compensation point (RCP) and to exercise cessation (PEAK)) and as a ratio (
V
·
E/
V
·
CO2 at the anaerobic threshold (AT) and at PEAK).
Results
Thirteen patients died and three had atrial septostomy. Multivariable regression analyses revealed that Δ
V
·
E/Δ
V
·
CO2(PEAK) <55 and
V
·
E/
V
·
CO2(PEAK) <57 were better related to prognosis than Δ
V
·
E/Δ
V
·
CO2(RCP) and
V
·
E/
V
·
CO2(AT) (p < 0.01). Δ oxygen uptake (
V
·
O2)/Δ work rate >5.5 ml/min per W was the only other independent prognostic index. According to a Kaplan–Meier survival analysis, 96.9% (90.8% to 100%) of patients showing Δ
V
·
E/Δ
V
·
CO2(PEAK) <55 and Δ
V
·
O2/Δ work rate >5.5 ml/min per W were free from a PAH-related event. In contrast, 74.7% (70.1% to 78.2%) with both parameters outside these ranges had a negative outcome.
Conclusion
Measurements of excessive exercise ventilation which consider all data points maximize the usefulness of incremental cardiopulmonary exercise testing in the prognosis evaluation of PAH.</description><identifier>ISSN: 2047-4873</identifier><identifier>EISSN: 2047-4881</identifier><identifier>DOI: 10.1177/2047487313494293</identifier><identifier>PMID: 23787797</identifier><language>eng</language><publisher>London, England: SAGE Publications</publisher><subject>Adult ; Arterial Pressure ; Biological and medical sciences ; Brazil ; Cardiology. Vascular system ; Chi-Square Distribution ; Cross-Sectional Studies ; Disease Progression ; Disease-Free Survival ; Exercise Test ; Female ; Heart ; Humans ; Hypertension, Pulmonary - diagnosis ; Hypertension, Pulmonary - mortality ; Hypertension, Pulmonary - physiopathology ; Hypertension, Pulmonary - therapy ; Kaplan-Meier Estimate ; Lung - physiopathology ; Male ; Medical sciences ; Middle Aged ; Multivariate Analysis ; Pneumology ; Predictive Value of Tests ; Proportional Hazards Models ; Prospective Studies ; Pulmonary Artery - physiopathology ; Pulmonary hypertension. Acute cor pulmonale. Pulmonary embolism. Pulmonary vascular diseases ; Pulmonary Ventilation ; Risk Factors ; Spirometry ; Tertiary Care Centers ; Time Factors ; Young Adult</subject><ispartof>European journal of preventive cardiology, 2014-11, Vol.21 (11), p.1409-1419</ispartof><rights>The European Society of Cardiology 2013 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav</rights><rights>2015 INIST-CNRS</rights><rights>The European Society of Cardiology 2013 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c409t-a5beb08e9dd3b4a09765d08f15517f3166f672d99f14a6064cfad7555c2031943</citedby><cites>FETCH-LOGICAL-c409t-a5beb08e9dd3b4a09765d08f15517f3166f672d99f14a6064cfad7555c2031943</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://journals.sagepub.com/doi/pdf/10.1177/2047487313494293$$EPDF$$P50$$Gsage$$H</linktopdf><linktohtml>$$Uhttps://journals.sagepub.com/doi/10.1177/2047487313494293$$EHTML$$P50$$Gsage$$H</linktohtml><link.rule.ids>314,780,784,21819,27924,27925,43621,43622</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=28843991$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/23787797$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Ferreira, Eloara VM</creatorcontrib><creatorcontrib>Ota-Arakaki, Jaquelina S</creatorcontrib><creatorcontrib>Ramos, Roberta P</creatorcontrib><creatorcontrib>Barbosa, Priscila B</creatorcontrib><creatorcontrib>Almeida, Melline</creatorcontrib><creatorcontrib>Treptow, Erika C</creatorcontrib><creatorcontrib>Valois, Fabricio M</creatorcontrib><creatorcontrib>Nery, Luiz E</creatorcontrib><creatorcontrib>Neder, J Alberto</creatorcontrib><title>Optimizing the evaluation of excess exercise ventilation for prognosis assessment in pulmonary arterial hypertension</title><title>European journal of preventive cardiology</title><addtitle>Eur J Cardiovasc Prev Rehabil</addtitle><description>Background
Increased ventilatory (
V
·
E) response to carbon dioxide output (
V
·
CO2) is a key finding of incremental cardiopulmonary exercise testing in both heart failure and pulmonary arterial hypertension (PAH). As with heart failure, measures of excessive exercise ventilation considering high-to-peak exercise
V
·
E–
V
·
CO2 might have higher prognostic relevance than those restrained to sub-maximal exercise in PAH.
Design
Cross-sectional and observational study on a tertiary center.
Methods
Eighty-four patients (36 idiopathic and 48 with associated conditions) were followed up for up to five years. Excessive exercise ventilation was calculated as a slope (Δ
V
·
E/Δ
V
·
CO2 to the respiratory compensation point (RCP) and to exercise cessation (PEAK)) and as a ratio (
V
·
E/
V
·
CO2 at the anaerobic threshold (AT) and at PEAK).
Results
Thirteen patients died and three had atrial septostomy. Multivariable regression analyses revealed that Δ
V
·
E/Δ
V
·
CO2(PEAK) <55 and
V
·
E/
V
·
CO2(PEAK) <57 were better related to prognosis than Δ
V
·
E/Δ
V
·
CO2(RCP) and
V
·
E/
V
·
CO2(AT) (p < 0.01). Δ oxygen uptake (
V
·
O2)/Δ work rate >5.5 ml/min per W was the only other independent prognostic index. According to a Kaplan–Meier survival analysis, 96.9% (90.8% to 100%) of patients showing Δ
V
·
E/Δ
V
·
CO2(PEAK) <55 and Δ
V
·
O2/Δ work rate >5.5 ml/min per W were free from a PAH-related event. In contrast, 74.7% (70.1% to 78.2%) with both parameters outside these ranges had a negative outcome.
Conclusion
Measurements of excessive exercise ventilation which consider all data points maximize the usefulness of incremental cardiopulmonary exercise testing in the prognosis evaluation of PAH.</description><subject>Adult</subject><subject>Arterial Pressure</subject><subject>Biological and medical sciences</subject><subject>Brazil</subject><subject>Cardiology. Vascular system</subject><subject>Chi-Square Distribution</subject><subject>Cross-Sectional Studies</subject><subject>Disease Progression</subject><subject>Disease-Free Survival</subject><subject>Exercise Test</subject><subject>Female</subject><subject>Heart</subject><subject>Humans</subject><subject>Hypertension, Pulmonary - diagnosis</subject><subject>Hypertension, Pulmonary - mortality</subject><subject>Hypertension, Pulmonary - physiopathology</subject><subject>Hypertension, Pulmonary - therapy</subject><subject>Kaplan-Meier Estimate</subject><subject>Lung - physiopathology</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Middle Aged</subject><subject>Multivariate Analysis</subject><subject>Pneumology</subject><subject>Predictive Value of Tests</subject><subject>Proportional Hazards Models</subject><subject>Prospective Studies</subject><subject>Pulmonary Artery - physiopathology</subject><subject>Pulmonary hypertension. Acute cor pulmonale. Pulmonary embolism. Pulmonary vascular diseases</subject><subject>Pulmonary Ventilation</subject><subject>Risk Factors</subject><subject>Spirometry</subject><subject>Tertiary Care Centers</subject><subject>Time Factors</subject><subject>Young Adult</subject><issn>2047-4873</issn><issn>2047-4881</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2014</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp1kE1LxDAQQIMoKurdk-QieKkmTdokRxG_QPCi55JtJ2ukTWqmFfXXG9lVQTCXGTJvZpJHyCFnp5wrdVYyqaRWggtpZGnEBtn9uiqk1nzzJ1dihxwgPrN8alaWWm-TnVIorZRRu2S6Hyc_-A8flnR6Agqvtp_t5GOg0VF4awExB0itR6CvECbfr8ouJjqmuAwRPVKLmMkh16kPdJz7IQab3qlNEyRve_r0PkLOA-befbLlbI9wsI575PHq8uHipri7v769OL8rWsnMVNhqAQumwXSdWEjLjKqrjmnHq4orJ3hdu1qVnTGOS1uzWrbOdqqqqrZkghsp9sjJam5-58sMODWDxxb63gaIMza85qXRWYvJKFuhbYqICVwzJj_kHzScNV-6m7-6c8vRevq8GKD7afiWm4HjNWCxtb1LNmSLv5zWUhjDM1esOLRLaJ7jnEK28v_iTyr1loY</recordid><startdate>20141101</startdate><enddate>20141101</enddate><creator>Ferreira, Eloara VM</creator><creator>Ota-Arakaki, Jaquelina S</creator><creator>Ramos, Roberta P</creator><creator>Barbosa, Priscila B</creator><creator>Almeida, Melline</creator><creator>Treptow, Erika C</creator><creator>Valois, Fabricio M</creator><creator>Nery, Luiz E</creator><creator>Neder, J Alberto</creator><general>SAGE Publications</general><general>Sage Publications</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>20141101</creationdate><title>Optimizing the evaluation of excess exercise ventilation for prognosis assessment in pulmonary arterial hypertension</title><author>Ferreira, Eloara VM ; Ota-Arakaki, Jaquelina S ; Ramos, Roberta P ; Barbosa, Priscila B ; Almeida, Melline ; Treptow, Erika C ; Valois, Fabricio M ; Nery, Luiz E ; Neder, J Alberto</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c409t-a5beb08e9dd3b4a09765d08f15517f3166f672d99f14a6064cfad7555c2031943</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2014</creationdate><topic>Adult</topic><topic>Arterial Pressure</topic><topic>Biological and medical sciences</topic><topic>Brazil</topic><topic>Cardiology. Vascular system</topic><topic>Chi-Square Distribution</topic><topic>Cross-Sectional Studies</topic><topic>Disease Progression</topic><topic>Disease-Free Survival</topic><topic>Exercise Test</topic><topic>Female</topic><topic>Heart</topic><topic>Humans</topic><topic>Hypertension, Pulmonary - diagnosis</topic><topic>Hypertension, Pulmonary - mortality</topic><topic>Hypertension, Pulmonary - physiopathology</topic><topic>Hypertension, Pulmonary - therapy</topic><topic>Kaplan-Meier Estimate</topic><topic>Lung - physiopathology</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Middle Aged</topic><topic>Multivariate Analysis</topic><topic>Pneumology</topic><topic>Predictive Value of Tests</topic><topic>Proportional Hazards Models</topic><topic>Prospective Studies</topic><topic>Pulmonary Artery - physiopathology</topic><topic>Pulmonary hypertension. Acute cor pulmonale. Pulmonary embolism. Pulmonary vascular diseases</topic><topic>Pulmonary Ventilation</topic><topic>Risk Factors</topic><topic>Spirometry</topic><topic>Tertiary Care Centers</topic><topic>Time Factors</topic><topic>Young Adult</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Ferreira, Eloara VM</creatorcontrib><creatorcontrib>Ota-Arakaki, Jaquelina S</creatorcontrib><creatorcontrib>Ramos, Roberta P</creatorcontrib><creatorcontrib>Barbosa, Priscila B</creatorcontrib><creatorcontrib>Almeida, Melline</creatorcontrib><creatorcontrib>Treptow, Erika C</creatorcontrib><creatorcontrib>Valois, Fabricio M</creatorcontrib><creatorcontrib>Nery, Luiz E</creatorcontrib><creatorcontrib>Neder, J Alberto</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>European journal of preventive cardiology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Ferreira, Eloara VM</au><au>Ota-Arakaki, Jaquelina S</au><au>Ramos, Roberta P</au><au>Barbosa, Priscila B</au><au>Almeida, Melline</au><au>Treptow, Erika C</au><au>Valois, Fabricio M</au><au>Nery, Luiz E</au><au>Neder, J Alberto</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Optimizing the evaluation of excess exercise ventilation for prognosis assessment in pulmonary arterial hypertension</atitle><jtitle>European journal of preventive cardiology</jtitle><addtitle>Eur J Cardiovasc Prev Rehabil</addtitle><date>2014-11-01</date><risdate>2014</risdate><volume>21</volume><issue>11</issue><spage>1409</spage><epage>1419</epage><pages>1409-1419</pages><issn>2047-4873</issn><eissn>2047-4881</eissn><abstract>Background
Increased ventilatory (
V
·
E) response to carbon dioxide output (
V
·
CO2) is a key finding of incremental cardiopulmonary exercise testing in both heart failure and pulmonary arterial hypertension (PAH). As with heart failure, measures of excessive exercise ventilation considering high-to-peak exercise
V
·
E–
V
·
CO2 might have higher prognostic relevance than those restrained to sub-maximal exercise in PAH.
Design
Cross-sectional and observational study on a tertiary center.
Methods
Eighty-four patients (36 idiopathic and 48 with associated conditions) were followed up for up to five years. Excessive exercise ventilation was calculated as a slope (Δ
V
·
E/Δ
V
·
CO2 to the respiratory compensation point (RCP) and to exercise cessation (PEAK)) and as a ratio (
V
·
E/
V
·
CO2 at the anaerobic threshold (AT) and at PEAK).
Results
Thirteen patients died and three had atrial septostomy. Multivariable regression analyses revealed that Δ
V
·
E/Δ
V
·
CO2(PEAK) <55 and
V
·
E/
V
·
CO2(PEAK) <57 were better related to prognosis than Δ
V
·
E/Δ
V
·
CO2(RCP) and
V
·
E/
V
·
CO2(AT) (p < 0.01). Δ oxygen uptake (
V
·
O2)/Δ work rate >5.5 ml/min per W was the only other independent prognostic index. According to a Kaplan–Meier survival analysis, 96.9% (90.8% to 100%) of patients showing Δ
V
·
E/Δ
V
·
CO2(PEAK) <55 and Δ
V
·
O2/Δ work rate >5.5 ml/min per W were free from a PAH-related event. In contrast, 74.7% (70.1% to 78.2%) with both parameters outside these ranges had a negative outcome.
Conclusion
Measurements of excessive exercise ventilation which consider all data points maximize the usefulness of incremental cardiopulmonary exercise testing in the prognosis evaluation of PAH.</abstract><cop>London, England</cop><pub>SAGE Publications</pub><pmid>23787797</pmid><doi>10.1177/2047487313494293</doi><tpages>11</tpages><oa>free_for_read</oa></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 2047-4873 |
| ispartof | European journal of preventive cardiology, 2014-11, Vol.21 (11), p.1409-1419 |
| issn | 2047-4873 2047-4881 |
| language | eng |
| recordid | cdi_proquest_miscellaneous_1612980609 |
| source | Access via SAGE; MEDLINE; Oxford University Press Journals All Titles (1996-Current); Alma/SFX Local Collection |
| subjects | Adult Arterial Pressure Biological and medical sciences Brazil Cardiology. Vascular system Chi-Square Distribution Cross-Sectional Studies Disease Progression Disease-Free Survival Exercise Test Female Heart Humans Hypertension, Pulmonary - diagnosis Hypertension, Pulmonary - mortality Hypertension, Pulmonary - physiopathology Hypertension, Pulmonary - therapy Kaplan-Meier Estimate Lung - physiopathology Male Medical sciences Middle Aged Multivariate Analysis Pneumology Predictive Value of Tests Proportional Hazards Models Prospective Studies Pulmonary Artery - physiopathology Pulmonary hypertension. Acute cor pulmonale. Pulmonary embolism. Pulmonary vascular diseases Pulmonary Ventilation Risk Factors Spirometry Tertiary Care Centers Time Factors Young Adult |
| title | Optimizing the evaluation of excess exercise ventilation for prognosis assessment in pulmonary arterial hypertension |
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