Document Detail


Exercise oscillatory ventilation in systolic heart failure: an indicator of impaired hemodynamic response to exercise.
MedLine Citation:
PMID:  21875912     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Exercise oscillatory ventilation (EOV) is a noninvasive parameter that potently predicts outcomes in systolic heart failure (HF). However, mechanistic insights into EOV have been limited by the absence of studies relating EOV to invasive hemodynamic measurements and blood gases performed during exercise.
METHODS AND RESULTS: Fifty-six patients with systolic HF (mean±SEM age, 59±2 years; left ventricular ejection fraction, 30±1%) and 19 age-matched control subjects were studied with incremental cardiopulmonary exercise testing. Fick cardiac outputs, filling pressures, and arterial blood gases were measured at 1-minute intervals during exercise. We detected EOV in 45% of HF (HF+EOV) patients and in none of the control subjects. The HF+EOV group did not differ from the HF patients without EOV (HF-EOV) in age, sex, body mass index, left ventricular ejection fraction, or origin of HF. Univariate predictors of the presence of EOV in HF, among measurements performed during exercise, included higher right atrial pressure and pulmonary capillary wedge pressure and lower cardiac index (CI) but not Paco2 or Pao2. Multivariate logistic regression identified that low exercise CI is the strongest predictor of EOV (odds ratio, 1.39 for each 1.0-L · min(-1) · m(-2) decrement in CI; 95% confidence interval, 1.14-1.70; P=0.001). Among HF patients with EOV, exercise CI was inversely related to EOV cycle length (R=-0.71) and amplitude (R=-0.60; both P<0.001). In 11 HF+EOV subjects treated with 12 weeks of sildenafil, EOV cycle length and amplitude decreased proportionately to increases in CI.
CONCLUSION: Exercise oscillatory ventilation is closely related to reduced CI and elevated filling pressures during exercise and may be an important surrogate for exercise-induced hemodynamic impairment in HF patients. Clinical Trial Registration- URL: http://www.clinicaltrials.gov. Unique identifier: NCT00309790.
Authors:
Ryan M Murphy; Ravi V Shah; Rajeev Malhotra; Paul P Pappagianopoulos; Stacyann S Hough; David M Systrom; Marc J Semigran; Gregory D Lewis
Publication Detail:
Type:  Controlled Clinical Trial; Journal Article; Research Support, N.I.H., Extramural; Research Support, Non-U.S. Gov't     Date:  2011-08-29
Journal Detail:
Title:  Circulation     Volume:  124     ISSN:  1524-4539     ISO Abbreviation:  Circulation     Publication Date:  2011 Sep 
Date Detail:
Created Date:  2011-09-28     Completed Date:  2011-11-21     Revised Date:  2013-06-27    
Medline Journal Info:
Nlm Unique ID:  0147763     Medline TA:  Circulation     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1442-51     Citation Subset:  AIM; IM    
Affiliation:
Cardiology Division, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA.
Data Bank Information
Bank Name/Acc. No.:
ClinicalTrials.gov/NCT00309790
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MeSH Terms
Descriptor/Qualifier:
Blood Gas Analysis
Carbon Dioxide / blood
Cardiac Output / drug effects,  physiology
Exercise Test / drug effects,  methods*
Female
Heart Failure, Systolic* / diagnosis,  drug therapy,  physiopathology
Humans
Male
Middle Aged
Oxygen / blood
Phosphodiesterase 5 Inhibitors / therapeutic use
Physical Exertion / physiology
Piperazines / therapeutic use*
Predictive Value of Tests
Pulmonary Gas Exchange / drug effects,  physiology
Pulmonary Wedge Pressure / drug effects,  physiology
Purines / therapeutic use
Respiratory Mechanics / drug effects,  physiology*
Rest / physiology
Stroke Volume / drug effects,  physiology
Sulfones / therapeutic use*
Ventricular Pressure / drug effects,  physiology
Grant Support
ID/Acronym/Agency:
K23 HL091106/HL/NHLBI NIH HHS; K23HL091106/HL/NHLBI NIH HHS; U01-HL084877/HL/NHLBI NIH HHS
Chemical
Reg. No./Substance:
0/Phosphodiesterase 5 Inhibitors; 0/Piperazines; 0/Purines; 0/Sulfones; 124-38-9/Carbon Dioxide; 3M7OB98Y7H/sildenafil; 7782-44-7/Oxygen
Comments/Corrections

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