Journal of Cardiac Failure
Volume 15, Issue 9 , Pages 756-762 , November 2009

The Lowest VE/VCO2 Ratio During Exercise as a Predictor of Outcomes in Patients With Heart Failure

  • Jonathan Myers, PhD

      Affiliations

    • Veterans Affairs Palo Alto Health Care System, Palo Alto, CA
    • Stanford University, Palo Alto, CA
    • Corresponding Author InformationReprint requests: Jonathan Myers, PhD, VA Palo Alto Health Care System, Cardiology Division – 111C, 3801 Miranda Ave., Palo Alto, CA 94304. Tel: (650) 493-5000, ext. 6-4661; Fax: (650) 852-3473.
    • ,
  • Ross Arena, PhD

      Affiliations

    • Virginia Commonwealth University, Richmond, VA
    • ,
  • Ricardo B. Oliveira, PhD

      Affiliations

    • Veterans Affairs Palo Alto Health Care System, Palo Alto, CA
    • ,
  • Daniel Bensimhon, MD

      Affiliations

    • Lebauer Cardiovascular Research Foundation, Greensboro, NC
    • ,
  • Leon Hsu, BS

      Affiliations

    • Veterans Affairs Palo Alto Health Care System, Palo Alto, CA
    • ,
  • Paul Chase, MEd

      Affiliations

    • Lebauer Cardiovascular Research Foundation, Greensboro, NC
    • ,
  • Marco Guazzi, MD, PhD

      Affiliations

    • University of Milano, Sao Paolo Hospital, Milan, Italy
    • ,
  • Peter Brubaker, PhD

      Affiliations

    • Wake Forest University School of Medicine, Winston-Salem NC
    • ,
  • Brian Moore, MS

      Affiliations

    • Wake Forest University School of Medicine, Winston-Salem NC
    • ,
  • Dalane Kitzman, MD

      Affiliations

    • Wake Forest University School of Medicine, Winston-Salem NC
    • ,
  • Mary Ann Peberdy, MD

      Affiliations

    • Virginia Commonwealth University, Richmond, VA

Received 4 September 2008 ,Revised 15 May 2009 ,Accepted 21 May 2009.

References 

  1. Arena R, Myers J, Guazzi M. The clinical and research applications of aerobic capacity and ventilatory efficiency in heart failure: an evidence-based review. Heart Failure Rev. 2008;13:245–269
  2. 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. Circulation. 2002;106:3079–3084
  3. Arena R, Myers J, Abella J, Peberdy MA, Bensimhon D, Chase P, et al. Development of a ventilatory classification system in patients with heart failure. Circulation. 2007;115:2410–2417
  4. Arena R, Myers J, Hsu L, Peberdy MA, Pinkstaff S, Bensimhon D, et al. The minute ventilation/carbon dioxide production slope in prognostically superior to the oxygen uptake efficiency slope. J Cardiac Fail. 2007;13:462–469
  5. Corra U, Mezzani A, Bosimini E, Scapellato F, Imparato A, Giannuzzi P. Ventilatory response to exercise improves risk stratification in patients with chronic heart failure and intermediate functional capacity. Am Heart J. 2002;143:418–426
  6. Davies LC, Wensel R, Georgiadou P, Cicoira M, Coats AJ, Piepoli MF, et al. Enhanced prognostic value from cardiopulmonary exercise testing in chronic heart failure by non-linear analysis: Oxygen uptake efficiency slope. Eur Heart J. 2006;27:684–690
  7. Rickli H, Kiowski W, Brehm M, Weilenmann D, Schalcher C, Bernheim A, et al. Combining low-intensity and maximal exercise test results improves prognostic prediction in chronic heart failure. J Am Coll Cardiol. 2003;42:116–122
  8. Arena R, Guazzi M, Myers J. Prognostic value of end-tidal carbon dioxide during exercise testing in heart failure. Int J Cardiol. 2007;117:103–108
  9. Arena R, Peberdy MA, Myers J, Guazzi M, Tevald M. Prognostic value of resting end-tidal carbon dioxide in patients with heart failure. Int J Cardiol. 2006;109:351–358
  10. De Groote P, Millaire A, Decoulxe , Nugue O, Guimier P, Ducloux G. Kinetics of oxygen consumption during and after exercise in patients with dilated cardiomyopathy. J Am Coll Cardiol. 1996;28:168–175
  11. Arena R, Myers J, Abella J, Peberdy MA, Pinkstaff S, Bensimhon D, et al. Prognostic value of timing and duration characteristics of exercise oscillatory ventilation in patients with heart failure. J Heart Lung Transplant. 2008;27:341–347
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  13. Hunt SA. American College of Cardiology; American Heart Association Task Force on Practice Guidelines (Writing Committee to Update the 2001 Guidelines for the Evaluation and Management of Heart Failure). J Am Coll Cardiol. 2005;46:e1–82
  14. Myers J, Buchanan N, Walsh D, Kraemer M, McAuley P, Hamilton-Wessler M, et al. Comparison of the ramp versus standard exercise protocols. J Am Coll Cardiol. 1991;17:1334–1342
  15. Arena R, Guazzi M, Myers J, Ann Peberdy M. Prognostic characteristics of cardiopulmonary exercise testing in heart failure: comparing American and European models. Eur J Cardiovasc Prev Rehabil. 2005;12:562–567
  16. Arena R, Myers J, Aslam S, Varughese EB, Peberdy MA. Technical considerations related to the minute ventilation/carbon dioxide output slope in patients with heart failure. Chest. 2003;124:720–727
  17. Bard RL, Gillespie BW, Clarke NS, Egan TG, Nicklas JM. Determining the best ventilatory efficiency measure to predict mortality in patients with heart failure. J Heart Lung Transpl. 2006;25:589–595
  18. Perkins NJ, Schisterman EF. The inconsistency of “optimal” cut-points using two ROC based criteria. Am J Epidemiol. 2006;163:670–675
  19. Wagenmakers EJ, Farrell S. AIC model selection using Akaike weights. Psychonomic Bull Rev. 2004;11:192–196
  20. Arena R, Myers J, Aslam SS, Varughese EB, Peberdy MA. Peak VO2 and VE/VCO2 slope in patients with heart failure: a prognostic comparison. Am Heart J. 2004;147:354–360
  21. Myers J, Arena R, Dewey F, Bensimhon D, Abella J, Hsu L, et al. A cardiopulmonary exercise testing score for predicting outcomes in patients with heart failure.. Am Heart J. 2008;156:1177–1183
  22. Ingle L. Theoretical rational and practical recommendations for cardiopulmonary exercise testing in patients with chronic heart failure. Heart Fail Rev. 2007;12:12–22
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  24. Ashley E, Myers J, Froelicher VF. Exercise testing scores as an example of better decisions through science. Med Sci Sports Exerc. 2002;34:1391–1398
  25. Statement on cardiopulmonary exercise testing in chronic heart failure due to left ventricular dysfunction. Recommendations for performance and interpretation. Task Force of the Italian Working Group on Cardiac Rehabilitation and Prevention. Piepoli MF, Corrà U, Agostoni PG, Belardinelli R, Cohen-Solal A, Hambrecht R, et al. Eur J Cardiovasc Prev Rehabil. 2006;13:300–311
  26. Wasserman K, Zhang YY, Gitt A, Belardinelli R, Koike A, et al. Lung function and exercise gas exchange in chronic heart failure. Circulation. 1997;96:2221–2227
  27. Myers J, Froelicher VF. Hemodynamic determinants of exercise capacity in chronic heart failure. Ann Internal Med. 1991;115:377–386
  28. Arena R, Myers J, Aslam SS, Varughese EB, Peberdy MA. Prognostic comparison of the minute ventilation/carbon dioxide production ratio and slope in patients with heart failure. Heart Drug. 2004;4:133–139
  29. Mejhert M, Linder-Klingsell E, Edner M, Kahan T, Persson H. Ventilatory variables are strong prognostic markers in elderly patients with heart failure. Heart. 2002;88:239–243
  30. MacGowan GA, Janosko K, Cecchetti A, Murali S. Exercise-related ventilatory abnormalities and survival in congestive heart failure. Am J Cardiol. 1997;79:1264–1266
  31. Robbins M, Francis G, Pashkow FJ, Snader CE, Hoercher K, Young JB, et al. Ventilatory and heart rate responses to exercise: Better predictors of heart failure mortality than peak oxygen consumption. Circulation. 1999;100:2411–2417

PII: S1071-9164(09)00188-2

doi: 10.1016/j.cardfail.2009.05.012

Journal of Cardiac Failure
Volume 15, Issue 9 , Pages 756-762 , November 2009

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