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Ventilatory and Heart Rate Responses to Exercise: Better Predictors of Heart Failure Mortality Than Peak Exercise Oxygen Consumption

2000; Lippincott Williams & Wilkins; Volume: 102; Issue: 24 Linguagem: Inglês

10.1161/01.cir.102.24.e182

1524-4539

Guy A. MacGowan, Srinivas Murali,

Heart Failure Treatment and Management

HomeCirculationVol. 102, No. 24Ventilatory and Heart Rate Responses to Exercise: Better Predictors of Heart Failure Mortality Than Peak Exercise Oxygen Consumption Free AccessLetterPDF/EPUBAboutView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissions ShareShare onFacebookTwitterLinked InMendeleyRedditDiggEmail Jump toFree AccessLetterPDF/EPUBVentilatory and Heart Rate Responses to Exercise: Better Predictors of Heart Failure Mortality Than Peak Exercise Oxygen Consumption Guy A. MacGowan and Srinivas Murali Guy A. MacGowanGuy A. MacGowan Section of Heart Failure and Transplantation Cardiology, Cardiovascular Institute of the University of Pittsburgh Medical Center, 200 Lothrop Street, Pittsburgh, PA 15213 and Srinivas MuraliSrinivas Murali Section of Heart Failure and Transplantation Cardiology, Cardiovascular Institute of the University of Pittsburgh Medical Center, 200 Lothrop Street, Pittsburgh, PA 15213 Originally published12 Dec 2000https://doi.org/10.1161/01.CIR.102.24.e182Circulation. 2000;102:e182To the Editor:We read with great interest the article by Robbins et al1 describing how exercise-related ventilatory and heart rate responses better predict heart failure mortality than peak exercise oxygen consumption.2Although Robbins et al1 correctly state that other investigators have shown that exercise-related ventilatory abnormalities can be useful in predicting mortality,3 they fail to acknowledge the fact that our group4 previously published similar findings, which demonstrated that ventilatory abnormalities were related to outcome in congestive heart failure. Importantly, we demonstrated that by combining ventilatory abnormalities and peak exercise oxygen consumption, patients at a particularly high risk for death could be identified. These findings are similar to the data presented in Figures 1, 5, and 7 of the article by Robbins et al.1 In patients with minute ventilation/carbon dioxide production (V̇e/V̇co2) >50 and a peak exercise oxygen consumption <15 mL · kg−1· min−1, we described a mortality rate of 82% (median follow-up time, 552±329 days) compared with a mortality of 22% in patients with a V̇e/V̇co2 <50 and a peak exercise oxygen consumption 50. The study by Robbins et al2 had a follow-up period similar to ours; however, they deserve credit for studying a larger patient population and for analyzing data regarding chronotropic responses to exercise.On the basis of these published data,4 we have used exercise-related ventilatory responses in conjunction with peak exercise oxygen consumption to evaluate candidates for transplantation for the past 3 years at the University of Pittsburgh Medical Center. We believe that a proper scientific evaluation of the hypothesis that exercise-related ventilatory responses provide additional prognostic information in heart failure beyond that provided by peak exercise oxygen consumption requires a full recognition of all pertinent, previously published studies. Clearly, this is an important area of clinical research that may have a substantial impact on the management of patients with congestive heart failure. References 1 Robbins M, Francis G, Pashkow FJ, et al. Ventilatory and heart rate responses to exercise: better predictors of heart failure mortality than peak oxygen consumption. Circulation.1999; 100:2411–2417.CrossrefMedlineGoogle Scholar2 Mancini DM, Eisen H, Kussmaul W, et al. Value of peak exercise oxygen consumption for optimal timing of cardiac transplantation in ambulatory patients with heart failure. Circulation.1991; 83:778–786.>CrossrefMedlineGoogle Scholar3 Chua TP, Ponikowksi P, Harrington D, et al. Clinical correlates and prognostic significance of the ventilatory response to exercise in chronic heart failure. J Am Coll Cardiol.1997; 29:1585–1590.CrossrefMedlineGoogle Scholar4 MacGowan GA, Janosko K, Cecchetti A, et al. Exercise-related ventilatory abnormalities and survival in congestive heart failureGoogle ScholarcirculationahaCirculationCirculationCirculation0009-73221524-4539Lippincott Williams & WilkinsResponseLauer Michael S., MD, Robbins Mark, MD, Pashkow Fredric, MD, Hoercher Kathy, RN, Snader Claire E., MA, Young James B., MD, and Francis Gary, MD12122000We thank Drs MacGowan and Murali for their letter. We agree that their study,R1 along with ours and those of others,R2 strongly support the view that ventilatory responses to exercise must be carefully considered when risk-stratifying patients with severe heart failure. We are also now routinely incorporating the ventilatory response to exercise in our metabolic stress test reports and in our considerations regarding candidacy for cardiac transplantation. Previous Back to top Next FiguresReferencesRelatedDetailsCited By Tucker M, Lee N, Rodriguez-Miguelez P, Looney J, Crandall R, Forseen C, McKie K and Harris R (2018) Exercise testing in patients with cystic fibrosis—importance of ventilatory parameters, European Journal of Applied Physiology, 10.1007/s00421-018-4018-5, 119:1, (227-234), Online publication date: 1-Jan-2019. Fu T, Chen C, Chang C, Chang H and Chu H (2018) Analysis of Exercise-Induced Periodic Breathing Using an Autoregressive Model and the Hilbert-Huang Transform, Computational and Mathematical Methods in Medicine, 10.1155/2018/4860204, 2018, (1-8), Online publication date: 26-Jun-2018. Wagner J, Agostoni P, Arena R, Belardinelli R, Dumitrescu D, Hager A, Myers J, Rauramaa R, Riley M, Takken T and Schmidt-Trucksäss A (2018) The Role of Gas Exchange Variables in Cardiopulmonary Exercise Testing for Risk Stratification and Management of Heart Failure with Reduced Ejection Fraction, American Heart Journal, 10.1016/j.ahj.2018.05.009, 202, (116-126), Online publication date: 1-Aug-2018. Gibelin P, Aldossari A, Bertora D, Moceri P and Hugues T (2012) New Parameters of Cardiopulmonary Exercise Testing in Patients with Chronic Heart Failure: Practical Applications, International Journal of Clinical Medicine, 10.4236/ijcm.2012.36096, 03:06, (532-537), . Guazzi M, Myers J, Peberdy M, Bensimhon D, Chase P and Arena R (2009) Maximal Dyspnea on Exertion During Cardiopulmonary Exercise Testing Is Related to Poor Prognosis and Echocardiography With Tissue Doppler Imaging in Heart Failure, Congestive Heart Failure, 10.1111/j.1751-7133.2009.00107.x, 15:6, (277-283), Online publication date: 1-Nov-2009. DeJong A, Gallagher M, Sandberg K, Lillystone M, Spring T, Franklin B and McCullough P (2008) Peak Oxygen Consumption and the Minute Ventilation/Carbon Dioxide Production Relation Slope in Morbidly Obese Men and Women: Influence of Subject Effort and Body Mass Index, Preventive Cardiology, 10.1111/j.1751-7141.2008.07591.x, 11:2, (100-105) Guazzi M, Myers J, Abella J, Peberdy M, Bensimhon D, Chase P and Arena R (2008) The added prognostic value of ventilatory efficiency to the Weber classification system in patients with heart failure, International Journal of Cardiology, 10.1016/j.ijcard.2007.05.028, 129:1, (86-92), Online publication date: 1-Sep-2008. Arena R, Guazzi M and Myers J (2007) Prognostic value of end-tidal carbon dioxide during exercise testing in heart failure, International Journal of Cardiology, 10.1016/j.ijcard.2006.04.058, 117:1, (103-108), Online publication date: 1-Apr-2007. ARENA R, GUAZZI M, MYERS J and ABELLA J (2007) The Prognostic Value of Ventilatory Efficiency with Beta-Blocker Therapy in Heart Failure, Medicine & Science in Sports & Exercise, 10.1249/01.mss.0000241655.45500.c7, 39:2, (213-219), Online publication date: 1-Feb-2007. Arena R, Myers J, Hsu L, Peberdy M, Pinkstaff S, Bensimhon D, Chase P, Vicenzi M and Guazzi M (2007) The Minute Ventilation/Carbon Dioxide Production Slope is Prognostically Superior to the Oxygen Uptake Efficiency Slope, Journal of Cardiac Failure, 10.1016/j.cardfail.2007.03.004, 13:6, (462-469), Online publication date: 1-Aug-2007. Arena R, Myers J, Aslam S, Varughese E and Peberdy M (2006) Impact of time past exercise testing on prognostic variables in heart failure, International Journal of Cardiology, 10.1016/j.ijcard.2004.12.071, 106:1, (88-94), Online publication date: 1-Jan-2006. Arena R, Peberdy M, Myers J, Guazzi M and Tevald M (2006) Prognostic value of resting end-tidal carbon dioxide in patients with heart failure, International Journal of Cardiology, 10.1016/j.ijcard.2005.06.032, 109:3, (351-358), Online publication date: 1-May-2006. Guazzi M, Arena R and Myers J (2006) Comparison of the prognostic value of cardiopulmonary exercise testing between male and female patients with heart failure, International Journal of Cardiology, 10.1016/j.ijcard.2005.11.105, 113:3, (395-400), Online publication date: 1-Nov-2006. Arena R, Myers J, Abella J and Peberdy M (2005) Influence of Heart Failure Etiology on the Prognostic Value of Peak Oxygen Consumption and Minute Ventilation/Carbon Dioxide Production Slope, Chest, 10.1378/chest.128.4.2812, 128:4, (2812-2817), Online publication date: 1-Oct-2005. Arena R, Guazzi M, Myers J and Ann Peberdy M (2005) Prognostic characteristics of cardiopulmonary exercise testing in heart failure: comparing American and European models, European Journal of Cardiovascular Prevention & Rehabilitation, 10.1097/00149831-200512000-00008, 12:6, (562-567), Online publication date: 1-Dec-2005. Arena R, Myers J, Aslam S, Varughese E and Peberdy M (2004) Influence of Subject Effort on the Prognostic Value of Peak VO2 and the VE/VCO2 Slope in Patients With Heart Failure, Journal of Cardiopulmonary Rehabilitation, 10.1097/00008483-200409000-00006, 24:5, (317-320), Online publication date: 1-Sep-2004. Arena R, Myers J, Aslam S, Varughese E and Peberdy M (2004) Peak VO2 and VE/VCO2 slope in patients with heart failure: a prognostic comparison, American Heart Journal, 10.1016/j.ahj.2003.07.014, 147:2, (354-360), Online publication date: 1-Feb-2004. Arena R, Humphrey R and Peberdy M (2016) Prognostic ability of VE/VCO 2 slope calculations using different exercise test time intervals in subjects with heart failure , European Journal of Cardiovascular Prevention & Rehabilitation, 10.1097/01.hjr.0000102817.74402.5b, 10:6, (463-468), Online publication date: 1-Dec-2003. Arena R, Myers J, Aslam S, Varughese E and Peberdy M (2003) Technical Considerations Related to the Minute Ventilation/Carbon Dioxide Output Slope in Patients With Heart Failure*, Chest, 10.1378/chest.124.2.720, 124:2, (720-727), Online publication date: 1-Aug-2003. December 12, 2000Vol 102, Issue 24Article InformationMetrics Copyright © 2000 by American Heart Associationhttps://doi.org/10.1161/01.CIR.102.24.e182 Originally publishedDecember 12, 2000 PDF download Advertisement