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Usefulness of the predicted percentage ventilatory efficiency for carbon dioxide output during exercise in patients with chronic heart failure

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Abstract

The ventilatory efficiency for carbon dioxide output (\({\dot{\text{V}}}\)CO2) during exercise, as measured by the minute ventilation vs. \({\dot{\text{V}}}\)CO2 slope (\({\dot{\text{V}}}\)E vs. \({\dot{\text{V}}}\)CO2 slope), is a powerful prognostic index in patients with chronic heart failure (CHF). This measurement is higher in women than in men, and it increases with age. This study aimed to investigate the usefulness of the predicted value of the percentage \({\dot{\text{V}}}\)E vs. \({\dot{\text{V}}}\)CO2 slope (%\({\dot{\text{V}}}\)E vs. \({\dot{\text{V}}}\)CO2 slope) as a prognostic index in patients with CHF. A total of 320 patients with CHF and a left ventricular ejection fraction (LVEF) < 45% (male, 85.6%; mean age, 64.6 years) who underwent symptom-limited cardiopulmonary exercise tests using a cycle ergometer were included in the study. The %\({\dot{\text{V}}}\)E vs. \({\dot{\text{V}}}\)CO2 was calculated using predictive formulae based on age and sex. Cardiovascular-related death was defined as the primary endpoint. The mean follow-up duration was 7.5 ± 3.3 years. Of 101 patients who died during the study period, 75 experienced cardiovascular-related deaths. The average \({\dot{\text{V}}}\)E vs. \({\dot{\text{V}}}\)CO2 slope was 32.8 ± 8.0, and the average %\({\dot{\text{V}}}\)E vs. \({\dot{\text{V}}}\)CO2 slope was 119.6 ± 28.2%. The cumulative incidence of cardiovascular-related death after 10 years of follow-up were 44.7% (95% CI 34.4–54.6%) in patients with %\({\dot{\text{V}}}\)E vs. \({\dot{\text{V}}}\)CO2 slope > 120 and 15.0% (95% CI 9.4–21.8%) in patients with %\({\dot{\text{V}}}\)E vs. \({\dot{\text{V}}}\)CO2 slope ≤ 120. The multivariate Cox regression analysis indicated that a %\({\dot{\text{V}}}\)E vs. \({\dot{\text{V}}}\)CO2 slope > 120 was an independent predictor of cardiovascular-related death (adjusted hazard ratio, 3.24; 95% confidence interval 1.65–6.67; p < 0.01). The %\({\dot{\text{V}}}\)E vs. \({\dot{\text{V}}}\)CO2 slope can be used for risk stratification in patients with CHF and an LVEF < 45%.

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Acknowledgements

The authors would like to thank all members and laboratory engineers in the rehabilitation room at the Sakakibara Heart Institute.

Funding

This research received no grant from any funding agency in the public, commercial, or not-for-profit sectors.

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Authors and Affiliations

  1. Department of Cardiology, Sakakibara Heart Institute, Fuchu, Tokyo, Japan

    Kohei Ashikaga, Haruki Itoh, Masatoshi Nagayama & Mitsuaki Isobe

  2. Division of Cardiology, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Kanagawa, Japan

    Kohei Ashikaga & Yoshihiro J. Akashi

  3. Department of Sports Medicine, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyakaeku, Kawasaki, Kanagawa, 216-8511, Japan

    Kohei Ashikaga

  4. Department of Clinical Laboratory, Sakakibara Heart Institute Clinic, Tokyo, Japan

    Tomoko Maeda

  5. Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan

    Hidetaka Itoh

  6. Department of Clinical Laboratory, Sakakibara Heart Institute, Fuchu, Tokyo, Japan

    Shiori Tanaka

  7. Department of Medical Technology, School of Health Science, Tokyo University of Technology, Hachioji, Tokyo, Japan

    Yuri Ichikawa

Authors
  1. Kohei Ashikaga
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  8. Yoshihiro J. Akashi
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  9. Mitsuaki Isobe
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Contributions

Conceptualization: KA, HI; methodology, KA, HI; formal analysis and investigation: KA, TM, HI, ST, YI; writing—original draft preparation: KA; writing—review and editing: KA, HI, MN, YJA, MI; supervision: HI.

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Correspondence to Kohei Ashikaga.

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The authors declare that there is no conflict of interest.

Ethical approval

This study was performed in accordance with the ethical principles of the Declaration of Helsinki and was approved by the Human Investigation Committee of Sakakibara Heart Institute (Study Protocol No. 16–084).

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Ashikaga, K., Itoh, H., Maeda, T. et al. Usefulness of the predicted percentage ventilatory efficiency for carbon dioxide output during exercise in patients with chronic heart failure. Heart Vessels 38, 56–65 (2023). https://doi.org/10.1007/s00380-022-02132-w

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