Respiratory gas kinetics in patients with congestive heart failure during recovery from peak exercise

Detalhes bibliográficos
Autor(a) principal: Patti, Alessandro
Data de Publicação: 2023
Outros Autores: Blumberg, Yair, Hedman, Kristofer, Neunhäuserer, Daniel, Haddad, Francois, Wheeler, Matthew, Ashley, Euan, Moneghetti, Kegan J., Myers, Jonathan, Christle, Jeffrey W.
Tipo de documento: Artigo
Idioma: eng
Título da fonte: Clinics
Texto Completo: https://www.revistas.usp.br/clinics/article/view/214036
Resumo: Background: Cardiopulmonary Exercise Testing (CPX) is essential for the assessment of exercise capacity for patients with Chronic Heart Failure (CHF). Respiratory gas and hemodynamic parameters such as Ventilatory Efficiency (VE/VCO2 slope), peak oxygen uptake (peak VO2), and heart rate recovery are established diagnostic and prognostic markers for clinical populations. Previous studies have suggested the clinical value of metrics related to respiratory gas collected during recovery from peak exercise, particularly recovery time to 50% (T1/2) of peak VO2. The current study explores these metrics in detail during recovery from peak exercise in CHF. Methods: Patients with CHF who were referred for CPX and healthy individuals without formal diagnoses were assessed for inclusion. All subjects performed CPX on cycle ergometers to volitional exhaustion and were monitored for at least five minutes of recovery. CPX data were analyzed for overshoot of respiratory exchange ratio (RER=VCO2/VO2), ventilatory equivalent for oxygen (VE/VO2), end-tidal partial pressure of oxygen (PETO2), and T1/2 of peak VO2 and VCO2. Results: Thirty-two patients with CHF and 30 controls were included. Peak VO2 differed significantly between patients and controls (13.5 ± 3.8 vs. 32.5 ± 9.8 mL/Kg*min−1, p < 0.001). Mean Left Ventricular Ejection Fraction (LVEF) was 35.9 ± 9.8% for patients with CHF compared to 61.1 ± 8.2% in the control group. The T1/2 of VO2, VCO2 and VE was significantly higher in patients (111.3 ± 51.0, 132.0 ± 38.8 and 155.6 ± 45.5s) than in controls (58.08 ± 13.2, 74.3 ± 21.1, 96.7 ± 36.8s; p < 0.001) while the overshoot of PETO2, VE/VO2 and RER was significantly lower in patients (7.2 ± 3.3, 41.9 ± 29.1 and 25.0 ± 13.6%) than in controls (10.1 ± 4.6, 62.1 ± 17.7 and 38.7 ± 15.1%; all p < 0.01). Most of the recovery metrics were significantly correlated with peak VO2 in CHF patients, but not with LVEF. Conclusions: Patients with CHF have a significantly blunted recovery from peak exercise. This is reflected in delays of VO2, VCO2, VE, PETO2, RER and VE/VO2, reflecting a greater energy required to return to baseline. Abnormal respiratory gas kinetics in CHF was negatively correlated with peak VO2 but not baseline LVEF.
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spelling Respiratory gas kinetics in patients with congestive heart failure during recovery from peak exerciseRespiratory exchange ratio (RER)Cardiopulmonary exercise testingOxygen uptakeCarbon dioxide productionOvershootBackground: Cardiopulmonary Exercise Testing (CPX) is essential for the assessment of exercise capacity for patients with Chronic Heart Failure (CHF). Respiratory gas and hemodynamic parameters such as Ventilatory Efficiency (VE/VCO2 slope), peak oxygen uptake (peak VO2), and heart rate recovery are established diagnostic and prognostic markers for clinical populations. Previous studies have suggested the clinical value of metrics related to respiratory gas collected during recovery from peak exercise, particularly recovery time to 50% (T1/2) of peak VO2. The current study explores these metrics in detail during recovery from peak exercise in CHF. Methods: Patients with CHF who were referred for CPX and healthy individuals without formal diagnoses were assessed for inclusion. All subjects performed CPX on cycle ergometers to volitional exhaustion and were monitored for at least five minutes of recovery. CPX data were analyzed for overshoot of respiratory exchange ratio (RER=VCO2/VO2), ventilatory equivalent for oxygen (VE/VO2), end-tidal partial pressure of oxygen (PETO2), and T1/2 of peak VO2 and VCO2. Results: Thirty-two patients with CHF and 30 controls were included. Peak VO2 differed significantly between patients and controls (13.5 ± 3.8 vs. 32.5 ± 9.8 mL/Kg*min−1, p < 0.001). Mean Left Ventricular Ejection Fraction (LVEF) was 35.9 ± 9.8% for patients with CHF compared to 61.1 ± 8.2% in the control group. The T1/2 of VO2, VCO2 and VE was significantly higher in patients (111.3 ± 51.0, 132.0 ± 38.8 and 155.6 ± 45.5s) than in controls (58.08 ± 13.2, 74.3 ± 21.1, 96.7 ± 36.8s; p < 0.001) while the overshoot of PETO2, VE/VO2 and RER was significantly lower in patients (7.2 ± 3.3, 41.9 ± 29.1 and 25.0 ± 13.6%) than in controls (10.1 ± 4.6, 62.1 ± 17.7 and 38.7 ± 15.1%; all p < 0.01). Most of the recovery metrics were significantly correlated with peak VO2 in CHF patients, but not with LVEF. Conclusions: Patients with CHF have a significantly blunted recovery from peak exercise. This is reflected in delays of VO2, VCO2, VE, PETO2, RER and VE/VO2, reflecting a greater energy required to return to baseline. Abnormal respiratory gas kinetics in CHF was negatively correlated with peak VO2 but not baseline LVEF.Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo2023-06-23info:eu-repo/semantics/articleinfo:eu-repo/semantics/publishedVersionapplication/pdfhttps://www.revistas.usp.br/clinics/article/view/21403610.1016/j.clinsp.2023.100225Clinics; v. 78 (2023); 100225Clinics; Vol. 78 (2023); 100225Clinics; Vol. 78 (2023); 1002251980-53221807-5932reponame:Clinicsinstname:Universidade de São Paulo (USP)instacron:USPenghttps://www.revistas.usp.br/clinics/article/view/214036/196271Copyright (c) 2023 Clinicsinfo:eu-repo/semantics/openAccessPatti, AlessandroBlumberg, YairHedman, KristoferNeunhäuserer, DanielHaddad, FrancoisWheeler, MatthewAshley, EuanMoneghetti, Kegan J.Myers, JonathanChristle, Jeffrey W.2023-07-05T14:58:29Zoai:revistas.usp.br:article/214036Revistahttps://www.revistas.usp.br/clinicsPUBhttps://www.revistas.usp.br/clinics/oai||clinics@hc.fm.usp.br1980-53221807-5932opendoar:2023-07-05T14:58:29Clinics - Universidade de São Paulo (USP)false
dc.title.none.fl_str_mv Respiratory gas kinetics in patients with congestive heart failure during recovery from peak exercise
title Respiratory gas kinetics in patients with congestive heart failure during recovery from peak exercise
spellingShingle Respiratory gas kinetics in patients with congestive heart failure during recovery from peak exercise
Patti, Alessandro
Respiratory exchange ratio (RER)
Cardiopulmonary exercise testing
Oxygen uptake
Carbon dioxide production
Overshoot
title_short Respiratory gas kinetics in patients with congestive heart failure during recovery from peak exercise
title_full Respiratory gas kinetics in patients with congestive heart failure during recovery from peak exercise
title_fullStr Respiratory gas kinetics in patients with congestive heart failure during recovery from peak exercise
title_full_unstemmed Respiratory gas kinetics in patients with congestive heart failure during recovery from peak exercise
title_sort Respiratory gas kinetics in patients with congestive heart failure during recovery from peak exercise
author Patti, Alessandro
author_facet Patti, Alessandro
Blumberg, Yair
Hedman, Kristofer
Neunhäuserer, Daniel
Haddad, Francois
Wheeler, Matthew
Ashley, Euan
Moneghetti, Kegan J.
Myers, Jonathan
Christle, Jeffrey W.
author_role author
author2 Blumberg, Yair
Hedman, Kristofer
Neunhäuserer, Daniel
Haddad, Francois
Wheeler, Matthew
Ashley, Euan
Moneghetti, Kegan J.
Myers, Jonathan
Christle, Jeffrey W.
author2_role author
author
author
author
author
author
author
author
author
dc.contributor.author.fl_str_mv Patti, Alessandro
Blumberg, Yair
Hedman, Kristofer
Neunhäuserer, Daniel
Haddad, Francois
Wheeler, Matthew
Ashley, Euan
Moneghetti, Kegan J.
Myers, Jonathan
Christle, Jeffrey W.
dc.subject.por.fl_str_mv Respiratory exchange ratio (RER)
Cardiopulmonary exercise testing
Oxygen uptake
Carbon dioxide production
Overshoot
topic Respiratory exchange ratio (RER)
Cardiopulmonary exercise testing
Oxygen uptake
Carbon dioxide production
Overshoot
description Background: Cardiopulmonary Exercise Testing (CPX) is essential for the assessment of exercise capacity for patients with Chronic Heart Failure (CHF). Respiratory gas and hemodynamic parameters such as Ventilatory Efficiency (VE/VCO2 slope), peak oxygen uptake (peak VO2), and heart rate recovery are established diagnostic and prognostic markers for clinical populations. Previous studies have suggested the clinical value of metrics related to respiratory gas collected during recovery from peak exercise, particularly recovery time to 50% (T1/2) of peak VO2. The current study explores these metrics in detail during recovery from peak exercise in CHF. Methods: Patients with CHF who were referred for CPX and healthy individuals without formal diagnoses were assessed for inclusion. All subjects performed CPX on cycle ergometers to volitional exhaustion and were monitored for at least five minutes of recovery. CPX data were analyzed for overshoot of respiratory exchange ratio (RER=VCO2/VO2), ventilatory equivalent for oxygen (VE/VO2), end-tidal partial pressure of oxygen (PETO2), and T1/2 of peak VO2 and VCO2. Results: Thirty-two patients with CHF and 30 controls were included. Peak VO2 differed significantly between patients and controls (13.5 ± 3.8 vs. 32.5 ± 9.8 mL/Kg*min−1, p < 0.001). Mean Left Ventricular Ejection Fraction (LVEF) was 35.9 ± 9.8% for patients with CHF compared to 61.1 ± 8.2% in the control group. The T1/2 of VO2, VCO2 and VE was significantly higher in patients (111.3 ± 51.0, 132.0 ± 38.8 and 155.6 ± 45.5s) than in controls (58.08 ± 13.2, 74.3 ± 21.1, 96.7 ± 36.8s; p < 0.001) while the overshoot of PETO2, VE/VO2 and RER was significantly lower in patients (7.2 ± 3.3, 41.9 ± 29.1 and 25.0 ± 13.6%) than in controls (10.1 ± 4.6, 62.1 ± 17.7 and 38.7 ± 15.1%; all p < 0.01). Most of the recovery metrics were significantly correlated with peak VO2 in CHF patients, but not with LVEF. Conclusions: Patients with CHF have a significantly blunted recovery from peak exercise. This is reflected in delays of VO2, VCO2, VE, PETO2, RER and VE/VO2, reflecting a greater energy required to return to baseline. Abnormal respiratory gas kinetics in CHF was negatively correlated with peak VO2 but not baseline LVEF.
publishDate 2023
dc.date.none.fl_str_mv 2023-06-23
dc.type.driver.fl_str_mv info:eu-repo/semantics/article
info:eu-repo/semantics/publishedVersion
format article
status_str publishedVersion
dc.identifier.uri.fl_str_mv https://www.revistas.usp.br/clinics/article/view/214036
10.1016/j.clinsp.2023.100225
url https://www.revistas.usp.br/clinics/article/view/214036
identifier_str_mv 10.1016/j.clinsp.2023.100225
dc.language.iso.fl_str_mv eng
language eng
dc.relation.none.fl_str_mv https://www.revistas.usp.br/clinics/article/view/214036/196271
dc.rights.driver.fl_str_mv Copyright (c) 2023 Clinics
info:eu-repo/semantics/openAccess
rights_invalid_str_mv Copyright (c) 2023 Clinics
eu_rights_str_mv openAccess
dc.format.none.fl_str_mv application/pdf
dc.publisher.none.fl_str_mv Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo
publisher.none.fl_str_mv Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo
dc.source.none.fl_str_mv Clinics; v. 78 (2023); 100225
Clinics; Vol. 78 (2023); 100225
Clinics; Vol. 78 (2023); 100225
1980-5322
1807-5932
reponame:Clinics
instname:Universidade de São Paulo (USP)
instacron:USP
instname_str Universidade de São Paulo (USP)
instacron_str USP
institution USP
reponame_str Clinics
collection Clinics
repository.name.fl_str_mv Clinics - Universidade de São Paulo (USP)
repository.mail.fl_str_mv ||clinics@hc.fm.usp.br
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