Anna Apostolo1, PierAntonio Laveneziana2, Paolo Palange3, Cecilia Agalbato1, Roberta Molle1, Dejana Popovic4, Maurizio Bussotti5, Mattia Internullo3, Susanna Sciomer6, Matteo Bonini3, Maria Clara Alencar7, Laurent Godinas8, Flavio Arbex7, Gilles Garcia8, J Alberto Neder9, Piergiuseppe Agostoni10. 1. Centro Cardiologico Monzino, IRCCS, Milano, Italy. 2. AP-HP, Hôpital Universitaire de Bicêtre, Service d'Explorations Fonctionnelles Respiratoires, Centre de Référence de l'Hypertension Pulmonaire Sévère, DHU TORINO "Thorax Innovation", Le Kremlin-Bicêtre, France; Sorbonne Universités, UPMC Univ. Paris 06, UMR_S 1158, Neurophysiologie Respiratoire Expérimentale et Clinique, Paris, France; INSERM, UMR_S 1158, Neurophysiologie Respiratoire Expérimentale et Clinique, Paris, France; AP-HP, Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Service des Explorations Fonctionnelles de la Respirationde l'Exercice et de la Dyspnée, Paris, France. 3. Dipartimento di Medicina Clinica, University La Sapienza, Viale Università 37, Rome, Italy. 4. Division of Cardiology, Faculty of Medicine, University of Belgrade, Visegradska 26, 11000 Belgrade, Serbia. 5. Cardiac Rehabilitation Unit, Fondazione Salvatore Maugeri, IRCCS, Scientific Institute of Milan, Italy. 6. Dipartimento di Scienze Cardiovascolari, Respiratorie, Anestesiologiche, Nefrologiche e Geriatriche, "La Sapienza", Rome,Italy. 7. Respiratory Division, Dept. of Medicine, Federal University of São Paulo - Paulista School of Medicine (UNIFESP-EPM), Brazil. 8. AP-HP, Hôpital Universitaire de Bicêtre, Service d'Explorations Fonctionnelles Respiratoires, Centre de Référence de l'Hypertension Pulmonaire Sévère, DHU TORINO "Thorax Innovation", Le Kremlin-Bicêtre, France; Univ. Paris-Sud 11, Faculté de médecine, Le Kremlin-Bicêtre, France; INSERM U999, LabEx LERMIT, Centre Chirurgical Marie Lannelongue, Le Plessis-Robinson, France. 9. Respiratory Division, Dept. of Medicine, Federal University of São Paulo - Paulista School of Medicine (UNIFESP-EPM), Brazil; Division of Respiratory and Critical Care Medicine, Faculty of Health Sciences, Queen's University, Kingston, ON, Canada. 10. Centro Cardiologico Monzino, IRCCS, Milano, Italy; Department of Clinical Sciences and Community Health, Cardiovascular Section, University of Milan, Italy. Electronic address: piergiuseppe.agostoni@unimi.it.
Abstract
BACKGROUND: Heart failure (HF) and chronic obstructive pulmonary disease (COPD) coexistence increases morbidity and mortality. The intercept of ventilation (VEint) on the VE vs. carbon dioxide production (VCO2) relationship during exercise has been found to vary in proportion with dead space (VD) in HF. Considering that increased VD is the key pathophysiological abnormality in COPD but a secondary finding in HF we hypothesized that a high VEint would be useful in suggesting COPD as HF co-morbidity. Our aim was to assess whether an elevated VEint suggests the presence of COPD in HF. METHODS: In a multicenter retrospective study, the VE-VCO2 relationship was analyzed both as slope and intercept in HF (n = 108), HF-COPD (n = 106) and COPD (n = 95). Patients with pulmonary arterial hypertension (PAH) (n = 85) and healthy subjects (HF) (n = 56) served as positive and negative controls relative to VE-VCO2 abnormalities, respectively. RESULTS: Slope and VEint varied in opposite directions in all groups (p < 0.05) being VE-VCO2 slope highest and lowest in PAH and healthy subjects, respectively. No slope differences were observed among HF, HF-COPD and COPD (32 ± 7, 31 ± 7, and 31 ± 6, respectively). VEint was higher in HF-COPD and COPD compared to HF, PAH and controls (4.8 ± 2.4 L/min, 5.9 ± 3.0 L/min, 3.0 ± 2.6L/min, 2.3 ± 3.3 L/min and 3.9 ± 2.5L/min, respectively; p < 0.01). A VEint ≥ 4.07 L/min identified patients with high probability of having COPD or HF-COPD (sensitivity of 71.6% and specificity of 72.0%). CONCLUSION: These data provide novel evidence that a high VEint (≥ 4.07 L/min) should be valued to suggest coexistent COPD in HF patients.
BACKGROUND:Heart failure (HF) and chronic obstructive pulmonary disease (COPD) coexistence increases morbidity and mortality. The intercept of ventilation (VEint) on the VE vs. carbon dioxide production (VCO2) relationship during exercise has been found to vary in proportion with dead space (VD) in HF. Considering that increased VD is the key pathophysiological abnormality in COPD but a secondary finding in HF we hypothesized that a high VEint would be useful in suggesting COPD as HF co-morbidity. Our aim was to assess whether an elevated VEint suggests the presence of COPD in HF. METHODS: In a multicenter retrospective study, the VE-VCO2 relationship was analyzed both as slope and intercept in HF (n = 108), HF-COPD (n = 106) and COPD (n = 95). Patients with pulmonary arterial hypertension (PAH) (n = 85) and healthy subjects (HF) (n = 56) served as positive and negative controls relative to VE-VCO2 abnormalities, respectively. RESULTS: Slope and VEint varied in opposite directions in all groups (p < 0.05) being VE-VCO2 slope highest and lowest in PAH and healthy subjects, respectively. No slope differences were observed among HF, HF-COPD and COPD (32 ± 7, 31 ± 7, and 31 ± 6, respectively). VEint was higher in HF-COPD and COPD compared to HF, PAH and controls (4.8 ± 2.4 L/min, 5.9 ± 3.0 L/min, 3.0 ± 2.6L/min, 2.3 ± 3.3 L/min and 3.9 ± 2.5L/min, respectively; p < 0.01). A VEint ≥ 4.07 L/min identified patients with high probability of having COPD or HF-COPD (sensitivity of 71.6% and specificity of 72.0%). CONCLUSION: These data provide novel evidence that a high VEint (≥ 4.07 L/min) should be valued to suggest coexistent COPD in HF patients.
Authors: Joshua R Smith; Erik H Van Iterson; Bruce D Johnson; Barry A Borlaug; Thomas P Olson Journal: Int J Cardiol Date: 2018-09-05 Impact factor: 4.164
Authors: Rocco F Rinaldo; Michele Mondoni; Sofia Comandini; Pietro Lombardo; Beatrice Vigo; Silvia Terraneo; Pierachille Santus; Stefano Carugo; Stefano Centanni; Fabiano Di Marco Journal: Multidiscip Respir Med Date: 2020-02-03
Authors: Polliana B Dos Santos; Rodrigo P Simões; Cássia da L Goulart; Meliza G Roscani; Renan S Marinho; Patrícia Faria Camargo; Renata F Arbex; Guilherme Casale; Cláudio R Oliveira; Renata G Mendes; Ross Arena; Audrey Borghi-Silva Journal: Int J Chron Obstruct Pulmon Dis Date: 2021-02-03