The Value of Cardiopulmonary Exercise Testing in Determining Severity in Patients with both Systolic Heart Failure and COPD

Our aim was to identify optimal cardiopulmonary exercise testing (CPET) threshold values that distinguish disease severity progression in patients with co-existing systolic heart failure (HF) and chronic obstructive pulmonary disease (COPD), and to evaluate the impact of the cut-off determined on th...

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Bibliographic Details
Published in:Scientific reports 2020-03, Vol.10 (1), p.4309-4309, Article 4309
Main Authors: Goulart, Cássia da Luz, Dos Santos, Polliana Batista, Caruso, Flávia Rossi, Arêas, Guilherme Peixoto Tinoco, Marinho, Renan Shida, Camargo, Patricia de Faria, Alexandre, Tiago da Silva, Oliveira, Claudio R, da Silva, Andréa Lúcia Gonçalves, Mendes, Renata Gonçalves, Roscani, Meliza Goi, Borghi-Silva, Audrey
Format: Article
Language:English
Subjects:
Aged
Carbon dioxide
Chronic obstructive pulmonary disease
Congestive heart failure
Cross-Sectional Studies
Doppler effect
Echocardiography
Exercise Test - methods
Exercise Tolerance
Female
Forced Expiratory Volume
Heart failure
Heart Failure, Systolic - diagnosis
Heart Failure, Systolic - physiopathology
Hospitalization - statistics & numerical data
Humans
Lung diseases
Male
Obstructive lung disease
Oxygen Consumption
Phenotypes
Prognosis
Pulmonary Disease, Chronic Obstructive - diagnosis
Pulmonary Disease, Chronic Obstructive - physiopathology
Respiratory function
Respiratory Function Tests
ROC Curve
Severity of Illness Index
Stroke Volume
Ventricle
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Summary:Our aim was to identify optimal cardiopulmonary exercise testing (CPET) threshold values that distinguish disease severity progression in patients with co-existing systolic heart failure (HF) and chronic obstructive pulmonary disease (COPD), and to evaluate the impact of the cut-off determined on the prognosis of hospitalizations. We evaluated 40 patients (30 men and 10 woman) with HF and COPD through pulmonary function testing, doppler echocardiography and maximal incremental CPET on a cycle ergometer. Several significant CPET threshold values were identified in detecting a forced expiratory volume in 1 second (FEV ) < 1.6 L: 1) oxygen uptake efficiency slope (OUES) < 1.3; and 2) circulatory power (CP) < 2383 mmHg.mlO .kg . CPET significant threshold values in identifying a left ventricular ejection fraction (LVEF) < 39% were: 1) OUES: < 1.3; 2) CP < 2116 mmHg.mlO .kg .min and minute ventilation/carbon dioxide production (V̇ /V̇CO ) slope>38. The 15 (38%) patients hospitalized during follow-up (8 ± 2 months). In the hospitalizations analysis, LVEF < 39% and FEV < 1.6, OUES < 1.3, CP  38 were a strong risk predictor for hospitalization (P ≤ 0.050). The CPET response effectively identified worsening disease severity in patients with a HF-COPD phenotype. LVEF, FEV CP, OUES, and the V̇ /V̇CO slope may be particularly useful in the clinical assessment and strong risk predictor for hospitalization.
ISSN:2045-2322
2045-2322
DOI:10.1038/s41598-020-61199-5