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European Journal of Heart Failure 2007 9(10):1024-1031; doi:10.1016/j.ejheart.2007.07.001
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© 2007 European Society of Cardiology

Excessive ventilation during early phase of exercise: A new predictor of poor long-term outcome in patients with chronic heart failure

Ewa A. Jankowskaa, Tomasz Witkowskia, Beata Ponikowskab, Krzysztof Reczucha, Ludmila Borodulin-Nadziejab, Stefan D. Ankerc, Massimo F. Piepolid, Waldemar Banasiaka and Piotr Ponikowskia,*

a Cardiology Department, Military Hospital Weigla 5, 50-981 Wroclaw, Poland
b Department of Physiology, Wroclaw Medical University Poland
c Division of Applied Cachexia Research, Department of Cardiology, Charite Medical School Berlin, Germany
d Heart Failure Unit, Cardiac Department, G. da Saliceto Polichirurgico Hospital Piacenza, Italy

* Corresponding author. Tel.: +48 71 7660 237; fax: +48 71 7660 228. E-mail address: piotrponikowski{at}4wsk.pl (P. Ponikowski)


  Abstract

Background: Studies demonstrating prognostic value of excessive exercise ventilation in chronic heart failure (CHF) have focused on data derived from the whole cardiopulmonary exercise test (CPET). Whether ventilatory response to early phase of exercise is useful for risk stratification in CHF is unknown.

Methods and results: We evaluated 216 patients with systolic CHF who underwent CPET (age: 60±11 years, NYHA class [I/II/III/IV]: 18/104/77/17). Ventilatory response to exercise (slope of regression line relating ventilation to carbon dioxide production) was calculated from the whole exercise test (VE-VCO2-all) and from the first 3min of exercise (early phase — VE-VCO2-3min). During follow-up (mean: 40± 20months, >3years in survivors), 89 (41%) CHF patients died. High VE-VCO2-all and VE-VCO2-3min predicted poor outcome in single predictor analyses, and in multivariable models when adjusted for prognosticators (age, NYHA class, ejection fraction, peak VO2) (P<0.0001). In receiver operating characteristic curve analysis, areas under curve for 3-year follow-up were similar for VE-VCO2-all and VE-VCO2-3min. VE-VCO2-3min maintained its prognostic value in patients taking β-blockers (P<0.0001) and those unable to perform maximal CPET (P=0.0009).

Conclusions: In CHF patients, excessive ventilation assessed over the first 3min predicts poor outcome. Assessment of ventilatory response to exercise for prognostic stratification may be extended to patients unable to perform maximal CPET.

Key Words: Heart failure • Exercise ventilation • Prognosis

Received October 12, 2006; Revised March 27, 2007; Accepted July 2, 2007


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