Characteristics of patients with a relatively greater minimum VE/VCO2 against peak VO2% and impaired exercise tolerance
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Cardiopulmonary exercise testing (CPX) is used to evaluate functional capacity and assess prognosis in cardiac patients. Ventilatory efficiency (VE/VCO2) reflects ventilation–perfusion mismatch; the minimum VE/VCO2 value (minVE/VCO2) is representative of pulmonary arterial blood flow in individuals without pulmonary disease. Usually, minVE/VCO2 has a strong relationship with the peak oxygen uptake (VO2), but dissociation can occur. Therefore, we investigated the relationship between minVE/VCO2 and predicted peak VO2 (peak VO2%) and evaluated the parameters associated with a discrepancy between these two parameters.
A total of 289 Japanese patients underwent CPX using a cycle ergometer with ramp protocols between 2013 and 2014. Among these, 174 patients with a peak VO2% lower than 70% were enrolled. Patients were divided into groups based on their minVE/VCO2 [Low group: minVE/VCO2 < mean − SD (38.8–5.6); High group: minVE/VCO2 > mean + SD (38.8 + 5.6)]. The characteristics and cardiac function at rest, evaluated using echocardiography, were compared between groups.
The High group had a significantly lower ejection fraction, stroke volume, and cardiac output, and higher brain natriuretic peptide, tricuspid regurgitation pressure gradient, right ventricular systolic pressure, and peak early diastolic LV filling velocity/peak atrial filling velocity ratio compared with the Low group (p’s < 0.01). In addition, the Low group had a significantly higher prevalence of pleural effusion than did the High group (26 vs 11%, p < 0.01).
Patients with a relatively greater minVE/VCO2 in comparison with peak VO2 had impaired cardiac output as well as restricted pulmonary blood flow increase during exercise, partly due to accumulated pleural effusion.
KeywordsPeak VO2 min VE/VCO2 Cardiopulmonary exercise test Cardiac output
Angiotensin-converting enzyme/angiotensin receptor blockers
Body fat mass
Body mass index
Brain natriuretic peptide
Cardiopulmonary exercise testing
Early diastolic mitral annular motion at the septum
Ratio of E to E′
Inferior vena cava
Left ventricular ejection fraction
Mean right atrial pressure
Minimum ventilatory efficiency
Respiratory compensation point
Right ventricular systolic pressure
Dead-space gas volume to tidal gas volume ratio
TN, HA and MM conceived and designed the study. TN, MM and SO extracted and analysed the data. TN and HA drafted the manuscript, and reviewed and revised the manuscript. TN: Taisuke Nakade, HA: Hitoshi Adachi, MM: Makoto Murata, SO: Shigeru Oshima.
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflict of interest.
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
Informed consent was obtained from all individual participants included in the study.
- Arena R, Myers J, Williams MA, Gulati M, Kligfield P, Balady GJ, Collins E, Fletcher G, American Heart Association Committee on Exercise, Rehabilitation, and Prevention of the Council on Clinical Cardiology; American Heart Association Council on Cardiovascular Nursing (2007) Assessment of functional capacity in clinical and research settings: a scientific statement from the American Heart Association Committee on Exercise, Rehabilitation, and Prevention of the Council on Clinical Cardiology and the Council on Cardiovascular Nursing. Circulation 116:329–343. https://doi.org/10.1161/CIRCULATIONAHA.106.184461 CrossRefPubMedGoogle Scholar
- Arena R, Myers J, Abella J, Pinkstaff S, Brubaker P, Moore B, Kitzman D, Peberdy MA, Bensimhon D, Chase P, Forman D, West E, Guazzi M (2009) Determining the preferred percent-predicted equation for peak oxygen consumption in patients with heart failure. Circ Heart Fail 2(2):113–120CrossRefPubMedPubMedCentralGoogle Scholar
- Borlaug BA, Nishimura RA, Sorajja P, Lam CS, Redfield MM (2010) Exercise hemodynamics enhance diagnosis of early heart failure with preserved ejection fraction. Circ Heart Fail 3:588–595. https://doi.org/10.1161/CIRCHEARTFAILURE.109.930701 CrossRefPubMedPubMedCentralGoogle Scholar
- Fonarow GC, Srikanthan P, Costanzo MR, Cintron GB, Lopatin M; ADHERE Scientific Advisory Committee and Investigators (2007) An obesity paradox in acute heart failure: analysis of body mass index and inhospital mortality for 108,927 patients in the Acute Decompensated Heart Failure National Registry. Am Heart J 153:74–81. https://doi.org/10.1016/j.ahj.2006.09.007 CrossRefPubMedGoogle Scholar
- Francis DP, Shamim W, Davies LC, Piepoli MF, Ponikowski P, Anker SD, Coats AJ (2000) Cardiopulmonary exercise testing for prognosis in chronic heart failure: continuous and independent prognostic value from VE/VCO(2)slope and peak VO(2). Eur Heart J 21:154–161. https://doi.org/10.1053/euhj.1999.1863 CrossRefPubMedGoogle Scholar
- Guazzi M, Myers J, Peberdy MA, Bensimhon D, Chase P, Arena R (2010) Cardiopulmonary exercise testing variables reflect the degree of diastolic dysfunction in patients with heart failure-normal ejection fraction. J Cardiopulm Rehabil Prev 30:165–172. https://doi.org/10.1097/HCR.0b013e3181d0c1ad CrossRefPubMedGoogle Scholar
- Hadano Y, Murata K, Yamamoto T, Kunichika H, Matsumoto T, Akagawa E, Sato T, Tanaka T, Nose Y, Tanaka N, Matsuzaki M (2006) Usefulness of mitral annular velocity in predicting exercise tolerance in patients with impaired left ventricular systolic function. Am J Cardiol 97:1025–1028. https://doi.org/10.1016/j.amjcard.2005.10.044 CrossRefPubMedGoogle Scholar
- Nagueh SF, Appleton CP, Gillebert TC, Marino PN, Oh JK, Smiseth OA, Waggoner AD, Flachskampf FA, Pellikka PA, Evangelisa A (2009) Recommendations for the evaluation of left ventricular diastolic function by echocardiography. Eur J Echocardiogr 10:165–193. https://doi.org/10.1093/ejechocard/jep007 CrossRefPubMedGoogle Scholar
- Podolec P, Rubis P, Tomkiewicz-Pajak L, Kopeć G, Tracz W (2008) Usefulness of the evaluation of left ventricular diastolic function changes during stress echocardiography in predicting exercise capacity in patients with ischemic heart failure. J Am Soc Echocardiogr 21:834–840. https://doi.org/10.1016/j.echo.2007.12.008 CrossRefPubMedGoogle Scholar
- Rudski LG, Lai WW, Afilalo J, Hua L, Handschumacher MD, Chandrasekaran K, Solomon SD, Louie EK, Schiller NB (2010) Guidelines for the echocardiographic assessment of the right heart in adults: a report from the American Society of Echocardiography endorsed by the European Association of Echocardiography, a registered branch of the European Society of Cardiology, and the Canadian Society of Echocardiography. J Am Soc Echocardiogr 23:685–713. https://doi.org/10.1016/j.echo.2010.05.010 CrossRefPubMedGoogle Scholar
- Shim CY, Kim SA, Choi D, Yang WI, Kim JM, Moon SH, Lee HJ, Park S, Choi EY, Chung N, Ha JW (2011) Clinical outcomes of exercise- induced pulmonary hypertension in subjects with preserved left ventricular ejection fraction: implication of an increase in left ventricular filling pressure during exercise. Heart 97:1417–1424. https://doi.org/10.1136/hrt.2010.220467 CrossRefPubMedGoogle Scholar
- Wasserman K, Hansen JE, Sue DY, Stringer W, Whipp BJ (2005) Normal values. In: Weinberg R (ed) Principles of exercise testing and interpretation, 4th edn. Lippincott Williams and Wilkins, Philadelphia, pp 160–182Google Scholar