Minute ventilation in cardiorespiratory exercise and its relationship with ventricular ejection fraction
Keywords:
heart failure, exercise test, observational study.Abstract
Introduction: Cardiorespiratory exercise testing is a non-invasive alternative in the assessment of subjects with heart failure.
Objective: To evaluate the validity of ventilatory equivalents for carbon dioxide (VE/VCO2) as a predictor of left ventricular ejection fraction (LVEF) compared to peak oxygen consumption.
Methods: Cross-sectional analytical study in patients undergoing cardiopulmonary exercise testing and transthoracic echocardiography. The study was divided into a group with reduced LVEF < 40 % and preserved = 40 %. Bivariate analysis comparing qualitative variables with the chi-square test and quantitative variables with Student's t-test was performed. A Receiver Operating Characteristic (ROC) curve was constructed to evaluate the discriminatory capacity between ventilatory equivalent for carbon dioxide and peak oxygen pulse.
Results: The final analysis included 138 patients. In patients with reduced LVEF, peak oxygen consumption averaged 1.6 L/min (SD ± 0.68) compared to 1.7 L/min (SD ± 0.66) in the control group (p= 0.513). VE/VCO2 during ventilatory threshold and peak exercise averaged 38.4 (SD ± 7.38) and 44.6 (SD ± 8.24), respectively. The discriminatory performance of VE/VCO2 versus peak oxygen consumption was 0.737 (95 % CI: 0.596-0.878; p= 0.008) in patients with reduced LVEF.
Conclusions: VE/VCO2 is a reliable predictor of normal or reduced LVEF and performs well compared to peak oxygen consumption.
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References
1. Bayoumi E, Karasik P. Cardiovascular Disease in Older Women [Internet]. Clin Geriatr Med. 2021; 37(4):651-65. DOI: 10.1016/j.cger.2021.05.010
2. Okunrintemi V, Tibuakuu M, Virani SS, Sperling LS, Volgman AS, Gulati M, et al. Sex Differences in the Age of Diagnosis for Cardiovascular Disease and Its Risk Factors Among US Adults: Trends From 2008 to 2017, the Medical Expenditure Panel Survey [Internet]. J Am Heart Assoc. 2020; 9(24):e018764. DOI: 10.1161/JAHA.120.018764
3. Kawada T. Socioeconomic status and cardiovascular disease [Internet]. Int J Cardiol. 2019; 274:378. DOI: 10.1016/j.ijcard.2018.07.034
4. Chen J, Aronowitz P. Congestive Heart Failure [Internet]. Med Clin North Am. 2022; 106(3):447-58. DOI: 10.1016/j.mcna.2021.12.002
5. McKeever AN, Drouet PC, Vera JA, Thomas WE, Coburn JW, Costa PB. A Retrospective Analysis of the Effects of Cardiac Rehabilitation on Health Markers and Performance Outcomes among Diabetic and Non-Diabetic Patients with Coronary Artery Bypass Grafting and Percutaneous Coronary Intervention [Internet]. Sports (Basel). 2024; 12(5):122. DOI: 10.3390/sports12050122
6. Shahid I, Avenatti E, Titus A, Al-Kindi S, Nasir K. Primary Prevention of Cardiovascular Disease in Women [Internet]. Methodist Debakey Cardiovasc J. 2024; 20(2):94-106. DOI: 10.14797/mdcvj.1313
7. Glaab T, Taube C. Practical guide to cardiopulmonary exercise testing in adults [Internet]. Respir Res. 2022; 23(1):9. DOI: 10.1186/s12931-021-01895-6
8. Song L, Qu H, Luo J, Wang W, Zheng L, Xue M,et al. Cardiopulmonary exercise test: A 20-year (2002-2021) bibliometric analysis [Internet]. Front Cardiovasc Med. 2022; 9:982351. DOI: 10.3389/fcvm.2022.982351
9. Stephan H, Klophaus N, Wehmeier UF, Tomschi F, Hilberg T. Calculation of Oxygen Uptake during Ambulatory Cardiac Rehabilitation [Internet]. J Clin Med. 2024; 13(8):2235. DOI: 10.3390/jcm13082235
10. MagrÌ D, Piepoli M, CorrÀ U, Gallo G, Maruotti A, Vignati C, et al. Cardiovascular Death Risk in Recovered Mid-Range Ejection Fraction Heart Failure: Insights From Cardiopulmonary Exercise Test [Internet]. J Card Fail. 2020;26(11):932-43. DOI: 10.1016/j.cardfail.2020.04.021
11. Sato T, Yoshihisa A, Kanno Y, Suzuki S, Yamaki T, Sugimoto K, et al. Cardiopulmonary exercise testing as prognostic indicators: Comparisons among heart failure patients with reduced, mid-range and preserved ejection fraction [Internet]. Eur J Prev Cardiol. 2017; 24(18):1979-87. DOI: 10.1177/2047487317739079
12. Ponikowski P, Voors AA, Anker SD, Bueno H, Cleland JGF, Coats AJS, et al. 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: The Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC) Developed with the special contribution of the Heart Failure Association (HFA) of the ESC [Internet]. Eur Heart J. 2016 ;37(27):2129-2200. DOI: 10.1093/eurheartj/ehw128
13. Fleisher LA, Fleischmann KE, Auerbach AD, Barnason SA, Beckman JA, Bozkurt B, et al. 2014 ACC/AHA guideline on perioperative cardiovascular evaluation and management of patients undergoing noncardiac surgery: executive summary: a report of the American College of Cardiology/American Heart Association Task Force on practice guidelines. Developed in collaboration with the American College of Surgeons, American Society of Anesthesiologists, American Society of Echocardiography, American Society of Nuclear Cardiology, Heart Rhythm Society, Society for Cardiovascular Angiography and Interventions, Society of Cardiovascular Anesthesiologists, and Society of Vascular Medicine Endorsed by the Society of Hospital Medicine [Internet]. J Nucl Cardiol. 2015; 22(1):162-215. DOI: 10.1007/s12350-014-0025-z
14. Nadruz W Jr, West E, Sengeløv M, Santos M, Groarke JD, Forman DE, et al. Prognostic Value of Cardiopulmonary Exercise Testing in Heart Failure With Reduced, Midrange, and Preserved Ejection Fraction [Internet]. J Am Heart Assoc. 2017; 6(11):e006000. DOI: 10.1161/JAHA.117.006000
15. Grinstein J, Sawalha Y, Medvedofsky DA, Ahmad S, Hofmeyer M, Rodrigo M, et al. VE/VCO2 slope predicts RV dysfunction and mortality after left ventricular assist device: a fresh look at cardiopulmonary stress testing for prognostication [Internet]. J Artif Organs. 2021; 24(4):425-32. DOI: 10.1007/s10047-021-01261-9
16. Harter TS, Dichiera AM, Esbaugh AJ. The physiological significance of plasma-accessible carbonic anhydrase in the respiratory systems of fishes [Internet]. J Comp Physiol B. 2024; 1(10):1-10. DOI: 10.1007/s00360-024-01562-4
17. Yang DE, Jo S, Lee DH, An WS, Jeong MJ, Son M. Dynamics of serum anion gaps with in-hospital mortality: Analysis of the multi-open databases [Internet]. PLoS One. 2024; 19(4):e0302206. DOI: 10.1371/journal.pone.0302206
18. Mortola JP. How to breathe? Respiratory mechanics and breathing pattern [Internet]. Respir Physiol Neurobiol. 2019; 261:48-54. DOI: 10.1016/j.resp.2018.12.005
19. Ghio S, Acquaro M, Agostoni P, Ambrosio G, Carluccio E, Castiglione V, et al. Right heart failure in left heart disease: imaging, functional, and biochemical aspects of right ventricular dysfunction [Internet]. Heart Fail Rev. 2023; 28(4):1009-22. DOI: 10.1007/s10741-022-10276-0
20. Petek BJ, Gustus SK, Wasfy MM. Cardiopulmonary Exercise Testing in Athletes: Expect the Unexpected [Internet]. Curr Treat Options Cardiovasc Med. 2021; 23(7):49. DOI: 10.1007/s11936-021-00928-z
21. Imai K, Sato H, Hori M, Kusuoka H, Ozaki H, Yokoyama H, et al. Vagally mediated heart rate recovery after exercise is accelerated in athletes but blunted in patients with chronic heart failure [Internet]. J Am Coll Cardiol. 1994; 24(6):1529-35. DOI: 10.1016/0735-1097(94)90150-3
22. Zweerink A, van der Lingen ACJ, Handoko ML, van Rossum AC, Allaart CP. Chronotropic Incompetence in Chronic Heart Failure [Internet]. Circ Heart Fail. 2018; 11(8):e004969. DOI: 10.1161/CIRCHEARTFAILURE.118.004969
23. Gitt AK, Wasserman K, Kilkowski C, Kleemann T, Kilkowski A, Bangert M, et al. Exercise anaerobic threshold and ventilatory efficiency identify heart failure patients for high risk of early death [Internet]. Circulation. 2002; 106(24):3079-84. DOI: 10.1161/01.cir.0000041428.99427.06
24. Kakutani N, Fukushima A, Yokota T, Katayama T, Nambu H, Shirakawa R, et al. Impact of High Respiratory Exchange Ratio During Submaximal Exercise on Adverse Clinical Outcome in Heart Failure [Internet]. Circ J. 2018 ;82(11):2753-60. DOI: 10.1253/circj.CJ-18-0103
25. Omar HR, Guglin M. Prognostic value of 6-minute walk test and cardiopulmonary exercise test in acute heart failure (from the ESCAPE trial) [Internet]. Am Heart J Plus. 2021; 1:100005. DOI: 10.1016/j.ahjo.2021.100005
26. Schierbauer J, Hoffmeister T, Treff G, Wachsmuth NB, Schmidt WFJ. Effect of Exercise-Induced Reductions in Blood Volume on Cardiac Output and Oxygen Transport Capacity [Internet]. Front Physiol. 2021; 12:679232. DOI: 10.3389/fphys.2021.679232
27. Souilla L, Avesani M, Boisson A, Requirand A, Matecki S, Vincenti M, et al. Cardiorespiratory fitness, muscle fitness, and physical activity in children with long QT syndrome: A prospective controlled study [Internet]. Front Cardiovasc Med. 2023; 9:1081106. DOI: 10.3389/fcvm.2022.1081106
28. Joyner MJ, Wiggins CC, Baker SE, Klassen SA, Senefeld JW. Exercise and Experiments of Nature [Internet]. Compr Physiol. 2023; 13(3):4879-4907. DOI: 10.1002/cphy.c220027
29. Lim ZX, Gyanwali B, Soh J, Koh AS, Goh J. The potential benefits of assessing post-cardiopulmonary exercise testing (CPET) in aging: a narrative review [Internet]. BMC Sports Sci Med Rehabil. 2023; 15(1):68. DOI: 10.1186/s13102-023-00671-x
30. Huiberts RO, Wüst RCI, van der Zwaard S. Concurrent Strength and Endurance Training: A Systematic Review and Meta-Analysis on the Impact of Sex and Training Status [Internet]. Sports Med. 2024; 54(2):485-503. DOI: 10.1007/s40279-023-01943-9
31. Garcia Brás P, Gonçalves AV, Reis JF, Moreira RI, Pereira-da-Silva T, Rio P, et al. Cardiopulmonary Exercise Testing in the Age of New Heart Failure Therapies: Still a Powerful Tool? [Internet]. Biomedicines. 2023; 11(8):2208. DOI: 10.3390/biomedicines11082208
32. Garcia Brás P, Gonçalves AV, Reis JF, Moreira RI, Pereira-da-Silva T, Rio P, et al. Age Differences in Cardiopulmonary Exercise Testing Parameters in Heart Failure with Reduced Ejection Fraction [Internet]. Medicina (Kaunas). 2023; 59(9):1685. DOI: 10.3390/medicina59091685
2. Okunrintemi V, Tibuakuu M, Virani SS, Sperling LS, Volgman AS, Gulati M, et al. Sex Differences in the Age of Diagnosis for Cardiovascular Disease and Its Risk Factors Among US Adults: Trends From 2008 to 2017, the Medical Expenditure Panel Survey [Internet]. J Am Heart Assoc. 2020; 9(24):e018764. DOI: 10.1161/JAHA.120.018764
3. Kawada T. Socioeconomic status and cardiovascular disease [Internet]. Int J Cardiol. 2019; 274:378. DOI: 10.1016/j.ijcard.2018.07.034
4. Chen J, Aronowitz P. Congestive Heart Failure [Internet]. Med Clin North Am. 2022; 106(3):447-58. DOI: 10.1016/j.mcna.2021.12.002
5. McKeever AN, Drouet PC, Vera JA, Thomas WE, Coburn JW, Costa PB. A Retrospective Analysis of the Effects of Cardiac Rehabilitation on Health Markers and Performance Outcomes among Diabetic and Non-Diabetic Patients with Coronary Artery Bypass Grafting and Percutaneous Coronary Intervention [Internet]. Sports (Basel). 2024; 12(5):122. DOI: 10.3390/sports12050122
6. Shahid I, Avenatti E, Titus A, Al-Kindi S, Nasir K. Primary Prevention of Cardiovascular Disease in Women [Internet]. Methodist Debakey Cardiovasc J. 2024; 20(2):94-106. DOI: 10.14797/mdcvj.1313
7. Glaab T, Taube C. Practical guide to cardiopulmonary exercise testing in adults [Internet]. Respir Res. 2022; 23(1):9. DOI: 10.1186/s12931-021-01895-6
8. Song L, Qu H, Luo J, Wang W, Zheng L, Xue M,et al. Cardiopulmonary exercise test: A 20-year (2002-2021) bibliometric analysis [Internet]. Front Cardiovasc Med. 2022; 9:982351. DOI: 10.3389/fcvm.2022.982351
9. Stephan H, Klophaus N, Wehmeier UF, Tomschi F, Hilberg T. Calculation of Oxygen Uptake during Ambulatory Cardiac Rehabilitation [Internet]. J Clin Med. 2024; 13(8):2235. DOI: 10.3390/jcm13082235
10. MagrÌ D, Piepoli M, CorrÀ U, Gallo G, Maruotti A, Vignati C, et al. Cardiovascular Death Risk in Recovered Mid-Range Ejection Fraction Heart Failure: Insights From Cardiopulmonary Exercise Test [Internet]. J Card Fail. 2020;26(11):932-43. DOI: 10.1016/j.cardfail.2020.04.021
11. Sato T, Yoshihisa A, Kanno Y, Suzuki S, Yamaki T, Sugimoto K, et al. Cardiopulmonary exercise testing as prognostic indicators: Comparisons among heart failure patients with reduced, mid-range and preserved ejection fraction [Internet]. Eur J Prev Cardiol. 2017; 24(18):1979-87. DOI: 10.1177/2047487317739079
12. Ponikowski P, Voors AA, Anker SD, Bueno H, Cleland JGF, Coats AJS, et al. 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: The Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC) Developed with the special contribution of the Heart Failure Association (HFA) of the ESC [Internet]. Eur Heart J. 2016 ;37(27):2129-2200. DOI: 10.1093/eurheartj/ehw128
13. Fleisher LA, Fleischmann KE, Auerbach AD, Barnason SA, Beckman JA, Bozkurt B, et al. 2014 ACC/AHA guideline on perioperative cardiovascular evaluation and management of patients undergoing noncardiac surgery: executive summary: a report of the American College of Cardiology/American Heart Association Task Force on practice guidelines. Developed in collaboration with the American College of Surgeons, American Society of Anesthesiologists, American Society of Echocardiography, American Society of Nuclear Cardiology, Heart Rhythm Society, Society for Cardiovascular Angiography and Interventions, Society of Cardiovascular Anesthesiologists, and Society of Vascular Medicine Endorsed by the Society of Hospital Medicine [Internet]. J Nucl Cardiol. 2015; 22(1):162-215. DOI: 10.1007/s12350-014-0025-z
14. Nadruz W Jr, West E, Sengeløv M, Santos M, Groarke JD, Forman DE, et al. Prognostic Value of Cardiopulmonary Exercise Testing in Heart Failure With Reduced, Midrange, and Preserved Ejection Fraction [Internet]. J Am Heart Assoc. 2017; 6(11):e006000. DOI: 10.1161/JAHA.117.006000
15. Grinstein J, Sawalha Y, Medvedofsky DA, Ahmad S, Hofmeyer M, Rodrigo M, et al. VE/VCO2 slope predicts RV dysfunction and mortality after left ventricular assist device: a fresh look at cardiopulmonary stress testing for prognostication [Internet]. J Artif Organs. 2021; 24(4):425-32. DOI: 10.1007/s10047-021-01261-9
16. Harter TS, Dichiera AM, Esbaugh AJ. The physiological significance of plasma-accessible carbonic anhydrase in the respiratory systems of fishes [Internet]. J Comp Physiol B. 2024; 1(10):1-10. DOI: 10.1007/s00360-024-01562-4
17. Yang DE, Jo S, Lee DH, An WS, Jeong MJ, Son M. Dynamics of serum anion gaps with in-hospital mortality: Analysis of the multi-open databases [Internet]. PLoS One. 2024; 19(4):e0302206. DOI: 10.1371/journal.pone.0302206
18. Mortola JP. How to breathe? Respiratory mechanics and breathing pattern [Internet]. Respir Physiol Neurobiol. 2019; 261:48-54. DOI: 10.1016/j.resp.2018.12.005
19. Ghio S, Acquaro M, Agostoni P, Ambrosio G, Carluccio E, Castiglione V, et al. Right heart failure in left heart disease: imaging, functional, and biochemical aspects of right ventricular dysfunction [Internet]. Heart Fail Rev. 2023; 28(4):1009-22. DOI: 10.1007/s10741-022-10276-0
20. Petek BJ, Gustus SK, Wasfy MM. Cardiopulmonary Exercise Testing in Athletes: Expect the Unexpected [Internet]. Curr Treat Options Cardiovasc Med. 2021; 23(7):49. DOI: 10.1007/s11936-021-00928-z
21. Imai K, Sato H, Hori M, Kusuoka H, Ozaki H, Yokoyama H, et al. Vagally mediated heart rate recovery after exercise is accelerated in athletes but blunted in patients with chronic heart failure [Internet]. J Am Coll Cardiol. 1994; 24(6):1529-35. DOI: 10.1016/0735-1097(94)90150-3
22. Zweerink A, van der Lingen ACJ, Handoko ML, van Rossum AC, Allaart CP. Chronotropic Incompetence in Chronic Heart Failure [Internet]. Circ Heart Fail. 2018; 11(8):e004969. DOI: 10.1161/CIRCHEARTFAILURE.118.004969
23. Gitt AK, Wasserman K, Kilkowski C, Kleemann T, Kilkowski A, Bangert M, et al. Exercise anaerobic threshold and ventilatory efficiency identify heart failure patients for high risk of early death [Internet]. Circulation. 2002; 106(24):3079-84. DOI: 10.1161/01.cir.0000041428.99427.06
24. Kakutani N, Fukushima A, Yokota T, Katayama T, Nambu H, Shirakawa R, et al. Impact of High Respiratory Exchange Ratio During Submaximal Exercise on Adverse Clinical Outcome in Heart Failure [Internet]. Circ J. 2018 ;82(11):2753-60. DOI: 10.1253/circj.CJ-18-0103
25. Omar HR, Guglin M. Prognostic value of 6-minute walk test and cardiopulmonary exercise test in acute heart failure (from the ESCAPE trial) [Internet]. Am Heart J Plus. 2021; 1:100005. DOI: 10.1016/j.ahjo.2021.100005
26. Schierbauer J, Hoffmeister T, Treff G, Wachsmuth NB, Schmidt WFJ. Effect of Exercise-Induced Reductions in Blood Volume on Cardiac Output and Oxygen Transport Capacity [Internet]. Front Physiol. 2021; 12:679232. DOI: 10.3389/fphys.2021.679232
27. Souilla L, Avesani M, Boisson A, Requirand A, Matecki S, Vincenti M, et al. Cardiorespiratory fitness, muscle fitness, and physical activity in children with long QT syndrome: A prospective controlled study [Internet]. Front Cardiovasc Med. 2023; 9:1081106. DOI: 10.3389/fcvm.2022.1081106
28. Joyner MJ, Wiggins CC, Baker SE, Klassen SA, Senefeld JW. Exercise and Experiments of Nature [Internet]. Compr Physiol. 2023; 13(3):4879-4907. DOI: 10.1002/cphy.c220027
29. Lim ZX, Gyanwali B, Soh J, Koh AS, Goh J. The potential benefits of assessing post-cardiopulmonary exercise testing (CPET) in aging: a narrative review [Internet]. BMC Sports Sci Med Rehabil. 2023; 15(1):68. DOI: 10.1186/s13102-023-00671-x
30. Huiberts RO, Wüst RCI, van der Zwaard S. Concurrent Strength and Endurance Training: A Systematic Review and Meta-Analysis on the Impact of Sex and Training Status [Internet]. Sports Med. 2024; 54(2):485-503. DOI: 10.1007/s40279-023-01943-9
31. Garcia Brás P, Gonçalves AV, Reis JF, Moreira RI, Pereira-da-Silva T, Rio P, et al. Cardiopulmonary Exercise Testing in the Age of New Heart Failure Therapies: Still a Powerful Tool? [Internet]. Biomedicines. 2023; 11(8):2208. DOI: 10.3390/biomedicines11082208
32. Garcia Brás P, Gonçalves AV, Reis JF, Moreira RI, Pereira-da-Silva T, Rio P, et al. Age Differences in Cardiopulmonary Exercise Testing Parameters in Heart Failure with Reduced Ejection Fraction [Internet]. Medicina (Kaunas). 2023; 59(9):1685. DOI: 10.3390/medicina59091685
Published
2024-07-15
How to Cite
1.
Bastidas-Goyes A, Tuta-Quintero E, Botero JD, Botero-Rosas D, Prieto D, Rubio D, et al. Minute ventilation in cardiorespiratory exercise and its relationship with ventricular ejection fraction. Rev Cubana Med Milit [Internet]. 2024 Jul. 15 [cited 2025 Apr. 4];53(3):e024059522. Available from: https://revmedmilitar.sld.cu/index.php/mil/article/view/59522
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