The role of exercise ventilation in clinical evaluation and risk stratification in patients with chronic heart failure

Background: Patients with chronic heart failure (CHF) are characterised by an increased ventilatory response to exercise. The role of exercise ventilation in the risk stratification and evaluation of patients with CHF has not yet been established. Aim: To examine the relationship between exercise ventilation indices and clinical parameters of CHF and to assess the prognostic value of the ventilatory response to exercise. Methods: The study group consisted of 87 patients with CHF (72 males, mean age 58 years) with a mean left ventricular ejection fraction of 32%. Ten patients were in NYHA class I, 38 - in NYHA class II, 34 - in NYHA class III, and 5 - in NYHA class IV. The control group consisted of 20 patients without CHF (13 males, mean age 58 years, mean LVEF - 61%). All studied subjects underwent maximal exercise test with gas-exchange measurement. The following parameters were analysed: peak exercise oxygen consumption [peak VO 2 (ml/kg/min)], VE-VCO 2 index [a coefficient of linear regression analysis depicting an association between ventilation (VE) and carbon dioxide production (VCO 2 ) during exercise] and VE/VCO 2 ratio at peak exercise to VE/VCO 2 ratio while at rest (VE/VCO 2 peak/rest ). Results: Ventilatory response indices were significantly higher in patients with CHF compared with controls: VE-VCO 2 - 37.9±11.1 vs 27.1±4.1; VE-VCO 2 peak/rest - 0.89±0.14 vs 0.75±0.10 (p 2 - r=0.52; VE/VCO 2 peak/rest - r=0.47) and a negative correlation with peak VO 2 (VE-VCO 2 - r=-0.52; VE/VCO 2 peak/rest - r=-0.49) were noted (p 2 and increased VE-VCO 2 and VE/VCO 2 peak/rest values were significantly associated with the risk of death. The multivariate analysis revealed that VE/VCO 2 peak/rest ≥1.0 was the adverse prognostic factor, independent of peak VO 2 (p=0.02) and NYHA class (p=0.01). The Kaplan-Meier analysis showed that prognosis during the 18-month follow-up period in patients with enhanced exercise ventilation was worse than in the remaining patients (59% survival in patients with VE/VCO 2 peak/rest ≥1.0 59% vs 91% survival in patients with VE/VCO 2 peak/rest Conclusions: In patients with stable CHF simple exercise ventilation parameters may provide important clinical and prognostic information.