| Exercise ventilation inefficiency and cardiovascular mortality in heart failure: the critical independent prognostic value of the arterial CO2 partial pressure. | |
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MedLine Citation:
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PMID: 15618042 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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AIMS: In chronic heart failure (CHF) patients, the ventilation (Ve) needed to eliminate metabolically produced CO(2) during exercise (i.e. the Ve/Vco(2) slope) is a strong prognosticator. Ve/Vco(2) slope determinants are the dead space-tidal volume (Vd/Vt) ratio and the arterial CO(2) partial pressure (Paco(2)). We aimed at defining the respective prognostic role of these two variables. METHODS AND RESULTS: One hundred and twenty-eight stable CHF patients (average left ventricular ejection fraction 34+/-10%) underwent cardiopulmonary exercise testing and blood gas analysis. The prognostic relevance of the Ve/Vco(2) slope, Vd/Vt, and Paco(2) at peak exercise was evaluated by the Kaplan-Meier approach with log-rank testing and by multivariate Cox regression analysis. During a mean period of 31.3+/-20 months, 24 patients died from cardiac causes. In univariate analysis, predictors of death included the use of anti-aldosterone drugs, low peak Vo(2), peak Ve/Vo(2), peak Paco(2) and high Ve/Vco(2) slope, and peak Vd/Vt. Multivariate analysis identified a low peak Paco(2) (<35 mmHg) as the strongest independent prognostic indicator [hazard ratio 4.65, 95% confidence interval (CI) (1.695-12.751), P=0.003] that primarily accounts for the Ve/Vco(2) slope prognostic power. CONCLUSION: These findings imply that regulatory mechanisms involved in the tight control of ventilatory command and blood gas tension, rather than lung function abnormalities, play a critical pathophysiological role in the exercise ventilation inefficiency of CHF patients. |
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Authors:
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Marco Guazzi; Giuseppe Reina; Gabriele Tumminello; Maurizio D Guazzi |
Publication Detail:
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Type: Journal Article; Research Support, Non-U.S. Gov't Date: 2004-12-14 |
Journal Detail:
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Title: European heart journal Volume: 26 ISSN: 0195-668X ISO Abbreviation: Eur. Heart J. Publication Date: 2005 Mar |
Date Detail:
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Created Date: 2005-02-16 Completed Date: 2005-06-16 Revised Date: 2007-11-15 |
Medline Journal Info:
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Nlm Unique ID: 8006263 Medline TA: Eur Heart J Country: England |
Other Details:
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Languages: eng Pagination: 472-80 Citation Subset: IM |
Affiliation:
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Cardiopulmonary Laboratory, Cardiology Division, University of Milano, San Paolo Hospital, Via A. di Rudinì, 8, 20142, Milano, Italy. marco.guazzi@unimi.it |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Blood Gas Analysis Carbon Dioxide / blood* Echocardiography Exercise / physiology* Exercise Test / methods Female Forced Expiratory Volume / physiology Heart Failure / blood, mortality, physiopathology* Humans Male Middle Aged Multivariate Analysis Oxygen Consumption / physiology Partial Pressure Prognosis Respiratory Dead Space / physiology* Respiratory Insufficiency / blood, mortality, physiopathology* Survival Analysis Vital Capacity / physiology |
| Chemical | |
Reg. No./Substance:
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124-38-9/Carbon Dioxide |
| Comments/Corrections | |
Comment In:
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Eur Heart J. 2005 Mar;26(5):426-7
[PMID:
15695528
]
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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