Effects of Respiratory Exchange Ratio on the Prognostic Value of Peak Oxygen Consumption and Ventilatory Efficiency in Patients With Systolic Heart Failure
Objectives The purpose of this analysis was to evaluate the prognostic characteristics of peak oxygen consumption (V o2 ) and the minute ventilation/carbon dioxide (VE/V co2 ) slope of different peak respiratory exchange ratios (RERs) obtained from cardiopulmonary exercise testing in patients with h...
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| creator | Chase, Paul J., MEd Kenjale, Aarti, MBBS, MS Cahalin, Lawrence P., PhD, PT Arena, Ross, PhD, PT Davis, Paul G., PhD Myers, Jonathan, PhD Guazzi, Marco, MD, PhD Forman, Daniel E., MD Ashley, Euan, MD Peberdy, Mary Ann, MD West, Erin, MS Kelly, Christopher T., BA Bensimhon, Daniel R., MD |
| description | Objectives The purpose of this analysis was to evaluate the prognostic characteristics of peak oxygen consumption (V o2 ) and the minute ventilation/carbon dioxide (VE/V co2 ) slope of different peak respiratory exchange ratios (RERs) obtained from cardiopulmonary exercise testing in patients with heart failure (HF). Background For patients with HF, peak V o2 and the VE/V co2 slope are used for assessing prognosis. Peak V o2 is assessed in association with peak RER ≥1.10, indicating maximal effort and prognostic sensitivity. Conversely, the VE/V co2 slope provides effort-independent prognostic discrimination. Methods Patients with HF scheduled to undergo cardiopulmonary exercise testing were enrolled. Patients were subclassified by peak RER (RER |
| doi_str_mv | 10.1016/j.jchf.2013.05.008 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_pubme</sourceid><recordid>TN_cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_7296992</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><els_id>S2213177913002576</els_id><sourcerecordid>1507795168</sourcerecordid><originalsourceid>FETCH-LOGICAL-c510t-61f34c69d7a1cf203e1ae654a2e0e51dae7fd16862823a935dede46fdd0f15ae3</originalsourceid><addsrcrecordid>eNp9ks1uEzEUhUcIRKvSF2CBvGSTwfbE8yOhSihKKVKlRi2UpWXs68RTxw62p-o8Cy-Lh4QIWOCNLd1zjq_ud4viNcElwaR-15e93OiSYlKVmJUYt8-KU0pJNSNN2zw_vpvupDiPscf5tIy0bfuyOKHzmpKuYafFj6XWIFNEXqNbiDsTRPJhRMsnuRFuDehWJOORdyhtAK2CXzsfk5HoXtgBJtcKxAO6eRrX4NDCuzhsd9nhkHAK3YNLxh4StTbSgJMjMg6tcmwuRvTVpA26G2PyNqdegQgJXQpjhwCvihda2Ajnh_us-HK5_Ly4ml3ffPy0-HA9k4zgNKuJruay7lQjiNQUV0AE1GwuKGBgRAlotCJ1W9OWVqKrmAIF81orhTVhAqqz4mKfuxu-bUHJ3FcQlu-C2Yowci8M_7vizIav_SNvaFd3Hc0Bbw8BwX8fICa-NVGCtcKBHyInDGcOLPeQpXQvlcHHGEAfvyGYT2B5zyewfALLMeOZWja9-bPBo-U3xix4vxdAHtOjgcDjr1GDMiHT5cqb_-df_GOX1jgjhX2AEWLvh-AyAE54pBzzu2m1ps0iFcaUNXX1E1pRzYI</addsrcrecordid><sourcetype>Open Access Repository</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>1507795168</pqid></control><display><type>article</type><title>Effects of Respiratory Exchange Ratio on the Prognostic Value of Peak Oxygen Consumption and Ventilatory Efficiency in Patients With Systolic Heart Failure</title><source>MEDLINE</source><source>EZB-FREE-00999 freely available EZB journals</source><source>Alma/SFX Local Collection</source><creator>Chase, Paul J., MEd ; Kenjale, Aarti, MBBS, MS ; Cahalin, Lawrence P., PhD, PT ; Arena, Ross, PhD, PT ; Davis, Paul G., PhD ; Myers, Jonathan, PhD ; Guazzi, Marco, MD, PhD ; Forman, Daniel E., MD ; Ashley, Euan, MD ; Peberdy, Mary Ann, MD ; West, Erin, MS ; Kelly, Christopher T., BA ; Bensimhon, Daniel R., MD</creator><creatorcontrib>Chase, Paul J., MEd ; Kenjale, Aarti, MBBS, MS ; Cahalin, Lawrence P., PhD, PT ; Arena, Ross, PhD, PT ; Davis, Paul G., PhD ; Myers, Jonathan, PhD ; Guazzi, Marco, MD, PhD ; Forman, Daniel E., MD ; Ashley, Euan, MD ; Peberdy, Mary Ann, MD ; West, Erin, MS ; Kelly, Christopher T., BA ; Bensimhon, Daniel R., MD</creatorcontrib><description>Objectives The purpose of this analysis was to evaluate the prognostic characteristics of peak oxygen consumption (V o2 ) and the minute ventilation/carbon dioxide (VE/V co2 ) slope of different peak respiratory exchange ratios (RERs) obtained from cardiopulmonary exercise testing in patients with heart failure (HF). Background For patients with HF, peak V o2 and the VE/V co2 slope are used for assessing prognosis. Peak V o2 is assessed in association with peak RER ≥1.10, indicating maximal effort and prognostic sensitivity. Conversely, the VE/V co2 slope provides effort-independent prognostic discrimination. Methods Patients with HF scheduled to undergo cardiopulmonary exercise testing were enrolled. Patients were subclassified by peak RER (RER <1.00, RER 1.00 to 1.04, RER 1.05 to 1.09, RER ≥1.10) and followed for up to 3 years for major cardiac-related events (death, left ventricular assist device implantation, or cardiac transplantation). Results Included were 1,728 patients with HF (75% males; 40% ischemic etiology; age: 55 ± 14 years; left ventricular ejection fraction: 28 ± 10%). Two hundred seventy major events occurred, with no proportional differences across the RER subgroups. Multivariate Cox regression analysis indicated that the VE/V co2 slope and peak V o2 remained prognostic within each subgroup; the VE/V co2 slope remained the strongest predictor. Receiver-operating characteristic analysis demonstrated equitable prognostic cutoffs for the VE/V co2 slope (range: 34.9 to 35.7; area under the curve [AUC] range: 0.69 to 0.75) and peak V o2 (range: 13.8 to 14.0 ml·kg–1 ·min–1 ; AUC range: 0.68 to 0.75). Conclusions Peak V o2 provided a sensitive assessment of prognosis in patients with HF in all RER subgroups. The VE/V co2 slope provided greater prognostic discrimination in all RER subgroups. Clinical consideration may be warranted for patients with low RER, low peak V o2 , and an elevated VE/V co2 slope.</description><identifier>ISSN: 2213-1779</identifier><identifier>EISSN: 2213-1787</identifier><identifier>DOI: 10.1016/j.jchf.2013.05.008</identifier><identifier>PMID: 24621975</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>cardiopulmonary exercise test ; Cardiovascular ; Exercise Test ; Female ; heart failure ; Heart Failure, Systolic - metabolism ; Heart Failure, Systolic - physiopathology ; Humans ; Male ; Middle Aged ; Oxygen Consumption ; Prognosis ; Pulmonary Gas Exchange ; Pulmonary Ventilation ; respiratory exchange ratio</subject><ispartof>JACC. Heart failure, 2013-10, Vol.1 (5), p.427-432</ispartof><rights>American College of Cardiology Foundation</rights><rights>2013 American College of Cardiology Foundation</rights><rights>Copyright © 2013 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c510t-61f34c69d7a1cf203e1ae654a2e0e51dae7fd16862823a935dede46fdd0f15ae3</citedby><cites>FETCH-LOGICAL-c510t-61f34c69d7a1cf203e1ae654a2e0e51dae7fd16862823a935dede46fdd0f15ae3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>230,315,781,785,886,27929,27930</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/24621975$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Chase, Paul J., MEd</creatorcontrib><creatorcontrib>Kenjale, Aarti, MBBS, MS</creatorcontrib><creatorcontrib>Cahalin, Lawrence P., PhD, PT</creatorcontrib><creatorcontrib>Arena, Ross, PhD, PT</creatorcontrib><creatorcontrib>Davis, Paul G., PhD</creatorcontrib><creatorcontrib>Myers, Jonathan, PhD</creatorcontrib><creatorcontrib>Guazzi, Marco, MD, PhD</creatorcontrib><creatorcontrib>Forman, Daniel E., MD</creatorcontrib><creatorcontrib>Ashley, Euan, MD</creatorcontrib><creatorcontrib>Peberdy, Mary Ann, MD</creatorcontrib><creatorcontrib>West, Erin, MS</creatorcontrib><creatorcontrib>Kelly, Christopher T., BA</creatorcontrib><creatorcontrib>Bensimhon, Daniel R., MD</creatorcontrib><title>Effects of Respiratory Exchange Ratio on the Prognostic Value of Peak Oxygen Consumption and Ventilatory Efficiency in Patients With Systolic Heart Failure</title><title>JACC. Heart failure</title><addtitle>JACC Heart Fail</addtitle><description>Objectives The purpose of this analysis was to evaluate the prognostic characteristics of peak oxygen consumption (V o2 ) and the minute ventilation/carbon dioxide (VE/V co2 ) slope of different peak respiratory exchange ratios (RERs) obtained from cardiopulmonary exercise testing in patients with heart failure (HF). Background For patients with HF, peak V o2 and the VE/V co2 slope are used for assessing prognosis. Peak V o2 is assessed in association with peak RER ≥1.10, indicating maximal effort and prognostic sensitivity. Conversely, the VE/V co2 slope provides effort-independent prognostic discrimination. Methods Patients with HF scheduled to undergo cardiopulmonary exercise testing were enrolled. Patients were subclassified by peak RER (RER <1.00, RER 1.00 to 1.04, RER 1.05 to 1.09, RER ≥1.10) and followed for up to 3 years for major cardiac-related events (death, left ventricular assist device implantation, or cardiac transplantation). Results Included were 1,728 patients with HF (75% males; 40% ischemic etiology; age: 55 ± 14 years; left ventricular ejection fraction: 28 ± 10%). Two hundred seventy major events occurred, with no proportional differences across the RER subgroups. Multivariate Cox regression analysis indicated that the VE/V co2 slope and peak V o2 remained prognostic within each subgroup; the VE/V co2 slope remained the strongest predictor. Receiver-operating characteristic analysis demonstrated equitable prognostic cutoffs for the VE/V co2 slope (range: 34.9 to 35.7; area under the curve [AUC] range: 0.69 to 0.75) and peak V o2 (range: 13.8 to 14.0 ml·kg–1 ·min–1 ; AUC range: 0.68 to 0.75). Conclusions Peak V o2 provided a sensitive assessment of prognosis in patients with HF in all RER subgroups. The VE/V co2 slope provided greater prognostic discrimination in all RER subgroups. Clinical consideration may be warranted for patients with low RER, low peak V o2 , and an elevated VE/V co2 slope.</description><subject>cardiopulmonary exercise test</subject><subject>Cardiovascular</subject><subject>Exercise Test</subject><subject>Female</subject><subject>heart failure</subject><subject>Heart Failure, Systolic - metabolism</subject><subject>Heart Failure, Systolic - physiopathology</subject><subject>Humans</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Oxygen Consumption</subject><subject>Prognosis</subject><subject>Pulmonary Gas Exchange</subject><subject>Pulmonary Ventilation</subject><subject>respiratory exchange ratio</subject><issn>2213-1779</issn><issn>2213-1787</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2013</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9ks1uEzEUhUcIRKvSF2CBvGSTwfbE8yOhSihKKVKlRi2UpWXs68RTxw62p-o8Cy-Lh4QIWOCNLd1zjq_ud4viNcElwaR-15e93OiSYlKVmJUYt8-KU0pJNSNN2zw_vpvupDiPscf5tIy0bfuyOKHzmpKuYafFj6XWIFNEXqNbiDsTRPJhRMsnuRFuDehWJOORdyhtAK2CXzsfk5HoXtgBJtcKxAO6eRrX4NDCuzhsd9nhkHAK3YNLxh4StTbSgJMjMg6tcmwuRvTVpA26G2PyNqdegQgJXQpjhwCvihda2Ajnh_us-HK5_Ly4ml3ffPy0-HA9k4zgNKuJruay7lQjiNQUV0AE1GwuKGBgRAlotCJ1W9OWVqKrmAIF81orhTVhAqqz4mKfuxu-bUHJ3FcQlu-C2Yowci8M_7vizIav_SNvaFd3Hc0Bbw8BwX8fICa-NVGCtcKBHyInDGcOLPeQpXQvlcHHGEAfvyGYT2B5zyewfALLMeOZWja9-bPBo-U3xix4vxdAHtOjgcDjr1GDMiHT5cqb_-df_GOX1jgjhX2AEWLvh-AyAE54pBzzu2m1ps0iFcaUNXX1E1pRzYI</recordid><startdate>20131001</startdate><enddate>20131001</enddate><creator>Chase, Paul J., MEd</creator><creator>Kenjale, Aarti, MBBS, MS</creator><creator>Cahalin, Lawrence P., PhD, PT</creator><creator>Arena, Ross, PhD, PT</creator><creator>Davis, Paul G., PhD</creator><creator>Myers, Jonathan, PhD</creator><creator>Guazzi, Marco, MD, PhD</creator><creator>Forman, Daniel E., MD</creator><creator>Ashley, Euan, MD</creator><creator>Peberdy, Mary Ann, MD</creator><creator>West, Erin, MS</creator><creator>Kelly, Christopher T., BA</creator><creator>Bensimhon, Daniel R., MD</creator><general>Elsevier Inc</general><scope>6I.</scope><scope>AAFTH</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><scope>5PM</scope></search><sort><creationdate>20131001</creationdate><title>Effects of Respiratory Exchange Ratio on the Prognostic Value of Peak Oxygen Consumption and Ventilatory Efficiency in Patients With Systolic Heart Failure</title><author>Chase, Paul J., MEd ; Kenjale, Aarti, MBBS, MS ; Cahalin, Lawrence P., PhD, PT ; Arena, Ross, PhD, PT ; Davis, Paul G., PhD ; Myers, Jonathan, PhD ; Guazzi, Marco, MD, PhD ; Forman, Daniel E., MD ; Ashley, Euan, MD ; Peberdy, Mary Ann, MD ; West, Erin, MS ; Kelly, Christopher T., BA ; Bensimhon, Daniel R., MD</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c510t-61f34c69d7a1cf203e1ae654a2e0e51dae7fd16862823a935dede46fdd0f15ae3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2013</creationdate><topic>cardiopulmonary exercise test</topic><topic>Cardiovascular</topic><topic>Exercise Test</topic><topic>Female</topic><topic>heart failure</topic><topic>Heart Failure, Systolic - metabolism</topic><topic>Heart Failure, Systolic - physiopathology</topic><topic>Humans</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Oxygen Consumption</topic><topic>Prognosis</topic><topic>Pulmonary Gas Exchange</topic><topic>Pulmonary Ventilation</topic><topic>respiratory exchange ratio</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Chase, Paul J., MEd</creatorcontrib><creatorcontrib>Kenjale, Aarti, MBBS, MS</creatorcontrib><creatorcontrib>Cahalin, Lawrence P., PhD, PT</creatorcontrib><creatorcontrib>Arena, Ross, PhD, PT</creatorcontrib><creatorcontrib>Davis, Paul G., PhD</creatorcontrib><creatorcontrib>Myers, Jonathan, PhD</creatorcontrib><creatorcontrib>Guazzi, Marco, MD, PhD</creatorcontrib><creatorcontrib>Forman, Daniel E., MD</creatorcontrib><creatorcontrib>Ashley, Euan, MD</creatorcontrib><creatorcontrib>Peberdy, Mary Ann, MD</creatorcontrib><creatorcontrib>West, Erin, MS</creatorcontrib><creatorcontrib>Kelly, Christopher T., BA</creatorcontrib><creatorcontrib>Bensimhon, Daniel R., MD</creatorcontrib><collection>ScienceDirect Open Access Titles</collection><collection>Elsevier:ScienceDirect:Open Access</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><collection>PubMed Central (Full Participant titles)</collection><jtitle>JACC. Heart failure</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Chase, Paul J., MEd</au><au>Kenjale, Aarti, MBBS, MS</au><au>Cahalin, Lawrence P., PhD, PT</au><au>Arena, Ross, PhD, PT</au><au>Davis, Paul G., PhD</au><au>Myers, Jonathan, PhD</au><au>Guazzi, Marco, MD, PhD</au><au>Forman, Daniel E., MD</au><au>Ashley, Euan, MD</au><au>Peberdy, Mary Ann, MD</au><au>West, Erin, MS</au><au>Kelly, Christopher T., BA</au><au>Bensimhon, Daniel R., MD</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Effects of Respiratory Exchange Ratio on the Prognostic Value of Peak Oxygen Consumption and Ventilatory Efficiency in Patients With Systolic Heart Failure</atitle><jtitle>JACC. Heart failure</jtitle><addtitle>JACC Heart Fail</addtitle><date>2013-10-01</date><risdate>2013</risdate><volume>1</volume><issue>5</issue><spage>427</spage><epage>432</epage><pages>427-432</pages><issn>2213-1779</issn><eissn>2213-1787</eissn><abstract>Objectives The purpose of this analysis was to evaluate the prognostic characteristics of peak oxygen consumption (V o2 ) and the minute ventilation/carbon dioxide (VE/V co2 ) slope of different peak respiratory exchange ratios (RERs) obtained from cardiopulmonary exercise testing in patients with heart failure (HF). Background For patients with HF, peak V o2 and the VE/V co2 slope are used for assessing prognosis. Peak V o2 is assessed in association with peak RER ≥1.10, indicating maximal effort and prognostic sensitivity. Conversely, the VE/V co2 slope provides effort-independent prognostic discrimination. Methods Patients with HF scheduled to undergo cardiopulmonary exercise testing were enrolled. Patients were subclassified by peak RER (RER <1.00, RER 1.00 to 1.04, RER 1.05 to 1.09, RER ≥1.10) and followed for up to 3 years for major cardiac-related events (death, left ventricular assist device implantation, or cardiac transplantation). Results Included were 1,728 patients with HF (75% males; 40% ischemic etiology; age: 55 ± 14 years; left ventricular ejection fraction: 28 ± 10%). Two hundred seventy major events occurred, with no proportional differences across the RER subgroups. Multivariate Cox regression analysis indicated that the VE/V co2 slope and peak V o2 remained prognostic within each subgroup; the VE/V co2 slope remained the strongest predictor. Receiver-operating characteristic analysis demonstrated equitable prognostic cutoffs for the VE/V co2 slope (range: 34.9 to 35.7; area under the curve [AUC] range: 0.69 to 0.75) and peak V o2 (range: 13.8 to 14.0 ml·kg–1 ·min–1 ; AUC range: 0.68 to 0.75). Conclusions Peak V o2 provided a sensitive assessment of prognosis in patients with HF in all RER subgroups. The VE/V co2 slope provided greater prognostic discrimination in all RER subgroups. Clinical consideration may be warranted for patients with low RER, low peak V o2 , and an elevated VE/V co2 slope.</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>24621975</pmid><doi>10.1016/j.jchf.2013.05.008</doi><tpages>6</tpages><oa>free_for_read</oa></addata></record> |
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| subjects | cardiopulmonary exercise test Cardiovascular Exercise Test Female heart failure Heart Failure, Systolic - metabolism Heart Failure, Systolic - physiopathology Humans Male Middle Aged Oxygen Consumption Prognosis Pulmonary Gas Exchange Pulmonary Ventilation respiratory exchange ratio |
| title | Effects of Respiratory Exchange Ratio on the Prognostic Value of Peak Oxygen Consumption and Ventilatory Efficiency in Patients With Systolic Heart Failure |
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