Cardiopulmonary Exercise Test in Advanced Heart Failure Among Heart Transplantation Candidates
AbstractCardiopulmonary exercise test has been raised through recent decades as a brilliant prognostic tool in a wide field of diseases and clinical conditions which makes it valuable to be used in prognostic assessment during the current study among chronic heart failure (CHF) patients. This study recruited 71 patients with severe CHF who were candidates for heart transplantation. Bicycle-protocol Cardiopulmonary Exercise Test was done, and several parameters were measured and compared between four groups of patients based on their VO2/kg to show four grades of the disease from G1 to G4. Total 71 CHF subjects from 18 to 46 year of age enrolled in the study. Statistically significant correlations were determined between HRR, VE/VCO2, VE/VO2, BR and the severity of CHF. VO2max, HRR, VE/VO2, VE/VCO2, BR, and AT were the most prominent factors of CPET which showed their validity and reliability in terms of prognosis of CHF. It seems that combination of CPET and other cardiac prognostic tools like echocardiography and measurement of the pressure in cardiac chambers can improve the prognosis in CHF.
Guazzi M, Dickstein K, Vicenzi M, Ross A. Six-Minute Walk Test and Cardiopulmonary Exercise Testing in Chronic Heart Failure: a Comparative Analysis on Clinical and Prognostic Insights. Circ Heart Fail 2009;2:549-55.
DeFrances CJ, Podgornik MN. 2004 national hospital discharge survey. Advance data from vital and health statistics. CDC 2006;371:1-20.
Cheraghi M, Sadeghi M, Tavassoli A, Sarrafzadegan N,Pourmoghadas A, Ramezani MA. Prognostic Factors for Survival at 6-Month Follow-up of Hospitalized Patients
with Decompensated Congestive Heart Failure. ARYA Atheroscler 2010;6:112-7.
Shahriari M, Shahsavari H, Alimohammadi N, Rafieian M. Patients experiences of cardiac rehabilitation effects. Iran J Nurs Midwifery Res 2008;12:125-9.
Arena R, Sietsema KE. Cardiopulmonary exercise testing in the clinical evaluation of patients with heart and lung disease. Circulation 2011;123:668-80.
Guazzi M, Adams V, Conraads V, Halle M, Mezzani A, Vanhees L, et al. EACPR/AHA Scientific Statement. Clinical recommendations for cardiopulmonary exercise testing data assessment in specific patient populations. Circulation 2012;126:2261-74.
Mandegar M-H, Bagheri J, Chitsaz S, Jebelli M, Javidi D, Sarzaeem M-R, et al. Heart transplantation in Iran; a comprehensive single-center review of 15-year performance. Arch Iran Med 2009;12:111-5.
Botta DM, Mancini M. Heart transplantation. Available from:[Last accessed on 2014 Nov 3] Back to cited text. 2012(5). https://emedicine.medscape.com/article/429816-overview
Wasserman K, Hansen JE, Sue DY, Stringer WW,Whipp BJ. Physiology of exercise. In: Wasserman K, Hansen JE, Sue DY, Stringer WW, Whipp BJ, eds. Principles of exercise testing and interpretation: including pathophysiology and clinical applications. Philadelphia: Lippincott Williams and Wilkins, 2005:10-65.
Binder RK,Wonisch M, Corra` U, Cohen-Solal A, Vanhees L, Saner H, et al. Methodological approach to the 1st and 2nd lactate threshold in incremental cardiopulmonary exercise testing. Eur J Cardiovasc Prev Rehabil 2008;15:726-34.
Meyer T, Lucı´a A, Earnest CP, Kindermann W. A conceptual framework for performance diagnosis and training prescription from submaximal gas exchange parameters-theory and application. Int J Sports Med 2005;26:S38-48.
ERS Task Force, Palange P, Ward SA, Carlsen KH, Casaburi R, Gallagher CG, et al. Recommendations on the use of exercise testing in clinical practice. Eur Respir J 2007;29:185-209.
Meyer T, Faude O, Scharhag J, Urhausen A, Kindermann W. Is lactic acidosis a cause of exercise induced hyperventilation at the respiratory compensation point? Br J Sports Med 2004;38:622-5.
Wasserman K, Hansen JE, Sue DY, Stringer WW, Whipp BJ. Normal values. In: Wasserman K, Hansen JE, Sue DY, Stringer WW, Whipp BJ, eds. Principles of exercise testing and interpretation: including pathophysiology and clinical applications. Philadelphia: Lippincott Williams Wilkins; 2005:160-82.
Joyner MJ, Coyle EF. Endurance exercise performance: the physiology of champions. J Physiol 2008;586:35-44.
Capelli C, Antonutto G, Kenfack MA, Cautero M, Lador F, Moia C, et al. Factors determining the time course of VO2(max) decay during bedrest: implications for VO2(max) limitation. Eur J Appl Physiol 2006;98:152-60.
Noakes TD. Testing for maximum oxygen consumption has produced a brainless model of human exercise performance. Br J Sports Med 2008;42:551-5.
Wasserman K, Hansen JE, Sue DY, Stringer WW, Whipp BJ. Measurements during integrative cardiopulmonary exercise testing. In: Wasserman K, Hansen JE, Sue DY, Stringer WW, Whipp BJ, eds. Principles of exercise testing and interpretation: including pathophysiology and clinical applications. Philadelphia: Lippincott Williams and Wilkins, 2005:76-110.
Rivera MA, Pe´ russe L, Simoneau JA, Gagnon J, Dionne FT, Leon AS, et al. Linkage between a muscle-specific CK gene marker and VO2max in the HERITAGE family study. Med Sci Sports Exerc 1999;31:698-701.
Astrand PO, Rodahl K. Physical training. In: Astrand PO, Rodahl K, eds. Textbook of work physiology. Physiological bases of exercise. New York: McGraw Hill Book Company, 1986:412-85.
Betik AC, Hepple RT. Determinants of VO2max decline with aging: an integrated perspective. Appl Physiol Nutr Metab 2008;33:130-40.
Solal AC, Chabernaud JN, Gourgon R. Comparison of oxygen uptake during bicycle exercise in patients with chronic heart failure and in normal subjects. J Am Coll Cardiol 1990;16:80-5.
Sullivan MJ, Cobb FR. Central hemodynamic response to exercise in patients with chronic heart failure. Chest 1992;101:340S-6S.
Tumminello G, Guazzi M, Lancellotti P, Pie´ rard LA. Exercise ventilation inefficiency in heart failure: pathophysiological and clinical significance. Eur Heart J 2007;28:673-8.
Garcia EL, Menezes MG, Stefani Cde M, Danzmann LC, Torres MA. Ergospirometry and echocardiography in early stage of heart failure with preserved ejection fraction and in healthy individuals. Arq Bras Cardiol 2015;105:248-55.
Hoppe MW, Sperlich B, Baumgart C, Janssen M, Freiwald J. Reliability of Selected Parameters of Cycling Ergospirometry from the PowerCube-Ergo Respiratory Gas Analyser. Sportverletz Sportschaden 2015;29:173-9.
Palau P, Domínguez E, Núñez E, Ramón JM, López L, Melero J, et al. Peak Exercise Oxygen Uptake Predicts
Recurrent Admissions in Heart Failure With Preserved Ejection Fraction. Rev Esp Cardiol 2017;17:S1885-5857.
Rocha A, Arbex FF, Sperandio PA, Souza A, Biazzim L, Mancuso F, et al. Excess Ventilation in COPD-heart Failure Overlap: Implications for Dyspnea and Exercise Intolerance. Am J Respir Crit Care Med 2017;196:1264-74.
Czubaszewski Ł, Straburzyńska-Lupa A, Migaj J, Straburzyńska-Migaj E. Comparison of prognostic values of cardiopulmonary and heart rate parameters in exercise testing in men with heart failure. Cardiol J 2017. [Epub ahead of print]
Grazzi G, Mazzoni G, Myers J, Codecà L, Pasanisi G, Mandini S, et al. Determining the best percent-predicted equation for estimated VO2 peak by a 1-km moderate perceptually-regulated treadmill walk to predict mortality in outpatients with cardiovascular disease. J Sci Med Sport 2018;21:307-11.
Piepoli MF, Corrà U, Agostoni P. Cardiopulmonary Exercise Testing in Patients with Heart Failure with Specific Comorbidities. Ann Am Thorac Soc 2017;14:S110-5.
Le VDT. Cardiopulmonary Exercise Testing in Aortic Stenosis. Dan Med J 2017;64:B5352.
Larsen AI, Lindal S, Myreng K, Ogne C, Kvaløy JT, Munk PS, et al. Cardiac resynchronization therapy improves minute ventilation/carbon dioxide production slope and skeletal muscle capillary density without reversal of skeletal muscle pathology or inflammation. Europace 2013;15:857-64.
Hussain S, Kayani AM, Munir R. Clinical Safety and Parameters of Maximum Oxygen Uptake (VO₂Max) Testing in Pakistani Patients With Heart Failure. J Coll Physicians Surg Pak 2015;25:634-9.
Malekmohammad M, Ahmadi-Nejad M, Adimi P, Jamaati HR, Marashian SM. Evaluation of maximum O2 consumption: using ergo-spirometry in severe heart failure. Acta Med Iran 2012;50:619-23.
Huang W, Resch S, Oliveira RK, Cockrill BA, Systrom DM, Waxman AB. Invasive cardiopulmonary exercise testing in the evaluation of unexplained dyspnea: Insights from a multidisciplinary dyspnea center. Eur J Prev Cardiol 2017;24:1190-9.
Christopoulos G, Bois J, Allison TG, Rodriguez-Porcel M, Chareonthaitawee P. The impact of combined cardiopulmonary exercise testing and SPECT myocardial perfusion imaging on downstream evaluation and management. J Nucl Cardiol 2017. [Epub ahead of print]