• Eur J Prev Cardiol · Nov 2014

    Observational Study

    Optimizing the evaluation of excess exercise ventilation for prognosis assessment in pulmonary arterial hypertension.

    • Eloara V M Ferreira, Jaquelina S Ota-Arakaki, Roberta P Ramos, Priscila B Barbosa, Melline Almeida, Erika C Treptow, Fabricio M Valois, Luiz E Nery, and J Alberto Neder.
    • Pulmonary Vascular Group, Division of Respiratory Diseases, Department of Medicine, São Paulo School of Medicine (EPM), Federal University of Sao Paulo (UNIFESP), Brazil Pulmonary Function and Clinical Exercise Physiology Unit, Division of Respiratory Diseases, Department of Medicine, São Paulo School of Medicine (EPM), Federal University of Sao Paulo (UNIFESP), Brazil.
    • Eur J Prev Cardiol. 2014 Nov 1; 21 (11): 1409-19.

    BackgroundIncreased ventilatory (.VE) response to carbon dioxide output (.VCO2) is a key finding of incremental cardiopulmonary exercise testing in both heart failure and pulmonary arterial hypertension (PAH). As with heart failure, measures of excessive exercise ventilation considering high-to-peak exercise .VE-VCO2 might have higher prognostic relevance than those restrained to sub-maximal exercise in PAH.DesignCross-sectional and observational study on a tertiary center.MethodsEighty-four patients (36 idiopathic and 48 with associated conditions) were followed up for up to five years. Excessive exercise ventilation was calculated as a slope (Δ .VE/Δ .VCO2 to the respiratory compensation point (RCP) and to exercise cessation (PEAK)) and as a ratio (.VE-VCO2 at the anaerobic threshold (AT) and at PEAK).ResultsThirteen patients died and three had atrial septostomy. Multivariable regression analyses revealed that Δ .VE/Δ .VCO2(PEAK) <55 and .VE/.VCO2(PEAK) <57 were better related to prognosis than Δ .VE/Δ .VCO2(RCP) and .VE/.VCO2(AT) (p < 0.01). Δ oxygen uptake (.VO2)/Δ work rate >5.5 ml/min per W was the only other independent prognostic index. According to a Kaplan-Meier survival analysis, 96.9% (90.8% to 100%) of patients showing Δ .VE/Δ .VCO2(PEAK) <55 and Δ .VO2/Δ work rate >5.5 ml/min per W were free from a PAH-related event. In contrast, 74.7% (70.1% to 78.2%) with both parameters outside these ranges had a negative outcome.ConclusionMeasurements of excessive exercise ventilation which consider all data points maximize the usefulness of incremental cardiopulmonary exercise testing in the prognosis evaluation of PAH.© The European Society of Cardiology 2013 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav.

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