Abstract
Background
Exercise oscillatory ventilation (EOV) is characterized by periodic oscillations of minute ventilation during cardiopulmonary exercise testing (CPET). Despite its prognostic value in chronic heart failure (HF), its diagnosis is complex due to technical limitations. An easier and more accurate way of EOV identification can contribute to a better approach and clinical diagnosis. This study aims to describe a software development to standardize the EOV diagnosis from CPET’s raw data in heart failure patients and test its reliability (intra- and inter-rater).
Methods
The software was developed in the “drag-and-drop” G-language using LabVIEW®. Five EOV definitions (Ben-Dov, Corrà, Kremser, Leite, and Sun definitions), two alternative approaches, one smoothing technique, and some basic statistics were incorporated into the interface to visualize four charts of the ventilatory response. EOV identification was based on a set of criteria verified from the interaction between amplitude, cycle length, and oscillation time. Two raters analyzed the datasets. In addition, repeated measurements were verified after six months using about 25% of the initial data. Cohen’s kappa coefficient (κ) was used to investigate the reliability.
Results
Overall, 391 tests were analyzed in duplicate (inter-rater reliability) and 100 tests were randomized for new analysis (intra-rater reliability). High inter-rater (κ > 0.80) and intra-rater (κ > 0.80) reliability of the five EOV diagnoses were observed.
Conclusion
The present study proposes novel semi-automated software to detect EOV in HF, with high inter and intra-rater agreements. The software project and its tutorial are freely available for download.
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References
Agostoni P, Salvioni E. Exertional periodic breathing in heart failure: mechanisms and clinical implications. Clin Chest Med. 2019;40(2):449–57. https://doi.org/10.1016/j.ccm.2019.02.016.
Ribeiro GS, Deresz LF, Salvioni E, Hansen D, Agostoni P, Karsten M. Sensitivity and specificity of different exercise oscillatory ventilation definitions to predict 2-year major adverse cardiovascular outcomes in chronic heart failure patients. Int J Cardiol. 2022. https://doi.org/10.1016/j.ijcard.2022.05.041.
Ribeiro GS, Cargnin C, Dal Lago P, Hansen D, Agostoni P, Karsten M. Exercise training effects on metabolic and ventilatory changes in heart failure patients with exercise oscillatory ventilation: systematic review and meta-analysis. Eur J Prev Cardiol. 2022;29(6):e233–6. https://doi.org/10.1093/eurjpc/zwab195.
Cornelis J, Taeymans J, Hens W, Beckers P, Vrints C, Vissers D. Prognostic respiratory parameters in heart failure patients with and without exercise oscillatory ventilation - a systematic review and descriptive meta-analysis. Int J Cardiol. 2015;182:476–86. https://doi.org/10.1016/j.ijcard.2015.01.029.
Guazzi M, Myers J, Peberdy M, Bensimhon D, Chase P, Arena R. Exercise oscillatory breathing in diastolic heart failure: prevalence and prognostic insights. Eur Heart J. 2008;29(22):2751–9. https://doi.org/10.1093/eurheartj/ehn437.
Guazzi M, Raimondo R, Vicenzi M, Arena R, Proserpio C, Sarzi B, et al. Exercise oscillatory ventilation may predict sudden cardiac death in heart failure patients. J Am Coll Cardiol. 2007;50(4):299–308. https://doi.org/10.1016/j.jacc.2007.03.042.
Cornelis J, Beckers P, Vanroy C, Volckaerts T, Vrints C, Vissers D. An overview of the applied definitions and diagnostic methods to assess exercise oscillatory ventilation - a systematic review. Int J Cardiol. 2015;190:161–9. https://doi.org/10.1016/j.ijcard.2015.04.111.
Cornelis J, Denis T, Beckers P, Vrints C, Vissers D, Goossens M. Development of a clinical applicable graphical user interface to automatically detect exercise oscillatory ventilation: the VOdEX-tool. Int J Cardiol. 2017;240:291–6. https://doi.org/10.1016/j.ijcard.2016.12.159.
Ben-Dov I, Sietsema K, Casaburi R, Wasserman K. Evidence that circulatory oscillations accompany ventilatory oscillations during exercise in patients with heart failure. Am Rev Resp Dis. 1992;145(4):776–81. https://doi.org/10.1164/ajrccm/145.4_pt_1.776.
Leite J, Mansur A, Freitas H, Chizola P, Bocchi E, Terra-Filho, et al. Periodic breathing during incremental exercise predicts mortality in patients with chronic heart failure evaluated for cardiac transplantation. J Am Coll Cardiol. 2003;41(12):2175–81. https://doi.org/10.1016/S0735-1097(03)00460-1.
Sun X, Hansen J, Beshai J, Wasserman K. Oscillatory breathing and exercise gas exchange abnormalities prognosticate early mortality and morbidity in heart failure. J Am Coll Cardiol. 2010;55(17):1814–23. https://doi.org/10.1016/j.jacc.2009.10.075.
Corrà U, Giordano A, Bosimini E, Mezzani A, Piepoli M, Coats A, et al. Oscillatory ventilation during exercise in patients with chronic heart failure: clinical correlates and prognostic implications. Chest. 2002;121(5):1572–80. https://doi.org/10.1378/chest.121.5.1572.
Smith S. Digital signal processing. A practical guide for engineers and scientists. Burlington, Newnes Elsevier; 2003.
Kremser C, O’Toole M, Leff A. Oscillatory hyperventilation in severe congestive heart failure secondary to idiopathic dilated cardiomyopathy or to ischemic cardiomyopathy. Am J Cardiol. 1987;59(8):900–5.
Mokkink L, Prinsen C, Bouter L, Cecilia A, Bouter L, Vet H, Terwee C. The COnsensus-based Standards for the selection of health measurement INstruments (COSMIN) and how to select an outcome measurement instrument. Braz J Phys Ther. 2016;20:105–13. https://doi.org/10.1590/bjpt-rbf.2014.0143.
McHugh M. Interrater reliability: the kappa statistic. Biochem Med. 2012;22(3):276–82.
Brawner C, Ehrman J, Myers J, Chase P, Vainshelboim B, Farha S, et al. Exercise oscillatory ventilation: interreviewer agreement and a novel determination. Med Sci Sports Exerc. 2018;50(2):369–74. https://doi.org/10.1249/mss.0000000000001423.
Guazzi M, Adams V, Conraads V, Halle M, Mezzani A, Vanhees L, et al. Clinical recommendations for cardiopulmonary exercise testing data assessment in specific patient populations. Circulation. 2012;126(18):2261–74. https://doi.org/10.1161/CIR.0b013e31826fb946.
Ingle L, Isted A, Witte KK, Cleland J, Clark A. Impact of different diagnostic criteria on the prevalence and prognostic significance of exertional oscillatory ventilation in patients with chronic heart failure. Eur J Cardiovasc Prev Rehabil. 2009;16(4):451–6. https://doi.org/10.1097/HJR.0b013e32832a4f54.
Castro R, Lima S, Sales A, Nobrega A. Minute-ventilation variability during cardiopulmonary exercise test is higher in sedentary men than in athletes. Arq Bras Cardiol. 2017;109(3):185–90. https://doi.org/10.5935/abc.20170104.
Funding
This study was financed in part by the Fundação de Amparo à Pesquisa do Estado do Rio Grande do Sul (FAPERGS) and Coordenação de Aperfeiçoamento de Pessoal de Nível Superior - Brasil (CAPES) - Finance Code 001.
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Gustavo Ribeiro: Conceptualization, Methodology, Formal analysis, Writing - Original draft preparation. Thomas Beltrame: Methodology, Software development, Writing - Original draft preparation. Luís Fernando Deresz: Formal analysis, Writing - Review & Editing. Dominique Hansen: Writing - Review & Editing, Supervision. Piergiuseppe Agostoni: Resources, Writing - Review & Editing, Supervision. Marlus Karsten: Conceptualization, Methodology, Writing - Review & Editing, Project administration.
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dos Santos Ribeiro, G., Beltrame, T., Fernando Deresz, L. et al. Software development to standardize the clinical diagnosis of exercise oscillatory ventilation in heart failure. J Clin Monit Comput 37, 1247–1253 (2023). https://doi.org/10.1007/s10877-023-00976-9
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DOI: https://doi.org/10.1007/s10877-023-00976-9