Cardiopulmonary Exercise Tests in Patients With Heart Failure and Chronic Obstructive Pulmonary Disease: Moving Beyond Risk Assessment
| Autor: | Mahesh J, Patel |
|---|---|
| Rok vydání: | 2016 |
| Předmět: |
Heart Failure
VO2 oxygen uptake Exercise Tolerance Mini-Focus Issue: Risk Prediction and Prognosis in Heart Failure OUES oxygen uptake efficiency slope Risk Assessment BR breathing reserve ROC receiver-operating characteristic chronic heart failure AUC area under the receiver-operator characteristic curve Pulmonary Disease Chronic Obstructive Oxygen Consumption obstructive pulmonary disease COPD chronic obstructive pulmonary disease Exercise Test cardiopulmonary exercise testing Humans AT anaerobic threshold Exercise BNP B-type natriuretic peptide MVV maximal voluntary ventilation exercise physiology CPX cardiopulmonary exercise testing |
| Zdroj: | Jacc. Heart Failure |
| ISSN: | 2213-1787 |
| Popis: | Objectives The study sought to compare the relative discrimination of various cardiopulmonary exercise testing (CPX) variables between cardiac and respiratory disease. Background CPX testing is used in many cardiorespiratory diseases. However, discrimination of cardiac and respiratory dysfunction can be problematic. Anaerobic threshold (AT) and oxygen-uptake to work-rate relationship (VO2/WR slope) have been proposed as diagnostic of cardiac dysfunction, but multiple variables have not been compared. Methods A total of 73 patients with chronic obstructive pulmonary disease (COPD) (n = 25), heart failure with reduced ejection fraction (HFrEF) (n = 40), or combined COPD and HFrEF (n = 8) were recruited and underwent CPX testing on a bicycle ergometer. Following a familiarization test, each patient underwent a personalized second test aiming for maximal exercise after ∼10 min. Measurements from this test were used to calculate area under the receiver-operator characteristic curve (AUC). Results Peak VO2 was similar between the 2 principal groups (COPD 17.1 ± 4.6 ml/min/kg; HFrEF 16.4 ± 3.6 ml/min/kg). Breathing reserve (AUC: 0.91) and percent predicted oxygen uptake efficiency slope (OUES) (AUC: 0.87) had the greatest ability to discriminate between COPD and HFrEF. VO2/WR slope performed significantly worse (AUC: 0.68). VO2 at the AT did not discriminate (AUC for AT as percent predicted peak VO2: 0.56). OUES and breathing reserve remained strong discriminators when compared with an external cohort of healthy matched controls, and were comparable to B-type natriuretic peptide. Conclusions Breathing reserve and OUES discriminate heart failure from COPD. Despite it being considered an important determinant of cardiac dysfunction, the AT could not discriminate these typical clinical populations while the VO2/WR slope showed poor to moderate discriminant ability. (Identifying an Ideal Cardiopulmonary Exercise Test Parameter [PVA]; NCT01162083) |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|