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Exercise Oscillatory Ventilation – is there more to it than just ups and downs?
Session:
Comunicações Orais (Sessão 26) - Insuficiência Cardíaca 4 - Vários Tópicos
Speaker:
Gonçalo José Lopes Da Cunha
Congress:
CPC 2022
Topic:
D. Heart Failure
Theme:
10. Chronic Heart Failure
Subtheme:
10.2 Chronic Heart Failure – Epidemiology, Prognosis, Outcome
Session Type:
Comunicações Orais
FP Number:
---
Authors:
Gonçalo Lopes da Cunha; Bruno Rocha; Sérgio Maltês; Pedro Freitas; Francisco Gama; Carlos Aguiar; Luís Moreno; Anaí Durazzo; Miguel Mendes
Abstract
<p>Introduction: <br /> Exercise Oscillatory Ventilation (EOV) is fundamentally defined by the presence of an oscillatory phenomenon of the ventilation/minute with a given amplitude and frequency. Recently, it was proposed that a delay in O2 consumption (VO2) peak to minute ventilation (VE) peak during ventilatory oscillation predicts a worse prognosis in patients with Heart Failure (HF) and left ventricular ejection fraction (LVEF) <50%.<br /> We aimed to evaluate whether these characteristics add further prognostic value to the subset of HF patients with EOV.</p> <p>Methods<br /> This was a single-centre retrospective cohort of consecutive patients with HF and LVEF <50% that underwent cardiopulmonary exercise testing (CPET) from 2016-2020. EOV was defined as per Vainshelboim and colleagues (i.e. ≥3 consecutive cyclic fluctuations of ventilation during exercise, average amplitude over 3 ventilatory oscillations ≥5L and an average length of three oscillatory cycles 40-140s). Ventilation/minute graphs, with a rolling average of 5 consecutive breaths, were evaluated by 3 independent observers. The presence of EOV was established if at least 2 observers agreed on the classification. A second graph was then plotted, with both VO2 and VE over time and the mean delay between VO2 peak to VE peak during EOV was manually calculated.<br /> The primary endpoint was a composite of time to all-cause death, heart transplantation or left ventricular assistance device (LVAD) implantation.</p> <p>Results<br /> Of the overall cohort of 285 patients with HF and LVEF <50%, 78 (27%) were classified as having EOV (mean age 58 ± 12, mean LVEF 31 ± 10%; ischaemic HF – 63%). Sixty three percent of patients had over 1 second of mean VO2 peak to VE peak delay and 22% had over 10 seconds of mean delay. During a median follow-up of 27 (17-43) months, there were 32 patients with a primary outcome event: 4 LVAD, 12 heart transplants and 18 deaths. The rate of the primary outcome was 19% and 36% at 1- and 2-years, respectively. <br /> The amplitude, frequency, and maximum number of EOV cycles were not associated with the likelihood of the primary endpoint. Contrastingly, the mean delay of VO2 peak to VE peak during EOV was predictive of time to primary endpoint. The predictive capacity of this new parameter remained significant after adjustment for peak VO2 and VE VCO2 slope (adjusted HR: 1,06 95% CI 1,01-1,11). We found a cut-off of 5 seconds to be the most useful to predict the primary outcome at 2-years, with a sensitivity and specificity of 48 and 84%, respectively. </p> <p>Conclusion<br /> A novel CPET parameter associated with time to all-cause death, heart transplantation or LVAD implantation in patients with HF, reduced LVEF (<50%) and EOV. VO2 peak to VE peak delay may have an added value in the prognostication of patients with HF and reduced LVEF.</p>
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