Oscillatory Breathing and Exercise Gas Exchange Abnormalities Prognosticate Early Mortality and Morbidity in Heart Failure

Sun, Xing‐Guo; Hansen, James E.; Beshai, John F.; Wasserman, Karlman

doi:10.1016/j.jacc.2009.10.075

Cited by 130 publications

(122 citation statements)

References 40 publications

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“…3,22,23 After obtaining informed consent, satisfactory baseline CPET studies were obtained in 508 patients with low ( , 35%) ejection fraction HF. Each received a biventricular implantable cardioverter defi brillator and was randomized into pacemaker OFF or pacemaker ON subgroups.…”

Section: Setting and Participantsmentioning

confidence: 99%

“…Repeat studies were requested and obtained for any studies considered questionable. 3 Authorinvestigators were blinded to patient assignments, catheterization fi ndings, and imaging results at the time of data analysis. The mortality outcome was all-cause death; morbidity outcome included death or a cardiac hospitalization for Ն 24 h within the 6-month follow-up period.…”

Section: Quality Control Protocol Gas Exchange Measurement and Folmentioning

confidence: 99%

“…The determination of an OB 1 pattern required all of the following: (1) the amplitude of oscillatory ventilation must exceed 30% of concurrent mean ventilation 3,7,8,31,32 ; (2) three or more consecutive cyclic fl uctuations of ventilation or Ն 60% of entire CPET period 3,7-10,31,32 ; (3) an oscillatory frequency of 40 to 140 (56 Ϯ 5.2) s 3 ; and (4) visible oscillations of similar frequency in three or more of the following variables: oxygen pulse, o 2 , co 2 , e / co 2 , respiratory exchange ratio , or end-tidal pressures for oxygen (O 2 ) and CO 2 . 3 …”

Section: Oscillatory Breathingmentioning

confidence: 99%

“…[1][2][3] We postulated that management of such patients could be improved by adding more sensitive predictors, further refi ning well-known predictors, or by combining predictors. Currently, in such patients, gas exchange measurements during incremental cardiopulmonary exercise testing (CPET) such as peak oxygen uptake (peak o 2 ) at standard conditions of 0ºC, 760 mm Hg, dry (STPD); anaerobic threshold (AT); peak oxygen pulse; lowest ratio of minute ventilation ( e) at body temperature, ambient atmospheric pressure, saturated with water vapor to minute CO 2 output ( co 2 ) STPD; e -vs-co 2 slope; oscillatory breathing (OB) pattern [3][4][5][6][7][8][9][10] ; and the slope of o 2 to log e (oxygen uptake effi ciency slope [OUES]) [11][12][13][14][15][16][17][18][19][20][21] have been found to be useful in predicting mortality and morbidity and guiding therapy. [3][4][5][6][7][8][9][10] However, the full exercise response pattern of oxygen uptake effi ciency (OUE) ( o 2 / e , mL/L) and specifi cally the measurement of its highest average plateau (OUEP) (mL/L) have not been evaluated.…”

mentioning

confidence: 99%

“…As the CPET core laboratory for two St. Jude Medical multicenter studies 3,22,23 involving 508 patients with HF, we previously reported the CPET parameters listed here, plus resting and exercise heart rates, systemic BP, 6-min walk distance, left ventricular ejection fraction, quality of life, and New York Heart Asso ciation classifi cation for their value in predicting 6-month mortality and cardiac hospitalizations. Our recent report presenting OUEP and OUES reference values 24 for normal subjects allowed us to now evaluate OUEP and OUES as additional prognosticating parameters in patients with HF.…”

mentioning

confidence: 99%

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Oxygen Uptake Efficiency Plateau Best Predicts Early Death in Heart Failure

Sun

Hansen

Stringer

2012

Chest

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Despite recent improvements in therapy, chronic left heart failure (HF) frequently requires hospitalization or is lethal. [1][2][3] We postulated that management of such patients could be improved by adding more sensitive predictors, further refi ning well-known predictors, or by combining predictors. Currently, in such patients, gas exchange measurements during incremental cardiopulmonary exercise testing (CPET) such as peak oxygen uptake (peak o 2 ) at standard conditions of 0ºC, 760 mm Hg, dry (STPD); anaerobic threshold (AT); peak oxygen pulse; lowest ratio of minute ventilation ( e) at body temperature, ambient atmospheric pressure, saturated with water vapor to minute CO 2 output ( co 2 ) STPD; e -vs-co 2 slope; oscillatory breathing (OB) pattern [3][4][5][6][7][8][9][10] ; and the slope of o 2 to log e (oxygen uptake effi ciency slope [OUES]) [11][12][13][14][15][16][17][18][19][20][21] have been found to be useful in predicting mortality and morbidity and guiding therapy. 3-10 However, the full exercise response pattern of oxygen uptake effi ciency (OUE) ( o 2 / e , mL/L) and specifi cally the measurement of its highest average plateau (OUEP) (mL/L) have not been evaluated.As the CPET core laboratory for two St. Jude Medical multicenter studies 3,22,23 involving 508 patientsBackground: The responses of oxygen uptake effi ciency (ie, oxygen uptake/ventilation 5 O 2 / E ) and its highest plateau (OUEP) during incremental cardiopulmonary exercise testing (CPET) in patients with chronic left heart failure (HF) have not been previously reported. We planned to test the hypothesis that OUEP during CPET is the best single predictor of early death in HF. Methods: We evaluated OUEP, slope of O 2 to log( E) ( oxygen uptake effi ciency slope ) , oscillatory breathing, and all usual resting and CPET measurements in 508 patients with low-ejectionfraction ( , 35%) HF. Each had further evaluations at other sites, including cardiac catheterization. Outcomes were 6-month all-reason mortality and morbidity (death or . 24 h cardiac hospitalization). Statistical analyses included area under curve of receiver operating characteristics, ORs, univariate and multivariate Cox regression, and Kaplan-Meier plots. Results: OUEP, which requires only moderate exercise, was often reduced in patients with HF. A low % predicted OUEP was the single best predictor of mortality ( P , .0001), with an OR of 13.0 ( P , .001). When combined with oscillatory breathing, the OR increased to 56.3, superior to all other resting or exercise parameters or combinations of parameters. Other statistical analyses and morbidity analysis confi rmed those fi ndings. Conclusions: OUEP is often reduced in patients with HF. Low % predicted OUEP ( , 65% predicted) is the single best predictor of early death, better than any other CPET or other cardiovascular measurement. Paired with oscillatory breathing, it is even more powerful.

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Section: Setting and Participantsmentioning

confidence: 99%

Section: Quality Control Protocol Gas Exchange Measurement and Folmentioning

confidence: 99%

Section: Oscillatory Breathingmentioning

confidence: 99%

mentioning

confidence: 99%

mentioning

confidence: 99%

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Oxygen Uptake Efficiency Plateau Best Predicts Early Death in Heart Failure

Sun

Hansen

Stringer

2012

Chest

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Early radiographic pneumoconiosis is associated with impaired exercise gas exchange among coal miners with normal resting spirometry

Gandhi

Cohen

Blanc

et al. 2021

American J Industrial Med

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Rationale We sought to determine if radiographic pneumoconiosis predicts abnormal gas exchange during exercise in coal mine workers with preserved resting lung function. Methods We analyzed data from former coal miners seen between 2006 and 2014 in a single clinic specializing in black lung evaluations. We limited the analysis to those with normal resting spirometry and an A‐a gradient at peak exercise ≥10 mmHg. We used multivariable logistic regression to estimate predictors of A‐a gradient widened to >150% of the reference value. We focused on chest radiographs consistent with pneumoconiosis, taking into account higher silica exposure mining activities and years underground, and adjusting for cigarette smoking, obesity, and coronary artery disease. Results Of 5507 miners, we analyzed data for 742 subjects with normal spirometry and all key clinical variables available, of whom 372 (50.1%) had radiographic evidence of pneumoconiosis. All but 21 had small opacity profusion of less than 2/1. The median A‐a gradient at peak exercise was 108% of reference value (interquartile range, 81%–141%). In the multivariable analysis, radiographic pneumoconiosis was associated with increased odds of widened A‐a gradient (odds ratio [OR], 2.47; 95% confidence interval [CI], 1.7–3.7). Limited to 660 subjects with normal diffusing capacity for carbon monoxide, the odds were similarly increased (OR, 3.20; 95% CI, 1.5–3.6). Discussion Among coal miners with preserved resting lung function, radiographic evidence of early pneumoconiosis more than doubled the odds of abnormal exercise physiology. Impairment in pneumoconiosis occurs in early disease and may only be evident on exercise testing.

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Skeletal Muscle Changes in Chronic Cardiac Disease and Failure

Kennel

Mancini

Schulze

2015

Comprehensive Physiology

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Peak exercise performance in healthy man is limited not only by pulmonary or skeletal muscle function but also by cardiac function. Thus, abnormalities in cardiac function will have a major impact on exercise performance. Many cardiac diseases affect exercise performance and indeed for some cardiac conditions such as atherosclerotic heart disease, exercise testing is frequently used not only to measure functional capacity but also to make a diagnosis of heart disease, evaluate the efficacy of treatment, and predict prognosis. Early in the course of cardiac diseases, exercise performance will be minimally affected but with disease progression impairment in exercise capacity will become apparent. Ejection fraction, that is, the percent of blood volume ejected with each cardiac cycle is often used as a measure of cardiac performance but frequently there is a dissociation between the ejection fraction and exercise capacity in patients with heart disease. How abnormalities in cardiac function impacts the muscles, vasculature, and lungs to impact exercise performance will here be reviewed. The focus of this work will be on patients with systolic heart failure as the incidence and prevalence of heart failure is reaching epidemic proportions and heart failure is the end result of many other chronic cardiac diseases. The prognostic role of exercise and benefits of exercise training will also be discussed.

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Oscillatory Breathing and Exercise Gas Exchange Abnormalities Prognosticate Early Mortality and Morbidity in Heart Failure

Abstract: Cardiopulmonary exercise testing parameters are powerful prognosticators of early mortality and morbidity in patients with CHF, especially the optimal 2-predictor model of a combination of elevated lowest .VE/.VCO(2) and OB.

Cited by 130 publications

References 40 publications

Oxygen Uptake Efficiency Plateau Best Predicts Early Death in Heart Failure

Oxygen Uptake Efficiency Plateau Best Predicts Early Death in Heart Failure

Early radiographic pneumoconiosis is associated with impaired exercise gas exchange among coal miners with normal resting spirometry

Skeletal Muscle Changes in Chronic Cardiac Disease and Failure

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