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Cunha G, Apostolo A, De Martino F, Salvioni E, Matavelli I, Agostoni P. Exercise oscillatory ventilation: the past, present, and future. Eur J Prev Cardiol 2023; 30:ii22-ii27. [PMID: 37819229 DOI: 10.1093/eurjpc/zwad205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Revised: 05/22/2023] [Accepted: 06/12/2023] [Indexed: 10/13/2023]
Abstract
Exercise oscillatory ventilation (EOV) is a fascinating event that can be appreciated in the cardiopulmonary exercise test and is characterized by a cyclic fluctuation of minute ventilation, tidal volume, oxygen uptake, carbon dioxide production, and end-tidal pressure for oxygen and carbon dioxide. Its mechanisms stem from a dysregulation of the normal control feedback of ventilation involving one or more of its components, namely, chemoreflex delay, chemoreflex gain, plant delay, and plant gain. In this review, we intend to breakdown therapeutic targets according to pathophysiology and revise the prognostic value of exercise oscillatory ventilation in the setting of heart failure and other diagnoses.
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Affiliation(s)
- Gonçalo Cunha
- Cardiology department, Hospital de Santa Cruz, Centro Hospitalar Lisboa Ocidental, Av. Prof. Dr. Reinaldo dos Santos, 2790-134 Carnaxide, Portugal
| | - Anna Apostolo
- Heart failure department, Centro Cardiologico Monzino, IRCCS, Milan, Italy
| | | | | | - Irene Matavelli
- Heart failure department, Centro Cardiologico Monzino, IRCCS, Milan, Italy
| | - Piergiuseppe Agostoni
- Heart failure department, Centro Cardiologico Monzino, IRCCS, Milan, Italy
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
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Dos Santos Ribeiro G, Beltrame T, Fernando Deresz L, Hansen D, Agostoni P, Karsten M. Software development to standardize the clinical diagnosis of exercise oscillatory ventilation in heart failure. J Clin Monit Comput 2023; 37:1247-1253. [PMID: 36735189 DOI: 10.1007/s10877-023-00976-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2022] [Revised: 01/12/2023] [Accepted: 01/18/2023] [Indexed: 02/04/2023]
Abstract
BACKGROUND Exercise oscillatory ventilation (EOV) is characterized by periodic oscillations of minute ventilation during cardiopulmonary exercise testing (CPET). Despite its prognostic value in chronic heart failure (HF), its diagnosis is complex due to technical limitations. An easier and more accurate way of EOV identification can contribute to a better approach and clinical diagnosis. This study aims to describe a software development to standardize the EOV diagnosis from CPET's raw data in heart failure patients and test its reliability (intra- and inter-rater). METHODS The software was developed in the "drag-and-drop" G-language using LabVIEW®. Five EOV definitions (Ben-Dov, Corrà, Kremser, Leite, and Sun definitions), two alternative approaches, one smoothing technique, and some basic statistics were incorporated into the interface to visualize four charts of the ventilatory response. EOV identification was based on a set of criteria verified from the interaction between amplitude, cycle length, and oscillation time. Two raters analyzed the datasets. In addition, repeated measurements were verified after six months using about 25% of the initial data. Cohen's kappa coefficient (κ) was used to investigate the reliability. RESULTS Overall, 391 tests were analyzed in duplicate (inter-rater reliability) and 100 tests were randomized for new analysis (intra-rater reliability). High inter-rater (κ > 0.80) and intra-rater (κ > 0.80) reliability of the five EOV diagnoses were observed. CONCLUSION The present study proposes novel semi-automated software to detect EOV in HF, with high inter and intra-rater agreements. The software project and its tutorial are freely available for download.
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Affiliation(s)
- Gustavo Dos Santos Ribeiro
- Programa de Pós-Graduação em Ciências da Reabilitação, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, RS, Brazil
| | - Thomas Beltrame
- Samsung R&D Institute Brazil - SRBR, Universidade Federal de São Carlos (UFSCAR), Campinas, SP, Brazil
| | - Luís Fernando Deresz
- Departamento de Educação Física, Universidade Federal de Juiz de Fora (UFJF), Governador Valadares, MG, Brazil
| | - Dominique Hansen
- Faculty of Rehabilitation Sciences, Hasselt University (UHASSELT), BIOMED/REVAL, Hasselt, Belgium
- Heart Centre Hasselt, Jessa Hospital, Hasselt, Belgium
| | - Piergiuseppe Agostoni
- Centro Cardiologico Monzino, IRCCS, Milan, Italy
- Department of Clinical Sciences of Community Health, Cardiovascular Section, University of Milano, Milano, Italy
| | - Marlus Karsten
- Programa de Pós-Graduação em Ciências da Reabilitação, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, RS, Brazil
- Departamento de Fisioterapia, Universidade do Estado de Santa Catarina (UDESC), Florianópolis, SC, Brazil
- Programa de Pós-Graduação em Fisioterapia, UDESC, Florianópolis, SC, Brazil
- Centro de Ciências da Saúde e do Esporte, UDESC, Rua Pascoal Simone 358, CEP 88080-350, Florianópolis, SC, Brazil
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Magrì D, Palermo P, Salvioni E, Mapelli M, Gallo G, Vignati C, Mattavelli I, Gugliandolo P, Maruotti A, Di Loro PA, Fiori E, Sciomer S, Agostoni P. Influence of exertional oscillatory breathing and its temporal behavior in patients with heart failure and reduced ejection fraction. Int J Cardiol 2023:S0167-5273(23)00659-9. [PMID: 37164295 DOI: 10.1016/j.ijcard.2023.05.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Revised: 04/12/2023] [Accepted: 05/05/2023] [Indexed: 05/12/2023]
Abstract
BACKGROUND Exertional oscillatory breathing (EOV) represents an emerging prognostic marker in heart failure (HF) patients, however little is known about EOV meaning with respect to its disappearance/persistence during cardiopulmonary exercise test (CPET). The present single-center study evaluated EOV clinical and prognostic impact in a large cohort of reduced ejection fraction HF patients (HFrEF) and, contextually, if a specific EOV temporal behavior might be an addictive risk predictor. METHODS AND RESULTS Data from 1.866 HFrEF patients on optimized medical therapy were analysed. The primary cardiovascular (CV) study end-point was cardiovascular death, heart transplantation or LV assistance device (LVAD) implantation at 5-years. For completeness a secondary end-point of total mortality at 5- years was also explored. EOV presence was identified in 251 patients (13%): 142 characterized by EOV early cessation (Group A) and 109 by EOV persistence during the whole CPET (Group B). The entire EOV Group showed worse clinical and functional status than NoEOV Group (n = 1.615) and, within the EOV Group, Group B was characterized by a more severe HF. At CV survival analysis, EOV patients showed a poorer outcome than the NoEOV Group (events 27.1% versus 13.1%, p < 0.001) both unpolished and after matching for main confounders. Instead, no significant differences were found between EOV Group A and B with respect to CV outcome. Conversely the analysis for total mortality failed to be significant. CONCLUSIONS Our analysis, albeit retrospective, supports the inclusion of EOV into a CPET-centered clinical and prognostic evaluation of the HFrEF patients. EOV characterizes per se a more advanced HFrEF stage with an unfavorable CV outcome. However, the EOV persistence, albeit suggestive of a more severe HF, does not emerge as a further prognostic marker.
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Affiliation(s)
- Damiano Magrì
- Department of Clinical and Molecular Medicine, Azienda Ospedaliera Sant'Andrea, "Sapienza" University, Rome, Italy
| | | | | | - Massimo Mapelli
- Centro Cardiologico Monzino, IRCCS, Milan, Italy.; Dept. of Clinical sciences and Community health, Cardiovascular Section, University of Milano, Milan, Italy
| | - Giovanna Gallo
- Department of Clinical and Molecular Medicine, Azienda Ospedaliera Sant'Andrea, "Sapienza" University, Rome, Italy
| | | | | | | | - Antonello Maruotti
- Dipartimento di Giurisprudenza, Economia, Politica e Lingue Moderne - Libera Università Maria Ss Assunta; Department of Mathematics, University of Bergen, Norway; School of Computing, University of Portsmouth, United Kingdom
| | | | - Emiliano Fiori
- Department of Clinical and Molecular Medicine, Azienda Ospedaliera Sant'Andrea, "Sapienza" University, Rome, Italy
| | - Susanna Sciomer
- Dipartimento di Scienze Cardiovascolari, Respiratorie, Nefrologiche, Anestesiologiche e Geriatriche, "Sapienza" University, Rome, Italy
| | - Piergiuseppe Agostoni
- Centro Cardiologico Monzino, IRCCS, Milan, Italy.; Dept. of Clinical sciences and Community health, Cardiovascular Section, University of Milano, Milan, Italy..
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Ribeiro GDS, Deresz LF, Salvioni E, Hansen D, Agostoni P, Karsten M. Sensitivity and specificity of different exercise oscillatory ventilation definitions to predict 2-year major adverse cardiovascular outcomes in chronic heart failure patients. Int J Cardiol 2022; 360:39-43. [PMID: 35623479 DOI: 10.1016/j.ijcard.2022.05.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Revised: 05/17/2022] [Accepted: 05/18/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Exercise oscillatory ventilation (EOV) shows a four-fold greater risk of adverse events. This study aims to analyze the sensitivity and specificity of three EOV diagnostic definitions to predict adverse outcomes at a 2-year follow-up and to compare its EOV prevalence and relations with the patient's profile. METHODS Cardiopulmonary exercise tests from 233 heart failure patients were analyzed. Two blinded reviewers used a semiautomated software to identify EOV cases pattern according to the definitions of Ben-Dov, Corrà, and Leite. Data were grouped in EOV-positive or EOV-negative according to each definition. Baseline characteristics, EOV prevalence, relative risk, sensitivity, and specificity to predict 2-years of major adverse cardiovascular outcomes were analyzed. RESULTS The Corrà definition led to the best prediction of 2-year major cardiovascular adverse outcomes (HR 2.46 [1.16 to 5.25]; p = 0.019, AUC = 0.618; p = 0.007). EOV prevalence was 17.2%, 17.2%, and 9.4% applying Ben-Dov, Corrà, and Leite definition, respectively. The main clinical differences between EOV-positive and EOV-negative patients were: MECKI score and VE/VCO2 slope (all definitions), and BNP levels (Ben-Dov and Leite). BNP levels were correlated with amplitude (rho = 0.255; p = 0.033) and cycle length (rho = 0.388; p = 0.002). CONCLUSION Corrà definition was the only one that exhibited the capacity to predict major adverse cardiovascular outcomes at a 2-year follow-up. Regardless of its definition, EOV was more often prevalent in patients with a greater MECKI score and VE/VCO2 slope values.
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Affiliation(s)
- Gustavo Dos Santos Ribeiro
- Programa de Pós-Graduação em Ciências da Reabilitação, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, Brazil
| | - Luís Fernando Deresz
- Departamento de Educação Física, Universidade Federal de Juiz de Fora (UFJF), Governador Valadares, Brazil
| | | | - Dominique Hansen
- Hasselt University (UHASSELT), Faculty of Rehabilitation Sciences, BIOMED/REVAL, Hasselt, Belgium; Heart Centre Hasselt, Jessa Hospital, Hasselt, Belgium
| | - Piergiuseppe Agostoni
- Centro Cardiologico Monzino, IRCCS, Milan, Italy; Department of Clinical Sciences of Community Health, Cardiovascular Section, University of Milano, Milano, Italy
| | - Marlus Karsten
- Programa de Pós-Graduação em Ciências da Reabilitação, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, Brazil; Departamento de Fisioterapia, Universidade do Estado de Santa Catarina (UDESC), Florianópolis, Brazil; Programa de Pós-Graduação em Fisioterapia, UDESC, Florianópolis, Brazil.
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Gentile F, Fabiani I, Emdin M. Exercise Oscillatory Ventilation in Heart Failure and Brain-Lung-Heart-Muscle Crosstalk. Eur J Prev Cardiol 2022; 29:1689-1691. [PMID: 35881494 DOI: 10.1093/eurjpc/zwac145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Francesco Gentile
- Cardiology Division, Pisa University Hospital, Pisa, Italy.,Cardiology and Cardiovascular Medicine Division, Fondazione Toscana Gabriele Monasterio, Pisa, Italy
| | - Iacopo Fabiani
- Cardiology and Cardiovascular Medicine Division, Fondazione Toscana Gabriele Monasterio, Pisa, Italy
| | - Michele Emdin
- Cardiology and Cardiovascular Medicine Division, Fondazione Toscana Gabriele Monasterio, Pisa, Italy.,Institute of Life Sciences, Scuola Superiore Sant'Anna, Pisa, Italy
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