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

Ferreira, Eloara Vieira Machado; Ota-­Arakaki, Jaquelina Sonoe; Barbosa, Priscila; Almeida, Matheus Oliveira de; Treptow, Erika; Valois, Fabrício Martins; Nery, Luíz Eduardo; Neder, J. Alberto

doi:10.1177/2047487313494293

Cited by 41 publications

(37 citation statements)

References 42 publications

(183 reference statements)

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“…it aims to reflect how effectively O 2 is extracted from the atmosphere and taken into the body as exercise progresses. We recently found that a combination of increased sub-maximal exercise V9E as a function of carbon dioxide output (V9CO 2 ) and reduced O 2 delivery/utilisation (as suggested by shallow V9O 2 -work rate relationship) were independent predictors of negative outcome in PAH of mixed aetiology [7]. These findings prompted the hypothesis that OUES would combine the prognostic information provided separately by those variables, thereby being the single predictor of poor outcome in our cohort.…”

Section: To the Editormentioning

confidence: 70%

“…Additional sources of increasing nonmetabolic drive include excessive sympathetic drive, respiratory muscle weakness, ergoreceptor stimuli and increased pulmonary artery/right ventricle pressures [1][2][3][4][5]. These premises fully justify the notion that excessive V9E response to CO 2 (DV9E/DV9CO 2 slope) is a valuable marker of disease severity and progression in PAH [1][2][3][4][5]7].…”

Section: To the Editormentioning

confidence: 96%

“…In the previous report [7], we described results from a group of 84 patients in whom 16 PAH-related deaths and two atrial septostomies were observed in a 5-year follow-up. In this present article, we extend these observations to 98 patients (70 females, 48 with idiopathic PAH and 50 with associated PAH) followed for up to 6.5 years, in whom 17 PAH-related deaths and four atrial septostomies were recorded.…”

Section: To the Editormentioning

confidence: 99%

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Exercise oxygen uptake efficiency slope independently predicts poor outcome in pulmonary arterial hypertension

Ramos

Ota-Arakaki

Alencar³

et al. 2013

Eur Respir J

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Section: To the Editormentioning

confidence: 70%

Section: To the Editormentioning

confidence: 96%

Section: To the Editormentioning

confidence: 99%

See 1 more Smart Citation

Exercise oxygen uptake efficiency slope independently predicts poor outcome in pulmonary arterial hypertension

Ramos

Ota-Arakaki

Alencar³

et al. 2013

Eur Respir J

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“…This explains why these findings may be useful to assess disease severity when mechanical abnormalities do not play a major role in limiting exercise capacity, e.g. heart failure and pulmonary arterial hypertension [7,8].…”

Section: Introductionmentioning

confidence: 99%

Exercise ventilatory inefficiency in mild to end-stage COPD

et al. 2014

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Ventilatory inefficiency during exercise is a key pathophysiological feature of chronic obstructive pulmonary disease. Currently, it is unknown how this physiological marker relates to clinically relevant outcomes as resting ventilatory impairment progresses across disease stages.Slope and intercept of the linear region of the ventilation-carbon dioxide output relationship and the ratio between these variables, at the lowest point (nadir), were contrasted in 316 patients with Global Initiative for Chronic Obstructive Lung Disease (GOLD) stages 1-4 (forced expiratory volume in 1 s, ranging from 148% pred to 12% pred) and 69 aged-and gender-matched controls, Compared to controls, slope and intercept were higher in GOLD stages 1 and 2, leading to higher nadirs ( p<0.05). Despite even larger intercepts in GOLD stages 3 and 4, slopes diminished as disease evolved (from mean±SD 35±6 in GOLD stage 1 to 24±5 in GOLD stage 3, p<0.05). As a result, there were no significant differences in nadirs among patient groups. Higher intercepts, across all stages ( p<0.01), and to a lesser extent lower slopes in GOLD stages 2-4 ( p<0.05), were related to greater mechanical constraints, worsening pulmonary gas exchange, higher dyspnoea scores, and poorer exercise capacity.Increases in the ventilation intercept best indicate the progression of exercise ventilatory inefficiency across the whole spectrum of chronic obstructive pulmonary disease severity. @ERSpublications Exercise ventilatory inefficiency relates to dyspnoea and exercise intolerance across whole COPD severity spectrum

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“…Peak

\dot{normalV} {normalO}_{2}

/heart rate was calculated as peak

\dot{normalV} {normalO}_{2}

divided by peak heart rate. Since previous studies show that

\dot{normalV} E / \dot{normalV} {CO}_{2}

slope calculated using the whole exercise period, as opposed to from the start of exercise to the ventilatory compensation point in patients with left‐sided heart failure and PAH, has better prognostic value,

\dot{normalV} E / \dot{normalV} {CO}_{2}

slope was determined by linear regression using the whole exercise period. OUES was determined by the slope of the regression line between log 10 minute ventilation

\dot{normalV} E

( x axis, L·min −1 ) and

\dot{normalV} {normalO}_{2}

( y axis, L·min −1 ) during the whole exercise period (

\dot{normalV} {normalO}_{2} = a log \dot{normalV} E+b; a=OUES

).…”

Section: Methodsmentioning

confidence: 99%

Oxygen Uptake Efficiency Slope Predicts Poor Outcome in Patients With Idiopathic Pulmonary Arterial Hypertension

Tang

Luo

Liu

et al. 2017

JAHA

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BackgroundFew published studies have evaluated the power of the oxygen uptake efficiency slope (OUES) to predict outcomes in patients with idiopathic pulmonary arterial hypertension (IPAH), who typically die of right‐sided heart failure. Our study sought to evaluate the power of OUES to predict clinical worsening and mortality in patients with IPAH.Methods and ResultsPatients with newly diagnosed IPAH who underwent symptom‐limited cardiopulmonary exercise testing from November 11, 2010, to June 25, 2015, in our hospital were prospectively enrolled and followed for up to 66 months. Clinical worsening and mortality were recorded. A total of 210 patients with IPAH (159 women; mean age, 32±10 years) were studied with a median follow‐up of 41 months. Thirty‐one patients died, 1 patient underwent lung transplantation, and 85 patients presented with clinical worsening. The univariate analysis revealed that OUES, OUESI (OUESI=OUES/body surface area), peak oxygen uptake (normalV˙normalO2), peak normalV˙normalO2/kg, ventilation (normalV˙E)/carbon dioxide output (normalV˙CO2) slope, peak systolic blood pressure, heart rate recovery, pulmonary vascular resistance, cardiac index, N‐terminal prohormone brain natriuretic peptide, and World Health Organization functional class were all predictive of clinical worsening and mortality (all P<0.05). Multivariate analysis demonstrated that OUESI and cardiac index were independently predictive of clinical worsening, and OUESI and N‐terminal prohormone brain natriuretic peptide were independently predictive of mortality. Patients with OUESI ≤0.52 m−2 had a worse 5‐year survival rate than patients with OUESI >0.52 m−2 (41.9% versus 89.8%, P<0.0001).ConclusionsThe OUES, a submaximal parameter obtained from cardiopulmonary exercise testing, provides prognostic information for predicting clinical worsening and mortality in patients with IPAH.

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

Abstract: Measurements of excessive exercise ventilation which consider all data points maximize the usefulness of incremental cardiopulmonary exercise testing in the prognosis evaluation of PAH.

Cited by 41 publications

References 42 publications

Exercise oxygen uptake efficiency slope independently predicts poor outcome in pulmonary arterial hypertension

Exercise oxygen uptake efficiency slope independently predicts poor outcome in pulmonary arterial hypertension

Exercise ventilatory inefficiency in mild to end-stage COPD

Oxygen Uptake Efficiency Slope Predicts Poor Outcome in Patients With Idiopathic Pulmonary Arterial Hypertension

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