Oxygen uptake efficiency slope, a new submaximal parameter in evaluating exercise capacity in chronic heart failure patients

Laethem, Christophe Van; Bartúnek, Jozef; Goethals, Marc; Nellens, Paul; Andries, Erik; Vanderheyden, Marc

doi:10.1016/j.ahj.2004.07.004

Cited by 126 publications

(154 citation statements)

References 17 publications

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“…Elevated CO 2 production and metabolic acidosis stimulates hyperventilation; this in turn will decrease the OUES value, as commonly seen in heart failure patients (81). Hyperventilation during exercise in the presence of heart failure is associated with a greater pulmonary dead space.…”

Section: Ouesmentioning

confidence: 99%

The Influence of Maturation on the Oxygen Uptake Efficiency Slope

Rogowski

Guilkey

Stephens³

et al. 2012

Pediatric Exercise Science

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This study examined the influence of maturation on the oxygen uptake efficiency slope (OUES) in healthy male subjects. Seventy-six healthy male subjects (8–27 yr) were divided into groups based on maturation status: prepubertal (PP), midpubertal (MP), late-pubertal (LP), and young-adult (YA) males. Puberty status was determined by physical examination. Subjects performed a graded exercise test on a cycle ergometer to determine OUES. Group differences were assessed using a one-way ANOVA. OUES values (VO2L·min1/log10VEL·min−1) were lower in PP and MP compared with LP and YA (p < .05). When OUES was expressed relative to body mass (VO2mL·kg−1·min−1/log10VEmL·kg−1·min−1) differences between groups reversed whereby PP and MP had higher mass relative OUES values compared with LP and YA (p < .05). Adjusting OUES by measures of body mass failed to eliminate differences across maturational groups. This suggests that qualitative factors, perhaps related to oxidative metabolism, account for the responses observed in this study.

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Section: Ouesmentioning

confidence: 99%

The Influence of Maturation on the Oxygen Uptake Efficiency Slope

Rogowski

Guilkey

Stephens³

et al. 2012

Pediatric Exercise Science

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“…199 and may possess prognostic value. 201 With respect to the latter, the prognostic value of the OUES over the V E/V CO 2 slope or other CPX variables remains unclear.…”

Section: Balady Et Al Guide To Cardiopulmonary Exercise Testing In Admentioning

confidence: 99%

Clinician’s Guide to Cardiopulmonary Exercise Testing in Adults

Balady¹,

Arena

Sietsema³

et al. 2010

Circulation

1,636

925

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E xercise testing remains a remarkably durable and versatile tool that provides valuable diagnostic and prognostic information regarding patients with cardiovascular and pulmonary disease. Exercise testing has been available for more than a half century and, like many other cardiovascular procedures, has evolved in its technology and scope. When combined with exercise testing, adjunctive imaging modalities offer greater diagnostic accuracy, additional information regarding cardiac structure and function, and additional prognostic information. Similarly, the addition of ventilatory gas exchange measurements during exercise testing provides a wide array of unique and clinically useful incremental information that heretofore has been poorly understood and underutilized by the practicing clinician. The reasons for this are many and include the requirement for additional equipment (cardiopulmonary exercise testing [CPX] systems), personnel who are proficient in the administration and interpretation of these tests, limited or absence of training of cardiovascular specialists and limited training by pulmonary specialists in this technique, and the lack of understanding of the value of CPX by practicing clinicians.Modern CPX systems allow for the analysis of gas exchange at rest, during exercise, and during recovery and yield breath-by-breath measures of oxygen uptake (V O 2 ), carbon dioxide output (V CO 2 ), and ventilation (V E). These advanced computerized systems provide both simple and complex analyses of these data that are easy to retrieve and store, which makes CPX available for widespread use. These data can be readily integrated with standard variables measured during exercise testing, including heart rate, blood pressure, work rate, electrocardiography findings, and symptoms, to provide a comprehensive assessment of exercise tolerance and exercise responses. CPX can even be performed with adjunctive imaging modalities for additional diagnostic assessment. Hence, CPX offers the clinician the ability to obtain a wealth of information beyond standard exercise electrocardiography testing that when appropriately applied and interpreted can assist in the management of complex cardiovascular and pulmonary disease.

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“…[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.…”

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confidence: 99%

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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Oxygen uptake efficiency slope, a new submaximal parameter in evaluating exercise capacity in chronic heart failure patients

Cited by 126 publications

References 17 publications

The Influence of Maturation on the Oxygen Uptake Efficiency Slope

The Influence of Maturation on the Oxygen Uptake Efficiency Slope

Clinician’s Guide to Cardiopulmonary Exercise Testing in Adults

Oxygen Uptake Efficiency Plateau Best Predicts Early Death in Heart Failure

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