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Ventilatory Power: A Novel Index that Enhances Prognostic Assessment of Patients with Heart Failure.
MedLine Citation:
PMID:  22899767     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
BACKGROUND: -Ventilatory efficiency (VE/VCO2 slope) is an index determined by cardiopulmonary exercise testing (CPX) which incorporates pertinent cardiac, pulmonary, and skeletal muscle physiology into a substantive composite assessment. The VE/VCO(2) slope has many applications, including utility as a well-validated prognostic gauge for heart failure (HF) patients. In this study, we combine VE/VCO(2) slope with systolic blood pressure (SBP), creating a novel index that we labeled "ventilatory power." Ventilatory power links the combined physiology inherent in the VE/VCO(2) slope to peripheral pressure, adding an additional dimension pertinent to HF assessment. Whereas the related concept of circulatory power links peak oxygen consumption (VO(2)) with peak SBP as a prognostic index, we hypothesized that ventilatory power would provide greater prognostic discrimination than VE/VO(2) slope, peak VO(2), and/or circulatory power for systolic heart failure (HF) patients. METHODS AND RESULTS: -Systolic HF patients (left ventricular ejection fraction [LVEF] ≤35%) underwent symptom-limited CPX as part of routine management and were followed for up to four years for major cardiac events (mortality, left ventricular assist device [LVAD] implantation, and heart transplantation). 875 HF patients (LVEF 26±9%; mean age 55±14) were studied. CPX indices peak VO(2), VE/VCO(2) slope, circulatory power and ventilatory power were all predictive of cardiac events (p <0.001). Multivariate analysis demonstrated that ventilatory power was the strongest indicator of prognosis. CONCLUSIONS: -While circulatory power and traditional CPX parameters can be used to predict prognosis among HF patients, ventilatory power provides relatively greater prognostic discrimination and may constitute a relatively more useful composite tool.
Authors:
Daniel E Forman; Marco Guazzi; Jonathan Myers; Paul Chase; Daniel Bensimhon; Lawrence P Cahalin; Mary Ann Peberdy; Euan Ashley; Erin West; Karla M Danels; Ross Arena
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2012-8-16
Journal Detail:
Title:  Circulation. Heart failure     Volume:  -     ISSN:  1941-3297     ISO Abbreviation:  Circ Heart Fail     Publication Date:  2012 Aug 
Date Detail:
Created Date:  2012-8-17     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  101479941     Medline TA:  Circ Heart Fail     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Affiliation:
1 Brigham and Women's Hospital, Boston, MA;
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