Document Detail


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.
MedLine Citation:
PMID:  11181471     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
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.
Authors:
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:
Type:  Clinical Trial; Comment; Journal Article    
Journal Detail:
Title:  Circulation     Volume:  103     ISSN:  1524-4539     ISO Abbreviation:  Circulation     Publication Date:  2001 Feb 
Date Detail:
Created Date:  2001-02-22     Completed Date:  2001-06-14     Revised Date:  2007-11-15    
Medline Journal Info:
Nlm Unique ID:  0147763     Medline TA:  Circulation     Country:  United States    
Other Details:
Languages:  eng     Pagination:  967-72     Citation Subset:  IM    
Affiliation:
Cardiac Medicine Department, Imperial College, National Heart & Lung Institute, London, UK.
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MeSH Terms
Descriptor/Qualifier:
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:
Circulation. 2001 Feb 20;103(7):916-8   [PMID:  11181463 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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