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European Journal of Heart Failure 2008 10(11):1117-1122; doi:10.1016/j.ejheart.2008.08.010
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© 2008 European Society of Cardiology

Is ventilatory efficiency (VE/VCO2 slope) associated with right ventricular oxidative metabolism in patients with congestive heart failure?

Heikki Ukkonena,*, Ian G. Burwashb, William Dafoed, Robert A. de Kempb,c, Haissam Haddadb, Keiichiro Yoshinagab, Ross A. Daviesb, Edward K. Gannonb, Jean N. DaSilvab,c and Rob S.B. Beanlandsb,c

a Department of Medicine, Turku University Hospital Turku, Finland
b Division of Cardiology, University of Ottawa Heart Institute Ottawa, Ontario, Canada
c Molecular Function and Imaging (MFI) Program, University of Ottawa Heart Institute Ottawa, Ontario, Canada
d University of Alberta Hospital Edmonton, Alberta, Canada

* Corresponding author.Department of Medicine, Turku University Hospital, P.O.B. 52, 20521 Turku, Finland. Tel.: +358 2 313 0011; fax: +358 2 313 2030. E-mail address: heikki.ukkonen{at}tyks.fi (H. Ukkonen)


  Abstract

Background: The relationship between minute ventilation and the rate of CO2 elimination (VE/VCO2 slope) is associated with mortality in patients with congestive heart failure (CHF). The VE/VCO2 slope ≥ 34 denotes a poor prognosis and has been proposed to reflect abnormalities in pulmonary perfusion.

Aims: To study whether increased VE/VCO2 slope is associated with elevated right ventricular (RV) oxidative metabolism relative to the left ventricle (LV).

Methods: 21 patients with stable NYHA II–III CHF underwent symptom limited cardiopulmonary exercise testing. Dynamic [11C]acetate positron emission tomography (PET) was used to measure oxidative metabolism (kmono) of the LV and RV. Corrected RV oxidative metabolism (RVOx) was calculated as RV/LV kmono ratio.

Results: Peak VO2 was 16.2±4.1 ml/min/kg and the VE/VCO2 slope was 33.4±6.1. LV and RV kmono were 0.046±0.009 and 0.037±0.007 min–1, respectively, with a RVOx of 0.83±0.17. There was a good correlation between RVOx and the VE/VCO2 slope (r=0.61, p=0.0034). RVOx was 0.77±0.16 in patients with a VE/VCO2 slope <34 and 0.93±0.16 in patients with VE/VCO2 slope ≥34 (p=0.047).

Conclusion: RVOx correlates with VE/VCO2 slope in CHF patients. This supports the hypothesis that pulmonary vascular resistance is a determinant of the VE/VCO2 slope.

Key Words: Congestive heart failure • Exercise • Oxidative metabolism • Right ventricle • Positron emission tomography

Received November 13, 2007; Revised June 9, 2008; Accepted August 20, 2008


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