Ventilation Dispersion Index as an Objective Evaluation Tool of Exercise Oscillatory Ventilation in Patients With Heart Failure

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Abstract

Background

Exercise oscillatory ventilation (EOV) is related to worse prognosis in patients with heart failure (HF). However, its determination is subjective and there is no standard measure to identify it. The aim of the study was to evaluate and characterize the EOV of patients with HF using the ventilation dispersion index (VDI).

Methods and Results

Patients underwent cardiopulmonary exercise testing (CPX), EOV was assessed by 2 reviewers and the VDI was calculated. The receiver operator curve analysis was used to assess the ability of the VDI to predict EOV. Pearson's correlation test was performed to determine the relationship between VDI and CPX variables. Forty-three patients with HF underwent CPX and were divided into 2 groups: with a VDI of less than 0.601 and a VDI of 0.601 or greater. An area under the curve of 0.759 was observed in the receiver operator curve analysis between VDI and EOV (P = .008). The VDI showed a significant correlation with the ventilatory CPX variables. According to the cut-off point obtained on the receiver operator curve, patients with a VDI of 0.601 or greater had lower left ventricular ejection fraction and higher values of resting minute ventilation and peak minute ventilation.

Conclusions

The VDI proved to be a good predictor of EOV in patients with HF.

Section snippets

Study Design and Participants

Consecutive patients who were referred to the cardiac rehabilitation unit of the University Hospital to perform the CPX between 2015 and 2017 were included as the study population. This is a cross-sectional study of a prospective cohort designed to monitor the results of a cardiac rehabilitation program. We included data from 43 patients of who presented the following inclusion criteria: (a) clinically stable (New York Heart Association functional classes I–III) diagnosed with HF; (b) clinical,

Results

Of the total of patients referred to the cardiac rehabilitation clinic during the research period, 43 individuals with HF met the inclusion criteria and were included. The sample predominantly included males (74.4%), with a mean age of 50 ± 12 years and a reduced ejection fraction (39 ± 15%); 13 patients had EOV(+) according to the reviewers’ analysis. The clinical and anthropometric characteristics of patients with HF included in the study are shown in Table 1. Fig. 1 shows that patients with

Discussion

The VDI was higher in the group of patients with EOV and proved to be a good predictor of EOV; the sensitivity and specificity in predicting EOV with a VDI of 0.601 was 83% and 61%, respectively. Patients with HF who had a VDI of 0.601 or greater had lower LVEF and higher resting and peak VE values when compared with the group with a VDI of less than 0.601. The VDI was shown to have a linear and positive relationship with the pulmonary function variables and with the ventilatory variables of

Disclosures

None.

References (35)

  • S Pardaens et al.

    Activation of the ergoreceptors in cardiac patients with and without heart failure

    J Card Fail

    (2014)
  • TP Chua et al.

    Relation between chemosensitivity and the ventilatory response to exercise in chronic heart failure

    J Am Coll Cardiol

    (1996)
  • TP Chua et al.

    Clinical correlates and prognostic significance of the ventilatory response to exercise in chronic heart failure

    J Am Coll Cardiol

    (1997)
  • M Guazzi et al.

    Exercise oscillatory ventilation may predict sudden cardiac death in heart failure patients

    J Am Coll Cardiol

    (2007)
  • M Guazzi et al.

    EACPR/AHA Scientific Statement. Clinical recommendations for cardiopulmonary exercise testing data assessment in specific patient populations

    Circulation

    (2012)
  • M Guazzi et al.

    2016 focused update: clinical recommendations for cardiopulmonary exercise testing data assessment in specific patient populations

    Eur Heart J

    (2018)
  • BP Dhakal et al.

    Exercise oscillatory ventilation: mechanisms and prognostic significance

    World J Cardiol

    (2016)
  • Cited by (0)

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