A case for assessment of oscillatory breathing during cardiopulmonary exercise test in risk stratification of elderly patients with chronic heart failure

Angela Beatrice Scardovi, Renata De Maria, Alessandro Ferraironi, Laura Gatto, Andrea Celestini, Silvia Forte, Marina Parolini, Sebastiano Sciarretta, Roberto Ricci, Marco Guazzi

Research output: Contribution to journalArticle

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Abstract

The prognostic value of exercise oscillatory breathing (EOB) during cardiopulmonary test (CPX) has been described in young chronic heart failure (HF) patients. We assessed the prognostic role of EOB vs other clinical and ventilatory parameters in elderly HF patients performing a maximal CPX. Methods and results: We prospectively followed-up 370 HF outpatients ≥65 years after a symptom limited CPX. We tested the predictive value of clinical and ventilatory parameters for all-cause mortality and a composite of all-cause mortality and HF hospitalizations. Median age was 74 years, 51% had ischemic heart disease, 25% NYHA class III; ejection fraction was 41% [34-50]. Peak oxygen consumption (PVO2) was 11.9 [9.9-14] mL/kg/min, the slope of the regression line relating ventilation to CO2 output, (VE/VCO 2 slope) was 33.9 [29.8-39.2]. EOB was found in 58% of patients. At follow-up, 84 patients died and overall 158, using a time-to-first event approach, met the composite end-point. Independent predictors of all-cause mortality were CPX EOB and the ratio of VE/VCO2 slope to peak VO 2, hemoglobin, creatinine and body mass index. The area under the ROC curve (AUC) of the Cox multivariable model was 0.80 (95% CI 0.73 to 0.87). Independent predictors of the composite end-point were EOB, VE/VCO2 slope, hemoglobin and HF admissions in the previous year (Model AUC 0.75) (95% CI 0.69 to 0.81). Conclusions: Among elderly HF patients, EOB prevalence is higher than middle-aged cohorts. EOB and the ratio of VE/VCO2 slope to peak VO2 resulted the strongest ventilatory predictor of all-cause mortality, independent of ventricular function.

Original languageEnglish
Pages (from-to)115-119
Number of pages5
JournalInternational Journal of Cardiology
Volume155
Issue number1
DOIs
Publication statusPublished - Feb 23 2012

Fingerprint

Breathing Exercises
Exercise Test
Respiration
Heart Failure
Mortality
ROC Curve
Area Under Curve
Hemoglobins
Ventricular Function
Proportional Hazards Models
Oxygen Consumption
Myocardial Ischemia
Ventilation
Creatinine
Hospitalization
Body Mass Index
Outpatients

Keywords

  • Cardiopulmonary exercise test
  • Elderly
  • Heart failure
  • Ventilatory inefficiency

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

A case for assessment of oscillatory breathing during cardiopulmonary exercise test in risk stratification of elderly patients with chronic heart failure. / Scardovi, Angela Beatrice; De Maria, Renata; Ferraironi, Alessandro; Gatto, Laura; Celestini, Andrea; Forte, Silvia; Parolini, Marina; Sciarretta, Sebastiano; Ricci, Roberto; Guazzi, Marco.

In: International Journal of Cardiology, Vol. 155, No. 1, 23.02.2012, p. 115-119.

Research output: Contribution to journalArticle

Scardovi, Angela Beatrice ; De Maria, Renata ; Ferraironi, Alessandro ; Gatto, Laura ; Celestini, Andrea ; Forte, Silvia ; Parolini, Marina ; Sciarretta, Sebastiano ; Ricci, Roberto ; Guazzi, Marco. / A case for assessment of oscillatory breathing during cardiopulmonary exercise test in risk stratification of elderly patients with chronic heart failure. In: International Journal of Cardiology. 2012 ; Vol. 155, No. 1. pp. 115-119.
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abstract = "The prognostic value of exercise oscillatory breathing (EOB) during cardiopulmonary test (CPX) has been described in young chronic heart failure (HF) patients. We assessed the prognostic role of EOB vs other clinical and ventilatory parameters in elderly HF patients performing a maximal CPX. Methods and results: We prospectively followed-up 370 HF outpatients ≥65 years after a symptom limited CPX. We tested the predictive value of clinical and ventilatory parameters for all-cause mortality and a composite of all-cause mortality and HF hospitalizations. Median age was 74 years, 51{\%} had ischemic heart disease, 25{\%} NYHA class III; ejection fraction was 41{\%} [34-50]. Peak oxygen consumption (PVO2) was 11.9 [9.9-14] mL/kg/min, the slope of the regression line relating ventilation to CO2 output, (VE/VCO 2 slope) was 33.9 [29.8-39.2]. EOB was found in 58{\%} of patients. At follow-up, 84 patients died and overall 158, using a time-to-first event approach, met the composite end-point. Independent predictors of all-cause mortality were CPX EOB and the ratio of VE/VCO2 slope to peak VO 2, hemoglobin, creatinine and body mass index. The area under the ROC curve (AUC) of the Cox multivariable model was 0.80 (95{\%} CI 0.73 to 0.87). Independent predictors of the composite end-point were EOB, VE/VCO2 slope, hemoglobin and HF admissions in the previous year (Model AUC 0.75) (95{\%} CI 0.69 to 0.81). Conclusions: Among elderly HF patients, EOB prevalence is higher than middle-aged cohorts. EOB and the ratio of VE/VCO2 slope to peak VO2 resulted the strongest ventilatory predictor of all-cause mortality, independent of ventricular function.",
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AU - Gatto, Laura

AU - Celestini, Andrea

AU - Forte, Silvia

AU - Parolini, Marina

AU - Sciarretta, Sebastiano

AU - Ricci, Roberto

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AB - The prognostic value of exercise oscillatory breathing (EOB) during cardiopulmonary test (CPX) has been described in young chronic heart failure (HF) patients. We assessed the prognostic role of EOB vs other clinical and ventilatory parameters in elderly HF patients performing a maximal CPX. Methods and results: We prospectively followed-up 370 HF outpatients ≥65 years after a symptom limited CPX. We tested the predictive value of clinical and ventilatory parameters for all-cause mortality and a composite of all-cause mortality and HF hospitalizations. Median age was 74 years, 51% had ischemic heart disease, 25% NYHA class III; ejection fraction was 41% [34-50]. Peak oxygen consumption (PVO2) was 11.9 [9.9-14] mL/kg/min, the slope of the regression line relating ventilation to CO2 output, (VE/VCO 2 slope) was 33.9 [29.8-39.2]. EOB was found in 58% of patients. At follow-up, 84 patients died and overall 158, using a time-to-first event approach, met the composite end-point. Independent predictors of all-cause mortality were CPX EOB and the ratio of VE/VCO2 slope to peak VO 2, hemoglobin, creatinine and body mass index. The area under the ROC curve (AUC) of the Cox multivariable model was 0.80 (95% CI 0.73 to 0.87). Independent predictors of the composite end-point were EOB, VE/VCO2 slope, hemoglobin and HF admissions in the previous year (Model AUC 0.75) (95% CI 0.69 to 0.81). Conclusions: Among elderly HF patients, EOB prevalence is higher than middle-aged cohorts. EOB and the ratio of VE/VCO2 slope to peak VO2 resulted the strongest ventilatory predictor of all-cause mortality, independent of ventricular function.

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