Exercise oscillatory ventilation in patients with coexisting chronic obstructive pulmonary disease and heart failure: Clinical implications.

Abstracts No Comments

Goulart CDL; Federal University of Sao Carlos, UFSCar, Sao Carlos, SP, Brazil.
& several oher institutions
Silva RN; Agostoni P; Franssen FME; Myers J; Arena R;
Borghi-Silva A

Respiratory Medicine. 217:107332, 2023 Oct.

BACKGROUND: Exercise oscillatory ventilation (EOV) is considered an
important variable for predicting poor prognosis in patients with heart
failure (HF) with reduced left ventricular ejection fraction (HFrEF).
However, there are no studies evaluating EOV presence in the coexistence
chronic obstructive pulmonary disease (COPD) and HFrEF.

AIMS: I) To compare the clinical characteristics of participants with
coexisting HFrEF-COPD with and without EOV during cardiopulmonary exercise
testing (CPET); and II) to identify the impact of EOV on mortality during
follow-up for 35 months.

METHODS: 50 stable HFrEF-COPD (EF<50%) participants underwent CPET and
were followed for 35 months. The parametric Student’s t-test, chi-square
tests, linear regression model and Kaplan-Meier analysis were applied.

RESULTS: We identified 13 (26%) participants with EOV and 37 (74%)
without EOV (N-EOV) during exercise. The EOV group had worse cardiac
function (LVEF: 30 +/- 6% vs. N-EOV 40 +/- 9%, p = 0.007), worse pulmonary
function (FEV1: 1.04 +/- 0.7 L vs. N-EOV 1.88 +/- 0.7 L, p = 0.007), a
higher mortality rate [7 (54%) vs. N-EOV 8 (27%), p = 0.02], higher minute
ventilation/carbon dioxide production (VE/ V CO2) slope (42 +/- 7 vs.
N-EOV 36 +/- 8, p = 0.04), reduced peak ventilation (L/min) (26.2 +/- 16.7
vs. N-EOV 40.3 +/- 16.4, p = 0.01) and peak oxygen uptake (mlO2 kg-1
min-1) (11.0 +/- 4.0 vs. N-EOV 13.5 +/- 3.4 mlkg-1min-1, p = 0.04) when
compared with N-EOV group. We found that EOV group had a higher risk of
mortality during follow-up (long-rank p = 0.001) than patients with N-EOV
group.

CONCLUSION: The presence of EOV is associated with greater severity of
coexisting HFrEF and COPD and a reduced prognosis. Assessment of EOV in
participants with coexisting HFrEF-COPD, as a biomarker for both clinical
status and prognosis may therefore be warranted.