| 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. | |
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MedLine Citation:
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PMID: 11181471 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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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 (VE/VCO(2)) predicts poor prognosis in advanced CHF. Derangement of cardiopulmonary reflexes may trigger exercise hyperpnea. We assessed the relationship between cardiopulmonary reflexes and VE/VCO(2)and investigated the prognostic value of (VE/VCO(2)) 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 VO(2)) >/=18 mL. kg(-1). min(-1) (age 56 years; left ventricular ejection fraction 28%; peak VO(2) 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 VE/VCO(2) (ie, >34.0). During follow-up (49+/-22 months, >3 years in all survivors), 34 patients died (3-year survival 81%). High VE/VCO(2) (hazard ratio 4.3, P<0.0001) but not peak f1.gif" BORDER="0">O(2) (P=0.7) predicted mortality. In patients with high VE/VCO(2), 3-year survival was 57%, compared with 93% in patients with normal VE/VCO(2) P<0.0001). Patients with high VE/VCO(2) 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 VE/VCO(2). 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 VO(2) does not. |
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Authors:
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P Ponikowski; D P Francis; M F Piepoli; L C Davies; T P Chua; C H Davos; V Florea; W Banasiak; P A Poole-Wilson; A J Coats; S D Anker |
Publication Detail:
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Type: Clinical Trial; Comment; Journal Article |
Journal Detail:
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Title: Circulation Volume: 103 ISSN: 1524-4539 ISO Abbreviation: Circulation Publication Date: 2001 Feb |
Date Detail:
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Created Date: 2001-02-22 Completed Date: 2001-06-14 Revised Date: 2007-11-15 |
Medline Journal Info:
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Nlm Unique ID: 0147763 Medline TA: Circulation Country: United States |
Other Details:
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Languages: eng Pagination: 967-72 Citation Subset: IM |
Affiliation:
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Cardiac Medicine Department, Imperial College, National Heart & Lung Institute, London, UK. |
Export Citation:
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APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
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Chronic Disease Exercise Test / statistics & numerical data Exercise Tolerance* Follow-Up Studies Heart Failure / diagnosis, physiopathology* Heart Function Tests / statistics & numerical data Humans Middle Aged Multivariate Analysis Oxygen Consumption Predictive Value of Tests Prognosis Proportional Hazards Models Respiratory Function Tests / statistics & numerical data* Risk Assessment Survival Rate Ventilation / statistics & numerical data* |
| Comments/Corrections | |
Comment On:
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Circulation. 2001 Feb 20;103(7):916-8
[PMID:
11181463
]
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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