| Exercise oscillatory breathing and increased ventilation to carbon dioxide production slope in heart failure: an unfavorable combination with high prognostic value. | |
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MedLine Citation:
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PMID: 17452165 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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BACKGROUND: Increased slope of exercise ventilation to carbon dioxide production (VE/VCO2) is an established prognosticator in patients with heart failure. Recently, the occurrence of exercise oscillatory breathing (EOB) has emerged as an additional strong indicator of survival. OBJECTIVE: The aim of this study is to define the respective prognostic significance of these variables and whether excess risk may be identified when either respiratory disorder is present. METHODS: In 288 stable chronic HF patients (average left ventricular ejection fraction, 33 +/- 13%) who underwent cardiopulmonary exercise testing, the prognostic relevance of VE/VCO2 slope, EOB, and peak VO2 was evaluated by multivariate Cox regression. RESULTS: During a mean interval of 28 +/- 13 months, 62 patients died of cardiac reasons. Thirty-five percent presented with EOB. Among patients exhibiting EOB, 54% had an elevated VE/VCO2 slope. The optimal threshold value for the VE/VCO2 slope identified by receiver operating characteristic analysis was < 36.2 or > or = 36.2 (sensitivity, 77%; specificity, 64%; P < .001). Univariate predictors of death included low left ventricular ejection fraction, low peak VO2, high VE/VCO2 slope, and EOB presence. Multivariate analysis selected EOB as the strongest predictor (chi2, 46.5; P < .001). The VE/VCO2 slope (threshold, < 36.2 or > or = 36.2) was the only other exercise test variable retained in the regression (residual chi2, 5.9; P = .02). The hazard ratio for subjects with EOB and a VE/VCO2 slope > or = 36.2 was 11.4 (95% confidence interval, 4.9-26.5; P < .001). CONCLUSION: These findings identify EOB as a strong survival predictor even more powerful than VE/VCO2 slope. Exercise oscillatory breathing presence does not necessarily imply an elevated VE/VCO2 slope, but combination of either both yields to a burden of risk remarkably high. |
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Authors:
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Marco Guazzi; Ross Arena; Aniello Ascione; Massimo Piepoli; Maurizio D Guazzi; |
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Publication Detail:
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Type: Comparative Study; Journal Article; Multicenter Study |
Journal Detail:
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Title: American heart journal Volume: 153 ISSN: 1097-6744 ISO Abbreviation: Am. Heart J. Publication Date: 2007 May |
Date Detail:
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Created Date: 2007-04-24 Completed Date: 2007-05-22 Revised Date: 2007-11-15 |
Medline Journal Info:
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Nlm Unique ID: 0370465 Medline TA: Am Heart J Country: United States |
Other Details:
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Languages: eng Pagination: 859-67 Citation Subset: AIM; IM |
Affiliation:
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Cardiopulmonary Unit, University of Milano, Milano, Italy. marco.guazzi@unimi.it |
Export Citation:
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APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
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Carbon Dioxide
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metabolism* Exercise Tolerance* Female Follow-Up Studies Heart Failure / diagnosis*, metabolism, mortality, physiopathology* Humans Italy / epidemiology Male Middle Aged Multivariate Analysis Oxygen Consumption Predictive Value of Tests Prognosis Proportional Hazards Models Pulmonary Ventilation* ROC Curve Respiration* Survival Analysis Virginia / epidemiology |
| Chemical | |
Reg. No./Substance:
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124-38-9/Carbon Dioxide |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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