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

Author(s):Show less -

Goulart, Cassia Luz ^[1] ; dos Santos, Polliana Batista ^[1] ; Caruso, Flavia Rossi ^[1] ; Tinoco Areas, Guilherme Peixoto ^[1] ; Marinho, Renan Shida ^[1] ; Camargo, Patricia de Faria ^[1] ; Alexandre, Tiago Silva ^[2] ; Oliveira, Claudio R. ^[1] ; Goncalves da Silva, Andrea Lucia ^[3] ; Mendes, Renata Goncalves ^[1] ; Roscani, Meliza Goi ^[4] ; Borghi-Silva, Audrey ^[1]

Affiliation

^[1] Univ Fed Sao Carlos, Physiotherapy Dept, Cardiopulm Physiotherapy Lab, UFSCar, Rod Washington Luis, KM 235, BR-13565905 Sao Carlos, SP - Brazil

^[2] Univ Fed Sao Carlos, Dept Gerontol, Sao Carlos - Brazil

^[3] Univ Santa Cruz do Sul, Dept Phys Educ & Hlth, Santa Cruz Do Sul, RS - Brazil

^[4] Univ Fed Sao Carlos, Dept Med, Sao Carlos, SP - Brazil

• Document type: Journal article
• Source: SCIENTIFIC REPORTS; v. 10, n. 1 MAR 9 2020.
• Web of Science Citations: 0

Abstract

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 1second (FEV1) < 1.6L: 1) oxygen uptake efficiency slope (OUES) < 1.3; and 2) circulatory power (CP) < 2383mmHg.mlO(2).kg(-1). CPET significant threshold values in identifying a left ventricular ejection fraction (LVEF) < 39% were: 1) OUES: < 1.3; 2) CP < 2116mmHg.mlO(2).kg(-1).min(-1) and minute ventilation/carbon dioxide production (V.(E)/V.CO2) slope>38. The 15 (38%) patients hospitalized during follow-up (8 +/- 2 months). In the hospitalizations analysis, LVEF < 39% and FEV1 < 1.6, OUES < 1.3, CP<2116mmHg.mlO(2).kg(-1).min(-1) and V.(E)/V.CO2>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, FEV1, CP, OUES, and the V.(E)/V.CO2 slope may be particularly useful in the clinical assessment and strong risk predictor for hospitalization. (AU)

• FAPESP's process: 18/03233-0 - Study of cardiorespiratory interaction and the supply of peripheral and cerebral oxygen as modulators of exercise capacity during bilevel application in the coexistence of COPD-CHF
• Grantee: Cássia da Luz Goulart
• Support Opportunities: Scholarships in Brazil - Doctorate (Direct)
• FAPESP's process: 15/26501-1 - Study of limiting factors to physical exercise and adjunct effects to rehabilitation on cardiorespiratory disease: a multicentre approach
• Grantee: Audrey Borghi e Silva
• Support Opportunities: Research Projects - Thematic Grants