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.
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