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Abstract

Background

Increased ventilatory ( $\overset{\cdot}{V}$ E) response to carbon dioxide output ( $\overset{\cdot}{V}$ CO₂) is a key finding of incremental cardiopulmonary exercise testing in both heart failure and pulmonary arterial hypertension (PAH). As with heart failure, measures of excessive exercise ventilation considering high-to-peak exercise $\overset{\cdot}{V}$ E– $\overset{\cdot}{V}$ CO₂ might have higher prognostic relevance than those restrained to sub-maximal exercise in PAH.

Design

Cross-sectional and observational study on a tertiary center.

Methods

Eighty-four patients (36 idiopathic and 48 with associated conditions) were followed up for up to five years. Excessive exercise ventilation was calculated as a slope (Δ $\overset{\cdot}{V}$ E/Δ $\overset{\cdot}{V}$ CO₂ to the respiratory compensation point (_RCP) and to exercise cessation (_PEAK)) and as a ratio ( $\overset{\cdot}{V}$ E/ $\overset{\cdot}{V}$ CO₂ at the anaerobic threshold (_AT) and at _PEAK).

Results

Thirteen patients died and three had atrial septostomy. Multivariable regression analyses revealed that Δ $\overset{\cdot}{V}$ E/Δ $\overset{\cdot}{V}$ CO_2(PEAK) <55 and $\overset{\cdot}{V}$ E/ $\overset{\cdot}{V}$ CO_2(PEAK) <57 were better related to prognosis than Δ $\overset{\cdot}{V}$ E/Δ $\overset{\cdot}{V}$ CO_2(RCP) and $\overset{\cdot}{V}$ E/ $\overset{\cdot}{V}$ CO_2(AT) (p < 0.01). Δ oxygen uptake ( $\overset{\cdot}{V}$ O₂)/Δ work rate >5.5 ml/min per W was the only other independent prognostic index. According to a Kaplan–Meier survival analysis, 96.9% (90.8% to 100%) of patients showing Δ $\overset{\cdot}{V}$ E/Δ $\overset{\cdot}{V}$ CO_2(PEAK) <55 and Δ $\overset{\cdot}{V}$ O_2/Δ work rate >5.5 ml/min per W were free from a PAH-related event. In contrast, 74.7% (70.1% to 78.2%) with both parameters outside these ranges had a negative outcome.

Conclusion

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

Keywords

Exertion pulmonary hypertension ventilation exercise testing prognosis

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

Abstract

Background

Design

Methods

Results

Conclusion

Keywords

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References