Anaerobic Threshold and Respiratory Compensation Point Identification During Cardiopulmonary Exercise Tests in Chronic Heart Failure

Carriere, Cosimo; Corrà, Ugo; Piepoli, Massimo F; Bonomi, Alice; Merlo, Marco; Barbieri, Simone; Salvioni, Elisabetta; Binno, Simone; Mapelli, Massimo; Righini, Francesca Maria; Sciomer, Susanna; Vignati, Carlo; Moscucci, Federica; Veglia, Fabrizio; Sinagra, Gianfranco; Agostoni, Piergiuseppe

doi:10.1016/j.chest.2019.03.013

Cited by 29 publications

(16 citation statements)

References 32 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…From the original 1995 cases, AT and RCP were identified in 782 patients, allowing an analysis of the isocapnic buffering period. Patients with a non-identifiable AT and/or RCP had severe heart failure and poor prognosis 22,23 whereas patients with an identified AT and RCP had parameters suggestive of a moderate heart failure and a favourable prognosis. Accordingly, these subjects are only a minority of heart failure patients able to perform a CPET (39% of cases), but prognosis identification in this setting of heart failure patients is particularly challenging, due to an expected low events rate.…”

Section: Discussionmentioning

confidence: 99%

Isocapnic buffering period: From physiology to clinics

Carriere

Corrà

Piepoli

et al. 2019

Eur J Prev Cardiolog

Self Cite

View full text Add to dashboard Cite

Background During cardiopulmonary exercise test, the isocapnic buffering period ranges between anaerobic threshold (AT) and respiratory compensation point (RCP). We investigated whether oxygen uptake (VO2) increase during the isocapnic buffering period (ΔVO2AT-RCP) is related to heart failure severity and prognosis. Methods We retrospectively analysed reduced ejection fraction heart failure patients who attained RCP at cardiopulmonary exercise test. The study endpoint was the composite of cardiovascular mortality and urgent heart transplantation/left ventricular assist device implantation. Hazard ratio was assessed to identify the increase of risk associated with ΔVO2AT-RCP (below and above the median of ΔVO2AT-RCP). Results AT and RCP were both identified in 782 (39.2%) out of 1995 reduced ejection fraction heart failure cases. Left ventricular ejection fraction and peak VO2 were 33 ± 9% and 16.5 ± 4.5 mL/kg per min (61 ± 16% of predicted value), suggesting moderate heart failure. At five years, endpoint did not vary between patients below and above the median ΔVO2AT-RCP (3.85 mL/min per kg (25–75th interquartile range = 2.69–5.46)). ΔVO2AT-RCP correlated with several parameters associated to heart failure prognosis, such as peak VO2, VE/VCO2 slope, brain natriuretic peptide and left ventricular ejection fraction. The ΔVO2AT-RCP value was associated with prognosis at univariate but not at multivariable analysis, where only VE/VCO2 slope endured. Conclusion ΔVO2AT-RCP correlates with several parameters linked to heart failure severity. Isocapnic buffering period stratifies heart failure patients, but not more than other prognostic indices.

show abstract

Section: Discussionmentioning

confidence: 99%

Isocapnic buffering period: From physiology to clinics

Carriere

Corrà

Piepoli

et al. 2019

Eur J Prev Cardiolog

Self Cite

View full text Add to dashboard Cite

show abstract

“…22,23 Moreover, over the following years, the population of the MECKI score registry was enlarged and continuously updated, so that the MECKI group conducted a number of studies in different subpopulations of patients according to comorbidities or to study-specific parameters. 22,[24][25][26][27][28][29][30][31][32][33][34][35][36][37][38][39][40][41][42][43] At present, 25 Italian centres participate in the collection of data, and the registry counts more than 7000 patients so far, with a median follow-up of 1421 (627-2713) days and 1899 events. Table 2 shows the evolution of the MECKI score registry over time with the main steps of data collection.…”

Section: The Evolution Of the Mecki Scorementioning

confidence: 99%

The MECKI score initiative: Development and state of the art

Salvioni

Bonomi

et al. 2020

European Journal of Preventive Cardiology

Self Cite

View full text Add to dashboard Cite

The high morbidity and poor survival rates associated with chronic heart failure still represent a big challenge, despite improvements in treatments and the development of new therapeutic opportunities. The prediction of outcome in heart failure is gradually moving towards a multiparametric approach in order to obtain more accurate models and to tailor the prognostic evaluation to the individual characteristics of a single subject. The Metabolic Exercise test data combined with Cardiac and Kidney Indexes (MECKI) score was developed 10 years ago from 2715 patients and subsequently validated in a different population. The score allows an accurate evaluation of the risk of heart failure patients using only six variables that include the evaluation of the exercise capacity (peak oxygen uptake and ventilation/CO2 production slope), blood samples (haemoglobin, Na+, Modification of Diet in Renal Disease) and echocardiography (left ventricular ejection fraction). Over the following years, the MECKI score was tested taking into account therapies and specific markers of heart failure, and it proved to be a simple, useful tool for risk stratification and for therapeutic strategies in heart failure patients. The close connection between the centres involved and the continuous updating of the data allow the participating sites to propose substudies on specific subpopulations based on a common dataset and to put together and develop new ideas and perspectives.

show abstract

“…Limited information is available on the prognostic role of the isocapnic buffering period and on measurements obtained during the isocapnic buffering period. Indeed, in an analysis of the MECKI score dataset, Carriere et al 42 showed relevant differences in prognosis in subjects in whom the anaerobic threshold and the respiratory compensation point were not identified (Figure 4). This suggests that the persistence of a normal exercise physiology bears a relevant prognostic impact regardless of the values of VO 2 , VCO 2 , or VE.…”

Section: Physiology Of Exercise-induced Periodic Breathing In Hf and mentioning

confidence: 99%

Roles of periodic breathing and isocapnic buffering period during exercise in heart failure

Agostoni

Emdin

Martino

et al. 2020

European Journal of Preventive Cardiology

Self Cite

View full text Add to dashboard Cite

In heart failure, exercise – induced periodic breathing and end tidal carbon dioxide pressure value during the isocapnic buffering period are two features identified at cardiopulmonary exercise testing strictly related to sympathetic activation. In the present review we analysed the physiology behind periodic breathing and the isocapnic buffering period and present the relevant prognostic value of both periodic breathing and the presence/absence of the identifiable isocapnic buffering period.

show abstract

Anaerobic Threshold and Respiratory Compensation Point Identification During Cardiopulmonary Exercise Tests in Chronic Heart Failure

Cited by 29 publications

References 32 publications

Isocapnic buffering period: From physiology to clinics

Isocapnic buffering period: From physiology to clinics

The MECKI score initiative: Development and state of the art

Roles of periodic breathing and isocapnic buffering period during exercise in heart failure

Contact Info

Product

Resources

About