title: Impact of chronic obstructive pulmonary disease on exercise ventilatory efficiency in heart failure.
abstract: BACKGROUND
  Heart failure (HF) and chronic obstructive pulmonary disease (COPD) coexistence increases morbidity and mortality. The intercept of ventilation (VEint) on the VE vs. carbon dioxide production (VCO2) relationship during exercise has been found to vary in proportion with dead space (VD) in HF. Considering that increased VD is the key pathophysiological abnormality in COPD but a secondary finding in HF we hypothesized that a high VEint would be useful in suggesting COPD as HF co-morbidity. Our aim was to assess whether an elevated VEint suggests the presence of COPD in HF.
  
  
  METHODS
  In a multicenter retrospective study, the VE-VCO2 relationship was analyzed both as slope and intercept in HF (n = 108), HF-COPD (n = 106) and COPD (n = 95). Patients with pulmonary arterial hypertension (PAH) (n = 85) and healthy subjects (HF) (n = 56) served as positive and negative controls relative to VE-VCO2 abnormalities, respectively.
  
  
  RESULTS
  Slope and VEint varied in opposite directions in all groups (p < 0.05) being VE-VCO2 slope highest and lowest in PAH and healthy subjects, respectively. No slope differences were observed among HF, HF-COPD and COPD (32 ± 7, 31 ± 7, and 31 ± 6, respectively). VEint was higher in HF-COPD and COPD compared to HF, PAH and controls (4.8 ± 2.4 L/min, 5.9 ± 3.0 L/min, 3.0 ± 2.6L/min, 2.3 ± 3.3 L/min and 3.9 ± 2.5L/min, respectively; p < 0.01). A VEint ≥ 4.07 L/min identified patients with high probability of having COPD or HF-COPD (sensitivity of 71.6% and specificity of 72.0%).
  
  
  CONCLUSIONS
  These data provide novel evidence that a high VEint (≥ 4.07 L/min) should be valued to suggest coexistent COPD in HF patients.
authors.affiliation: Centro Cardiologico Monzino, IRCCS, Milano, Italy.
authors.forename: Anna
authors.initials: A
authors.lastname: Apostolo
authors.affiliation: AP-HP, Hôpital Universitaire de Bicêtre, Service d'Explorations Fonctionnelles Respiratoires, Centre de Référence de l'Hypertension Pulmonaire Sévère, DHU TORINO "Thorax Innovation", Le Kremlin-Bicêtre, France; Sorbonne Universités, UPMC Univ. Paris 06, UMR_S 1158, Neurophysiologie Respiratoire Expérimentale et Clinique, Paris, France; INSERM, UMR_S 1158, Neurophysiologie Respiratoire Expérimentale et Clinique, Paris, France; AP-HP, Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Service des Explorations Fonctionnelles de la Respirationde l'Exercice et de la Dyspnée, Paris, France.
authors.forename: PierAntonio
authors.initials: P
authors.lastname: Laveneziana
authors.affiliation: Dipartimento di Medicina Clinica, University La Sapienza, Viale Università 37, Rome, Italy.
authors.forename: Paolo
authors.initials: P
authors.lastname: Palange
authors.affiliation: Centro Cardiologico Monzino, IRCCS, Milano, Italy.
authors.forename: Cecilia
authors.initials: C
authors.lastname: Agalbato
authors.affiliation: Centro Cardiologico Monzino, IRCCS, Milano, Italy.
authors.forename: Roberta
authors.initials: R
authors.lastname: Molle
authors.affiliation: Division of Cardiology, Faculty of Medicine, University of Belgrade, Visegradska 26, 11000 Belgrade, Serbia.
authors.forename: Dejana
authors.initials: D
authors.lastname: Popovic
authors.affiliation: Cardiac Rehabilitation Unit, Fondazione Salvatore Maugeri, IRCCS, Scientific Institute of Milan, Italy.
authors.forename: Maurizio
authors.initials: M
authors.lastname: Bussotti
authors.affiliation: Dipartimento di Medicina Clinica, University La Sapienza, Viale Università 37, Rome, Italy.
authors.forename: Mattia
authors.initials: M
authors.lastname: Internullo
authors.affiliation: Dipartimento di Scienze Cardiovascolari, Respiratorie, Anestesiologiche, Nefrologiche e Geriatriche, "La Sapienza", Rome,Italy.
authors.forename: Susanna
authors.initials: S
authors.lastname: Sciomer
authors.affiliation: Dipartimento di Medicina Clinica, University La Sapienza, Viale Università 37, Rome, Italy.
authors.forename: Matteo
authors.initials: M
authors.lastname: Bonini
authors.affiliation: Respiratory Division, Dept. of Medicine, Federal University of São Paulo - Paulista School of Medicine (UNIFESP-EPM), Brazil.
authors.forename: Maria Clara
authors.initials: MC
authors.lastname: Alencar
authors.affiliation: AP-HP, Hôpital Universitaire de Bicêtre, Service d'Explorations Fonctionnelles Respiratoires, Centre de Référence de l'Hypertension Pulmonaire Sévère, DHU TORINO "Thorax Innovation", Le Kremlin-Bicêtre, France; Univ. Paris-Sud 11, Faculté de médecine, Le Kremlin-Bicêtre, France; INSERM U999, LabEx LERMIT, Centre Chirurgical Marie Lannelongue, Le Plessis-Robinson, France.
authors.forename: Laurent
authors.initials: L
authors.lastname: Godinas
authors.affiliation: Respiratory Division, Dept. of Medicine, Federal University of São Paulo - Paulista School of Medicine (UNIFESP-EPM), Brazil.
authors.forename: Flavio
authors.initials: F
authors.lastname: Arbex
authors.affiliation: AP-HP, Hôpital Universitaire de Bicêtre, Service d'Explorations Fonctionnelles Respiratoires, Centre de Référence de l'Hypertension Pulmonaire Sévère, DHU TORINO "Thorax Innovation", Le Kremlin-Bicêtre, France; Univ. Paris-Sud 11, Faculté de médecine, Le Kremlin-Bicêtre, France; INSERM U999, LabEx LERMIT, Centre Chirurgical Marie Lannelongue, Le Plessis-Robinson, France.
authors.forename: Gilles
authors.initials: G
authors.lastname: Garcia
authors.affiliation: Respiratory Division, Dept. of Medicine, Federal University of São Paulo - Paulista School of Medicine (UNIFESP-EPM), Brazil; Division of Respiratory and Critical Care Medicine, Faculty of Health Sciences, Queen's University, Kingston, ON, Canada.
authors.forename: J Alberto
authors.initials: JA
authors.lastname: Neder
authors.affiliation: Centro Cardiologico Monzino, IRCCS, Milano, Italy; Department of Clinical Sciences and Community Health, Cardiovascular Section, University of Milan, Italy. Electronic address: piergiuseppe.agostoni@unimi.it.
authors.forename: Piergiuseppe
authors.initials: P
authors.lastname: Agostoni
mesh_terms: D000368:Aged; D000704:Analysis of Variance; D016022:Case-Control Studies; D005080:Exercise Test / Q000379:methods; D017079:Exercise Tolerance / Q000502:physiology*; D005260:Female; D006333:Heart Failure / Q000453:epidemiology / Q000503:physiopathology*; D006801:Humans; D006976:Hypertension, Pulmonary / Q000453:epidemiology / Q000503:physiopathology*; D007558:Italy; D008297:Male; D008875:Middle Aged; D010101:Oxygen Consumption / Q000502:physiology; D029424:Pulmonary Disease, Chronic Obstructive / Q000453:epidemiology / Q000503:physiopathology*; D011659:Pulmonary Gas Exchange / Q000502:physiology*; D012123:Pulmonary Ventilation / Q000502:physiology; D012372:ROC Curve; D012016:Reference Values; D012126:Respiratory Dead Space / Q000502:physiology*; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013147:Spirometry; D014797:Vital Capacity / Q000502:physiology
keywords: Dead space; Exercise; Heart failure; Lung diseases; Ventilatory efficiency