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 language | English |
|---|---|
| Pages (from-to) | 115-119 |
| Number of pages | 5 |
| Journal | International Journal of Cardiology |
| Volume | 155 |
| Issue number | 1 |
| DOIs | |
| Publication status | Published - Feb 23 2012 |
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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 journal › Article
}
TY - JOUR
T1 - A case for assessment of oscillatory breathing during cardiopulmonary exercise test in risk stratification of elderly patients with chronic heart failure
AU - Scardovi, Angela Beatrice
AU - De Maria, Renata
AU - Ferraironi, Alessandro
AU - Gatto, Laura
AU - Celestini, Andrea
AU - Forte, Silvia
AU - Parolini, Marina
AU - Sciarretta, Sebastiano
AU - Ricci, Roberto
AU - Guazzi, Marco
PY - 2012/2/23
Y1 - 2012/2/23
N2 - 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.
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.
KW - Cardiopulmonary exercise test
KW - Elderly
KW - Heart failure
KW - Ventilatory inefficiency
UR - http://www.scopus.com/inward/record.url?scp=84859888483&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84859888483&partnerID=8YFLogxK
U2 - 10.1016/j.ijcard.2011.02.033
DO - 10.1016/j.ijcard.2011.02.033
M3 - Article
VL - 155
SP - 115
EP - 119
JO - International Journal of Cardiology
JF - International Journal of Cardiology
SN - 0167-5273
IS - 1
ER -