Clinical utility of ventilatory and gas exchange evaluation during low‐intensity exercise for risk stratification and prognostication in pulmonary arterial hypertension
Exercise capacity correlates with PAH severity and prognosis. However, exercise contraindications and poor patient tolerance might limit its use in clinical practice. We identified that low PETCO2 during low‐intensity (FW) exercise is associated with PAH exercise capacity, providing predictive infor...
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| Veröffentlicht in: | Respirology (Carlton, Vic.) Vic.), 2021-03, Vol.26 (3), p.264-272 |
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| creator | Sayegh, Ana Luiza C. Silva, Bruno Moreira Ferreira, Eloara V.M. Ramos, Roberta P. Fisher, James P. Nery, Luiz E. Ota‐Arakaki, Jaquelina S. Oliveira, Rudolf K.F. |
| description | Exercise capacity correlates with PAH severity and prognosis. However, exercise contraindications and poor patient tolerance might limit its use in clinical practice. We identified that low PETCO2 during low‐intensity (FW) exercise is associated with PAH exercise capacity, providing predictive information for PAH risk stratification and prognostication.
ABSTRACT
Background and objective
Peak oxygen consumption (pVO2), determined from CPET, provides a valuable indication of PAH severity and patient prognosis. However, CPET is often contraindicated in severe PAH and frequently terminated prior to achievement of a sufficient exercise effort. We sought to determine whether in PAH low‐intensity [i.e. freewheeling exercise (FW)] exercise reveals abnormal VE/VCO2 and PETCO2 responses that are associated with pVO2 and serve as indices of PAH risk stratification and mortality.
Methods
Retrospective analysis of CPET from 97 PAH patients and 20 age‐matched controls was undertaken. FW VE/VCO2 and PETCO2 were correlated with pVO2% age‐predicted. Prognostication analysis was conducted using pVO2 > 65% age‐predicted, as known to represent a low mortality risk. Primary outcome was mortality from any cause.
Results
FW PETCO2 was correlated with pVO2 (P 65% age‐predicted (best cut‐off value of 28 mm Hg). By Cox analysis, FW PETCO2 |
| doi_str_mv | 10.1111/resp.13959 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_2455835740</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2455835740</sourcerecordid><originalsourceid>FETCH-LOGICAL-c3579-47ab05bfa1970f3149504b0a511b263e3f477974c1d2c81f471cc0d102bf5e4b3</originalsourceid><addsrcrecordid>eNp9kctu1DAUhi0EohfY8ADIEpuqUopPbJN4iUblIlUCcVlHjnMydfHYwXbazo5H4Dl4LJ4EZ6ZlwQJv7GN95_-P_RPyDNgZlPUyYprOgCupHpBDEIJV0Ar-sJx5zaumUeqAHKV0xRjjksnH5IBzgLZW_JD8WjnrrdGOztk6m7c0jPQafSl0DnFLtR_oWieKt-ZS-zVSvNZu1tkGT4c5Wr-mLtz8_vHT-ow-LQp4i9HYhHQMkUabvtGUY-kYi8-ub9GcYlj7kPL9nfV0mt0meL2YxozRlqEutxPGnW7wT8ijUbuET-_2Y_L1zfmX1bvq4sPb96vXF5XhslGVaHTPZD9qUA0bOQglmeiZlgB9_YojH0X5kkYYGGrTQqnAGDYAq_tRouj5MTnZ65YRv8-YcrexyaBz2mOYU1cLKdtiJVhBX_yDXoU5-jJdoRRrWQutLNTpnjIxpBRx7KZoN-WdHbBuSbBbEux2CRb4-Z3k3G9w-IveR1YA2AM31uH2P1Ldp_PPH_eifwCOgqwy</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2490808185</pqid></control><display><type>article</type><title>Clinical utility of ventilatory and gas exchange evaluation during low‐intensity exercise for risk stratification and prognostication in pulmonary arterial hypertension</title><source>Wiley Online Library Journals Frontfile Complete</source><creator>Sayegh, Ana Luiza C. ; Silva, Bruno Moreira ; Ferreira, Eloara V.M. ; Ramos, Roberta P. ; Fisher, James P. ; Nery, Luiz E. ; Ota‐Arakaki, Jaquelina S. ; Oliveira, Rudolf K.F.</creator><creatorcontrib>Sayegh, Ana Luiza C. ; Silva, Bruno Moreira ; Ferreira, Eloara V.M. ; Ramos, Roberta P. ; Fisher, James P. ; Nery, Luiz E. ; Ota‐Arakaki, Jaquelina S. ; Oliveira, Rudolf K.F.</creatorcontrib><description>Exercise capacity correlates with PAH severity and prognosis. However, exercise contraindications and poor patient tolerance might limit its use in clinical practice. We identified that low PETCO2 during low‐intensity (FW) exercise is associated with PAH exercise capacity, providing predictive information for PAH risk stratification and prognostication.
ABSTRACT
Background and objective
Peak oxygen consumption (pVO2), determined from CPET, provides a valuable indication of PAH severity and patient prognosis. However, CPET is often contraindicated in severe PAH and frequently terminated prior to achievement of a sufficient exercise effort. We sought to determine whether in PAH low‐intensity [i.e. freewheeling exercise (FW)] exercise reveals abnormal VE/VCO2 and PETCO2 responses that are associated with pVO2 and serve as indices of PAH risk stratification and mortality.
Methods
Retrospective analysis of CPET from 97 PAH patients and 20 age‐matched controls was undertaken. FW VE/VCO2 and PETCO2 were correlated with pVO2% age‐predicted. Prognostication analysis was conducted using pVO2 > 65% age‐predicted, as known to represent a low mortality risk. Primary outcome was mortality from any cause.
Results
FW PETCO2 was correlated with pVO2 (P < 0.0001; r = 0.52), while FW VE/VCO2 was not (P = 0.13; r = −0.16). ROC curve analyses showed that FW PETCO2 (AUC = 0.659), but not FW VE/VCO2 (AUC = 0.587), provided predictive information identifying pVO2 > 65% age‐predicted (best cut‐off value of 28 mm Hg). By Cox analysis, FW PETCO2 < 28 mm Hg remained a predictor of mortality after adjusting for age and PAH aetiology (HR: 2.360, 95% CI: 1.144–4.866, P = 0.020).
Conclusion
Low PETCO2 during FW is associated with reduced pVO2 in PAH and provides predictive information for PAH risk stratification and prognostication.</description><identifier>ISSN: 1323-7799</identifier><identifier>EISSN: 1440-1843</identifier><identifier>DOI: 10.1111/resp.13959</identifier><identifier>PMID: 33118293</identifier><language>eng</language><publisher>Chichester, UK: John Wiley & Sons, Ltd</publisher><subject>Age ; exercise intolerance ; Gas exchange ; Mortality ; Oxygen consumption ; prognosis ; pulmonary hypertension ; risk assessment ; ventilation</subject><ispartof>Respirology (Carlton, Vic.), 2021-03, Vol.26 (3), p.264-272</ispartof><rights>2020 Asian Pacific Society of Respirology</rights><rights>2020 Asian Pacific Society of Respirology.</rights><rights>2021 Asian Pacific Society of Respirology</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c3579-47ab05bfa1970f3149504b0a511b263e3f477974c1d2c81f471cc0d102bf5e4b3</citedby><cites>FETCH-LOGICAL-c3579-47ab05bfa1970f3149504b0a511b263e3f477974c1d2c81f471cc0d102bf5e4b3</cites><orcidid>0000-0002-2383-6527 ; 0000-0002-5350-7679 ; 0000-0002-2252-8119</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1111%2Fresp.13959$$EPDF$$P50$$Gwiley$$H</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1111%2Fresp.13959$$EHTML$$P50$$Gwiley$$H</linktohtml><link.rule.ids>314,776,780,1411,27901,27902,45550,45551</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/33118293$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Sayegh, Ana Luiza C.</creatorcontrib><creatorcontrib>Silva, Bruno Moreira</creatorcontrib><creatorcontrib>Ferreira, Eloara V.M.</creatorcontrib><creatorcontrib>Ramos, Roberta P.</creatorcontrib><creatorcontrib>Fisher, James P.</creatorcontrib><creatorcontrib>Nery, Luiz E.</creatorcontrib><creatorcontrib>Ota‐Arakaki, Jaquelina S.</creatorcontrib><creatorcontrib>Oliveira, Rudolf K.F.</creatorcontrib><title>Clinical utility of ventilatory and gas exchange evaluation during low‐intensity exercise for risk stratification and prognostication in pulmonary arterial hypertension</title><title>Respirology (Carlton, Vic.)</title><addtitle>Respirology</addtitle><description>Exercise capacity correlates with PAH severity and prognosis. However, exercise contraindications and poor patient tolerance might limit its use in clinical practice. We identified that low PETCO2 during low‐intensity (FW) exercise is associated with PAH exercise capacity, providing predictive information for PAH risk stratification and prognostication.
ABSTRACT
Background and objective
Peak oxygen consumption (pVO2), determined from CPET, provides a valuable indication of PAH severity and patient prognosis. However, CPET is often contraindicated in severe PAH and frequently terminated prior to achievement of a sufficient exercise effort. We sought to determine whether in PAH low‐intensity [i.e. freewheeling exercise (FW)] exercise reveals abnormal VE/VCO2 and PETCO2 responses that are associated with pVO2 and serve as indices of PAH risk stratification and mortality.
Methods
Retrospective analysis of CPET from 97 PAH patients and 20 age‐matched controls was undertaken. FW VE/VCO2 and PETCO2 were correlated with pVO2% age‐predicted. Prognostication analysis was conducted using pVO2 > 65% age‐predicted, as known to represent a low mortality risk. Primary outcome was mortality from any cause.
Results
FW PETCO2 was correlated with pVO2 (P < 0.0001; r = 0.52), while FW VE/VCO2 was not (P = 0.13; r = −0.16). ROC curve analyses showed that FW PETCO2 (AUC = 0.659), but not FW VE/VCO2 (AUC = 0.587), provided predictive information identifying pVO2 > 65% age‐predicted (best cut‐off value of 28 mm Hg). By Cox analysis, FW PETCO2 < 28 mm Hg remained a predictor of mortality after adjusting for age and PAH aetiology (HR: 2.360, 95% CI: 1.144–4.866, P = 0.020).
Conclusion
Low PETCO2 during FW is associated with reduced pVO2 in PAH and provides predictive information for PAH risk stratification and prognostication.</description><subject>Age</subject><subject>exercise intolerance</subject><subject>Gas exchange</subject><subject>Mortality</subject><subject>Oxygen consumption</subject><subject>prognosis</subject><subject>pulmonary hypertension</subject><subject>risk assessment</subject><subject>ventilation</subject><issn>1323-7799</issn><issn>1440-1843</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2021</creationdate><recordtype>article</recordtype><recordid>eNp9kctu1DAUhi0EohfY8ADIEpuqUopPbJN4iUblIlUCcVlHjnMydfHYwXbazo5H4Dl4LJ4EZ6ZlwQJv7GN95_-P_RPyDNgZlPUyYprOgCupHpBDEIJV0Ar-sJx5zaumUeqAHKV0xRjjksnH5IBzgLZW_JD8WjnrrdGOztk6m7c0jPQafSl0DnFLtR_oWieKt-ZS-zVSvNZu1tkGT4c5Wr-mLtz8_vHT-ow-LQp4i9HYhHQMkUabvtGUY-kYi8-ub9GcYlj7kPL9nfV0mt0meL2YxozRlqEutxPGnW7wT8ijUbuET-_2Y_L1zfmX1bvq4sPb96vXF5XhslGVaHTPZD9qUA0bOQglmeiZlgB9_YojH0X5kkYYGGrTQqnAGDYAq_tRouj5MTnZ65YRv8-YcrexyaBz2mOYU1cLKdtiJVhBX_yDXoU5-jJdoRRrWQutLNTpnjIxpBRx7KZoN-WdHbBuSbBbEux2CRb4-Z3k3G9w-IveR1YA2AM31uH2P1Ldp_PPH_eifwCOgqwy</recordid><startdate>202103</startdate><enddate>202103</enddate><creator>Sayegh, Ana Luiza C.</creator><creator>Silva, Bruno Moreira</creator><creator>Ferreira, Eloara V.M.</creator><creator>Ramos, Roberta P.</creator><creator>Fisher, James P.</creator><creator>Nery, Luiz E.</creator><creator>Ota‐Arakaki, Jaquelina S.</creator><creator>Oliveira, Rudolf K.F.</creator><general>John Wiley & Sons, Ltd</general><general>Wiley Subscription Services, Inc</general><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7T5</scope><scope>H94</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0002-2383-6527</orcidid><orcidid>https://orcid.org/0000-0002-5350-7679</orcidid><orcidid>https://orcid.org/0000-0002-2252-8119</orcidid></search><sort><creationdate>202103</creationdate><title>Clinical utility of ventilatory and gas exchange evaluation during low‐intensity exercise for risk stratification and prognostication in pulmonary arterial hypertension</title><author>Sayegh, Ana Luiza C. ; Silva, Bruno Moreira ; Ferreira, Eloara V.M. ; Ramos, Roberta P. ; Fisher, James P. ; Nery, Luiz E. ; Ota‐Arakaki, Jaquelina S. ; Oliveira, Rudolf K.F.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c3579-47ab05bfa1970f3149504b0a511b263e3f477974c1d2c81f471cc0d102bf5e4b3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2021</creationdate><topic>Age</topic><topic>exercise intolerance</topic><topic>Gas exchange</topic><topic>Mortality</topic><topic>Oxygen consumption</topic><topic>prognosis</topic><topic>pulmonary hypertension</topic><topic>risk assessment</topic><topic>ventilation</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Sayegh, Ana Luiza C.</creatorcontrib><creatorcontrib>Silva, Bruno Moreira</creatorcontrib><creatorcontrib>Ferreira, Eloara V.M.</creatorcontrib><creatorcontrib>Ramos, Roberta P.</creatorcontrib><creatorcontrib>Fisher, James P.</creatorcontrib><creatorcontrib>Nery, Luiz E.</creatorcontrib><creatorcontrib>Ota‐Arakaki, Jaquelina S.</creatorcontrib><creatorcontrib>Oliveira, Rudolf K.F.</creatorcontrib><collection>PubMed</collection><collection>CrossRef</collection><collection>Immunology Abstracts</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>MEDLINE - Academic</collection><jtitle>Respirology (Carlton, Vic.)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Sayegh, Ana Luiza C.</au><au>Silva, Bruno Moreira</au><au>Ferreira, Eloara V.M.</au><au>Ramos, Roberta P.</au><au>Fisher, James P.</au><au>Nery, Luiz E.</au><au>Ota‐Arakaki, Jaquelina S.</au><au>Oliveira, Rudolf K.F.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Clinical utility of ventilatory and gas exchange evaluation during low‐intensity exercise for risk stratification and prognostication in pulmonary arterial hypertension</atitle><jtitle>Respirology (Carlton, Vic.)</jtitle><addtitle>Respirology</addtitle><date>2021-03</date><risdate>2021</risdate><volume>26</volume><issue>3</issue><spage>264</spage><epage>272</epage><pages>264-272</pages><issn>1323-7799</issn><eissn>1440-1843</eissn><abstract>Exercise capacity correlates with PAH severity and prognosis. However, exercise contraindications and poor patient tolerance might limit its use in clinical practice. We identified that low PETCO2 during low‐intensity (FW) exercise is associated with PAH exercise capacity, providing predictive information for PAH risk stratification and prognostication.
ABSTRACT
Background and objective
Peak oxygen consumption (pVO2), determined from CPET, provides a valuable indication of PAH severity and patient prognosis. However, CPET is often contraindicated in severe PAH and frequently terminated prior to achievement of a sufficient exercise effort. We sought to determine whether in PAH low‐intensity [i.e. freewheeling exercise (FW)] exercise reveals abnormal VE/VCO2 and PETCO2 responses that are associated with pVO2 and serve as indices of PAH risk stratification and mortality.
Methods
Retrospective analysis of CPET from 97 PAH patients and 20 age‐matched controls was undertaken. FW VE/VCO2 and PETCO2 were correlated with pVO2% age‐predicted. Prognostication analysis was conducted using pVO2 > 65% age‐predicted, as known to represent a low mortality risk. Primary outcome was mortality from any cause.
Results
FW PETCO2 was correlated with pVO2 (P < 0.0001; r = 0.52), while FW VE/VCO2 was not (P = 0.13; r = −0.16). ROC curve analyses showed that FW PETCO2 (AUC = 0.659), but not FW VE/VCO2 (AUC = 0.587), provided predictive information identifying pVO2 > 65% age‐predicted (best cut‐off value of 28 mm Hg). By Cox analysis, FW PETCO2 < 28 mm Hg remained a predictor of mortality after adjusting for age and PAH aetiology (HR: 2.360, 95% CI: 1.144–4.866, P = 0.020).
Conclusion
Low PETCO2 during FW is associated with reduced pVO2 in PAH and provides predictive information for PAH risk stratification and prognostication.</abstract><cop>Chichester, UK</cop><pub>John Wiley & Sons, Ltd</pub><pmid>33118293</pmid><doi>10.1111/resp.13959</doi><tpages>9</tpages><orcidid>https://orcid.org/0000-0002-2383-6527</orcidid><orcidid>https://orcid.org/0000-0002-5350-7679</orcidid><orcidid>https://orcid.org/0000-0002-2252-8119</orcidid></addata></record> |
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| source | Wiley Online Library Journals Frontfile Complete |
| subjects | Age exercise intolerance Gas exchange Mortality Oxygen consumption prognosis pulmonary hypertension risk assessment ventilation |
| title | Clinical utility of ventilatory and gas exchange evaluation during low‐intensity exercise for risk stratification and prognostication in pulmonary arterial hypertension |
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