Impact of oxygen uptake efficiency slope as a marker of cardiorespiratory reserve on response to cardiac resynchronization therapy

Berger, Thomas; Zwick, Ralf Harun; Stuehlinger, Markus; Dichtl, Wolfgang; Poelzl, Gerhard; Edlinger, Michael; Pachinger, Otmar; Hintringer, Florian

doi:10.1007/s00392-010-0226-7

Cited by 10 publications

(3 citation statements)

References 37 publications

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“…To our knowledge, this is one of the first studies that show that submaximal exercise parameters can help in predicting outcome of CRT. Previously, Berger et al showed that the OUES at baseline was related to the CRT response 21. However, we were unable to reproduce the high sensitivity and specificity of OUES that was reported.…”

Section: Discussionmentioning

confidence: 55%

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Does recovery from submaximal exercise predict response to cardiac resynchronisation therapy?

et al. 2022

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BackgroundExercise parameters are not routinely incorporated in decision making for cardiac resynchronisation therapy (CRT). Submaximal exercise parameters better reflect daily functional capacity of heart failure patients than parameters measured at maximal exertion, and may therefore better predict response to CRT. We compared various exercise parameters, and sought to establish which best predict CRT response.MethodsIn 31 patients with chronic heart failure (61% male; age 68±7 years), submaximal and maximal cycling testing was performed before and 3 months after CRT. Submaximal oxygen onset (τVO2onset) and recovery kinetics (τVO2recovery), peak oxygen uptake (VO2peak) and oxygen uptake efficiency slope (OUES) where measured. Response was defined as ≥15% relative reduction in end-systolic volume.ResultsAfter controlling for age, New York Heart Association and VO2peak, fast submaximal VO2kinetics were significantly associated with response to CRT, measured either during onset or recovery of submaximal exercise (area under the curve, AUC=0.719 for both; p<0.05). By contrast, VO2peak (AUC=0.632; p=0.199) and OUES (AUC=0.577; p=0.469) were not associated with response. Among patients with fast onset and recovery kinetics, below 60 s, a significantly higher percentage of responders was observed (91% and 92% vs 43% and 40%, respectively).ConclusionsImpaired VO2kinetics may serve as an objective marker of submaximal exercise capacity that is age-independently associated with non-response following CRT, whereas maximal exercise parameters are not. Assessment of VO2kinetics is feasible and easy to perform, but larger studies should confirm their clinical utility.

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Section: Discussionmentioning

confidence: 55%

“…Previously, Berger et al showed that the OUES at baseline was related to the CRT response. 21 However, we were unable to reproduce the high sensitivity and specificity of OUES that was reported. VO 2 peak and VE/VCO 2 slope were shown to be related to CRT response in other studies, possibly because of their higher sample size.…”

Section: Discussionmentioning

confidence: 84%

Does recovery from submaximal exercise predict response to cardiac resynchronisation therapy?

et al. 2022

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“…No entanto, a literatura tem mostrado que a mensuração do VO 2 pico pode ter um viés por ser altamente influenciado pela motivação do paciente e do investigador24,25 . Devido a essas limitações na mensuração do VO 2 pico, vários investigadores têm utilizado parâmetros de exercício submáximo para reproduzir o desempenho geral do indivíduo26,27,28 .O parâmetro submáximo capaz de avaliar de forma global a eficiência cardiorrespiratória frente à realização do exercício físico é o chamado slope da eficiência do consumo de oxigênio ou oxygen uptake efficiency slope (OUES)29 .Fisiologicamente, o OUES é definido como a taxa de aumento no consumo de oxigênio em resposta ao aumento na ventilação pulmonar29 , sendo um índice que indica a eficiência na captação de oxigênio pelos pulmões e sua extração em nível periférico30 .Mais especificamente, o OUES reflete a combinação das modulações cardiovasculares, musculoesqueléticas e pulmonares, podendo ser afetado tanto pelo metabolismo muscular como alterações na relação ventilação-perfusão em nível pulmonar29,77 . Por exemplo, estudos prévios demonstraram que pacientes com insuficiência cardíaca apresentam acidose metabólica precoce durante a realização do exercício físico em comparação a indivíduos saudáveis, dessa forma levando a uma diminuição do OUES78,79 .…”

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Eficiência cardiorrespiratória durante o exercício progressivo em pacientes com síndrome metabólica e apneia obstrutiva do sono

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Not left ventricular lead position, but the extent of immediate asynchrony reduction predicts long-term response to cardiac resynchronization therapy

et al. 2014

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Cardiac resynchronization therapy (CRT) is an effective treatment for a large subgroup of chronic heart failure patients. Various attempts to improve the high non-responder rate of 30 % by preoperative asynchrony assessment have failed. We hypothesized that superior response to CRT is correlated with greater acute reduction of asynchrony and that a concordant left ventricular (LV) lead is beneficial compared to a discordant lead. Hundred and eight consecutive CRT patients from our center were prospectively included. Clinical status and asynchrony parameters were assessed before, 1 day and 6 months after CRT implantation. Super-response was defined as an increase of the LV ejection fraction by ≥15 % and a decrease in LV end systolic volume (LVESV) by ≥30 %. When the criteria for super-response were not met, average response was given with a decrease of baseline LVESV ≥15 %. Sixty eight patients were classified as responders (63 %). Comparing super- (n = 19) and average (n = 49) responders, we found that greater acute reduction of LV asynchrony (change of asynchronous segments under CRT: -1.3 vs. -0.4, p < 0.05; decrease of LV intraventricular delay: -34 ms vs. -16 ms, p < 0.05) is associated with superior reverse remodeling after 6 months. Importantly, asynchrony parameters of super-, average and non-responders were almost identical at baseline. A concordant LV lead (n = 63) was not associated with improved LV reverse remodeling compared to a discordant lead (n = 28): LVEF: +8.6 % vs. +7.8 %, p = 0.91; LVESV: -30.5 ml vs. -23.8 mL, p = 0.84. A greater immediate reduction of LV asynchrony predicts superior response. Preoperative asynchrony parameters do not correlate with outcome. A concordant LV lead is not superior to a discordant lead.

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Impact of oxygen uptake efficiency slope as a marker of cardiorespiratory reserve on response to cardiac resynchronization therapy

Abstract: Nonresponders to CRT showed a more preserved cardiorespiratory functional reserve as compared to responders despite similar NYHA classification. Evaluation of the OUES by submaximal exercise testing improves identification of responders to CRT.

Cited by 10 publications

References 37 publications

Does recovery from submaximal exercise predict response to cardiac resynchronisation therapy?

Does recovery from submaximal exercise predict response to cardiac resynchronisation therapy?

Eficiência cardiorrespiratória durante o exercício progressivo em pacientes com síndrome metabólica e apneia obstrutiva do sono

Not left ventricular lead position, but the extent of immediate asynchrony reduction predicts long-term response to cardiac resynchronization therapy

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