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ventilatory inefficiency

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https://www.readbyqxmd.com/read/28867128/severely-impaired-cardiorespiratory-fitness-in-patients-with-recently-decompensated-systolic-heart-failure
#1
Justin McNair Canada, Cory Ross Trankle, Leo Francis Buckley, Salvatore Carbone, Nayef Antar Abouzaki, Dinesh Kadariya, Keyur Shah, Richard Cooke, Michael Christopher Kontos, Jaideep Patel, Pranav Mankad, Aaron Schatz, Amit Bhatnagar, Ross Arena, Benjamin Wallace Van Tassell, Antonio Abbate
Hospital admission for decompensated heart failure marks a critical inflection point in a patient's health. Despite the improvement in signs or symptoms during hospitalization, patients have a high likelihood of readmission, reflecting a lack of resolution of the underlying condition. Surprisingly, no studies have characterized the cardiorespiratory fitness of such patients. Fifty-two patients (38 [73%] male, age 57 [52 to 65] years, left ventricular ejection fraction 31% [24 to 38]) underwent cardiopulmonary exercise testing 4 (1 to 10) days after hospital discharge, when stable and without overt signs of volume overload...
August 7, 2017: American Journal of Cardiology
https://www.readbyqxmd.com/read/28767523/respiratory-mechanical-and-cardiorespiratory-consequences-of-cycling-with-aerobars
#2
Jesse M Charlton, Andrew H Ramsook, Reid A Mitchell, Michael A Hunt, Joseph H Puyat, Jordan A Guenette
PURPOSE: Aerobars place a cyclist in a position where the trunk is flexed forward and the elbows are close to the midline of the body. This position is known to improve cycling aerodynamics and time trial race performance compared to upright cycling positions. However, the aggressive nature of this position may have important cardiorespiratory and metabolic consequences. The purpose of this investigation was to examine the respiratory mechanical, ventilatory, metabolic, and sensory consequences of cycling while using aerobars during laboratory based cycling...
July 31, 2017: Medicine and Science in Sports and Exercise
https://www.readbyqxmd.com/read/28665692/excess-ventilation-in-copd-heart-failure-overlap-implications-for-dyspnea-and-exercise-intolerance
#3
Alcides Rocha, Flavio F Arbex, Priscilla A Sperandio, Aline Souza, Ligia Biazzim, Frederico Mancuso, Danilo C Berton, Bruno Hochhegger, Maria Clara N Alencar, Luiz E Nery, Denis E O'Donnell, J Alberto Neder
BACKGROUND: An increased ventilatory response to exertional metabolic demand (high ventilation (⩒E)-carbon dioxide output (⩒CO2) relationship) is a common finding in patients with coexistent COPD-heart failure. We aimed to determine the mechanisms underlying high ⩒E-⩒CO2 and its impact on operating lung volumes, dyspnea and exercise tolerance in these patients. METHODS: Twenty-two ex-smokers with combined COPD and heart failure with reduced left ventricular ejection fraction (LVEF) undertook, after careful treatment optimization, a progressive cycle exercise test with capillary (c) blood gas collection...
June 30, 2017: American Journal of Respiratory and Critical Care Medicine
https://www.readbyqxmd.com/read/28550471/blood-lactate-accumulation-decreases-during-the-slow-component-of-oxygen-uptake-without-a-decrease-in-muscular-efficiency
#4
J M O'Connell, J M Weir, B R MacIntosh
Pulmonary oxygen uptake ([Formula: see text]) slowly increases during exercise above the anaerobic threshold, and this increase is called the slow component of [Formula: see text]. The mechanism of the increase in [Formula: see text] is assumed to be due to increasing energy cost associated with increasingly inefficient muscle contraction. We hypothesized that the increase in [Formula: see text] would be accompanied by a constant or increasing rate of accumulation of blood lactate, indicating sustained anaerobic metabolism while [Formula: see text] increased...
May 26, 2017: Pflügers Archiv: European Journal of Physiology
https://www.readbyqxmd.com/read/28487387/different-determinants-of-ventilatory-inefficiency-at-different-stages-of-reduced-ejection-fraction-chronic-heart-failure-natural-history
#5
Alessandro Mezzani, Andrea Giordano, Klara Komici, Ugo Corrà
BACKGROUND: It is not known whether determinants of ventilation (VE)/volume of exhaled carbon dioxide (VCO2) slope during incremental exercise may differ at different stages of reduced ejection fraction chronic heart failure natural history. METHODS AND RESULTS: VE/VCO2 slope was fitted up to lowest VE/VCO2 ratio, that is, a proxy of the VE/perfusion ratio devoid of nonmetabolic stimuli to ventilatory drive. VE/VCO2 slope tertiles were generated from our database (<27...
May 9, 2017: Journal of the American Heart Association
https://www.readbyqxmd.com/read/28412423/rv-contractile-function-and-its-coupling-to-pulmonary-circulation-in-heart-failure-with-preserved%C3%A2-ejection%C3%A2-fraction-stratification-of-clinical-phenotypes-and-outcomes
#6
Marco Guazzi, Debra Dixon, Valentina Labate, Lauren Beussink-Nelson, Francesco Bandera, Michael J Cuttica, Sanijv J Shah
OBJECTIVES: This study sought to investigate how right ventricular (RV) contractile function and its coupling with pulmonary circulation (PC) stratify clinical phenotypes and outcome in heart failure preserved ejection fraction (HFpEF) patients. BACKGROUND: Pulmonary hypertension and RV dysfunction are key hemodynamic abnormalities in HFpEF. METHODS: Three hundred eighty seven HFpEF patients (mean age 64 ± 12 years, 59% females, left ventricular ejection fraction 59 ± 7%) underwent RV and pulmonary hemodynamic evaluation by echocardiography (entire population) and right heart catheterization (219 patients)...
April 7, 2017: JACC. Cardiovascular Imaging
https://www.readbyqxmd.com/read/28375677/cardiopulmonary-exercise-testing-in-adult-congenital-heart-disease
#7
Valentina Mantegazza, Anna Apostolo, Alfred Hager
Recently, the number of patients with congenital heart diseases reaching adulthood has been progressively increasing in developed countries, and new issues are emerging: the evaluation of their capacity to cope with physical activity and whether this knowledge can be used to optimize medical management. A symptom-limited cardiopulmonary exercise test has proven to be an essential tool, because it can objectively evaluate the functional cardiovascular capacity of these patients, identify the pathological mechanisms of the defect (circulatory failure, shunts, and/or pulmonary hypertension), and help prescribe an individualized rehabilitation program when needed...
July 2017: Annals of the American Thoracic Society
https://www.readbyqxmd.com/read/28375670/cardiopulmonary-exercise-testing-in-pulmonary-hypertension
#8
Jason Weatherald, Stefania Farina, Noemi Bruno, Pierantonio Laveneziana
Cardiopulmonary exercise testing allows the assessment of the integrative cardiopulmonary response to exercise and is a useful tool to assess the underlying pathophysiologic mechanisms leading to exercise intolerance. Patients with pulmonary hypertension often face a considerable delay in diagnosis due to the rarity of the disease and nonspecific symptoms of dyspnea, fatigue, and exercise limitation. Cardiopulmonary exercise testing may be suggestive of pulmonary hypertension in patients with evidence of both circulatory impairment and ventilatory inefficiency...
July 2017: Annals of the American Thoracic Society
https://www.readbyqxmd.com/read/28345959/ventilatory-inefficiency-and-exertional-dyspnea-in-early-chronic-obstructive-pulmonary-disease
#9
J Alberto Neder, Danilo C Berton, Paulo de Tarso Müller, Amany F Elbehairy, Alcides Rocha, Paolo Palange, Denis E O'Donnell
Exertional dyspnea is present across the spectrum of chronic obstructive pulmonary disease (COPD) severity. However, without realizing it themselves, patients may decrease daily physical activity to avoid distressing respiratory sensations. Dyspnea also may be associated with deconditioning. Cardiopulmonary exercise testing can uncover exertional dyspnea and its physiological determinants in patients with preserved or only mildly reduced FEV1. Dyspnea in mild COPD can largely be explained by increased "wasted" ventilation in the physiological dead space, which heightens the drive to breathe and worsens the inspiratory mechanical constraints...
July 2017: Annals of the American Thoracic Society
https://www.readbyqxmd.com/read/28210319/physiology-of-respiratory-disturbances-in-muscular-dystrophies
#10
Antonella Lo Mauro, Andrea Aliverti
Muscular dystrophy is a group of inherited myopathies characterised by progressive skeletal muscle wasting, including of the respiratory muscles. Respiratory failure, i.e. when the respiratory system fails in its gas exchange functions, is a common feature in muscular dystrophy, being the main cause of death, and it is a consequence of lung failure, pump failure or a combination of the two. The former is due to recurrent aspiration, the latter to progressive weakness of respiratory muscles and an increase in the load against which they must contract...
December 2016: Breathe
https://www.readbyqxmd.com/read/27997623/the-coupling-of-peripheral-blood-pressure-and-ventilatory-responses-during-exercise-in-young-adults-with-cystic-fibrosis
#11
COMPARATIVE STUDY
Erik H Van Iterson, Courtney M Wheatley, Sarah E Baker, Thomas P Olson, Wayne J Morgan, Eric M Snyder
PURPOSE: Cystic fibrosis (CF) is commonly recognized as a pulmonary disease associated with reduced airway function. Another primary symptom of CF is low exercise capacity where ventilation and gas-exchange are exacerbated. However, an independent link between pathophysiology of the pulmonary system and abnormal ventilatory and gas-exchange responses during cardiopulmonary exercise testing (CPET) has not been established in CF. Complicating this understanding, accumulating evidence suggests CF demonstrate abnormal peripheral vascular function; although, the clinical implications are unclear...
2016: PloS One
https://www.readbyqxmd.com/read/27997255/emphysema-on-thoracic-ct-and-exercise-ventilatory-inefficiency-in-mild-to-moderate-copd
#12
Joshua H Jones, Joel T Zelt, Daniel M Hirai, Camilla V Diniz, Aida Zaza, Denis E O'Donnell, J Alberto Neder
There is growing evidence that emphysema on thoracic computed tomography (CT) is associated with poor exercise tolerance in COPD patients with only mild-to-moderate airflow obstruction. We hypothesized that an excessive ventilatory response to exercise (ventilatory inefficiency) would underlie these abnormalities. In a prospective study, 19 patients (FEV1 = 82 ± 13%, 12 Global Initiative for Chronic Obstructive Lung Disease (GOLD) stage 1) and 26 controls underwent an incremental exercise test. Ventilatory inefficiency was assessed by the ventilation ([Formula: see text]E)/CO2 output ([Formula: see text]CO2) nadir...
December 20, 2016: COPD
https://www.readbyqxmd.com/read/27779551/does-exercise-ventilatory-inefficiency-predict-poor-outcome-in-heart-failure-patients-with-copd
#13
Maria Clara Alencar, Flavio F Arbex, Aline Souza, Adriana Mazzuco, Priscila A Sperandio, Alcides Rocha, Daniel M Hirai, Frederico Mancuso, Danilo C Berton, Audrey Borghi-Silva, Dirceu Almeida, Denis E OʼDonnel, J Alberto Neder
PURPOSE: To investigate whether the opposite effects of heart failure (HF) and chronic obstructive pulmonary disease (COPD) on exercise ventilatory inefficiency (minute ventilation [(Equation is included in full-text article.)E]-carbon dioxide output [(Equation is included in full-text article.)CO2] relationship) would negatively impact its prognostic relevance. METHODS: After treatment optimization and an incremental cardiopulmonary exercise test, 30 male patients with HF-COPD (forced expiratory volume in 1 second [FEV1] = 57% ± 17% predicted, ejection fraction = 35% ± 6%) were prospectively followed up during 412 ± 261 days for major cardiac events...
November 2016: Journal of Cardiopulmonary Rehabilitation and Prevention
https://www.readbyqxmd.com/read/27734959/respiratory-constraints-during-activities-in-daily-life-and-the-impact-on-health-status-in-patients-with-early-stage-copd-a-cross-sectional-study
#14
Hanneke Ac van Helvoort, Laura M Willems, Pn Richard Dekhuijzen, Hieronymus Wh van Hees, Yvonne F Heijdra
In patients with chronic obstructive pulmonary disease (COPD), exercise capacity is reduced, resulting over time in physical inactivity and worsened health status. It is unknown whether ventilatory constraints occur during activities of daily life (ADL) in early stages of COPD. The aim of this study was to assess respiratory mechanics during ADL and to study its consequences on dyspnoea, physical activity and health status in early-stage COPD compared with healthy controls. In this cross-sectional study, 39 early-stage COPD patients (mean FEV1 88±s...
October 13, 2016: NPJ Primary Care Respiratory Medicine
https://www.readbyqxmd.com/read/27701063/physiological-and-sensory-consequences-of-exercise-oscillatory-ventilation-in-heart-failure-copd
#15
Alcides Rocha, Flavio F Arbex, Maria Clara N Alencar, Priscila A Sperandio, Daniel M Hirai, Danilo C Berton, Denis E O'Donnell, J Alberto Neder
BACKGROUND: Exercise oscillatory ventilation (EOV) is associated with poor ventilatory efficiency and higher operating lung volumes in heart failure. These abnormalities may be particularly deleterious to dyspnea and exercise tolerance in mechanically-limited patients, e.g. those with coexistent COPD. METHODS: Ventilatory, gas exchange and sensory responses to incremental exercise were contrasted in 68 heart failure-COPD patients (12 EOV+). EOV was established by standard criteria...
December 1, 2016: International Journal of Cardiology
https://www.readbyqxmd.com/read/27629375/comparing-changing-neurally-adjusted-ventilatory-assist-nava-levels-in-intubated-and-recently-extubated-neonates
#16
B LoVerde, K S Firestone, H M Stein
OBJECTIVE: Neurally adjusted ventilatory assist (NAVA) is a mode of mechanical ventilation that delivers ventilatory support in synchrony to the patient's respiratory needs using NAVA level, a proportionality constant that converts the electrical activity of the diaphragm (Edi) into a peak pressure (PIP). Recent published studies suggest that neonates can control the delivered ventilatory support through neural feedback. Systematically increasing the NAVA level initially increases the PIP while maintaining a constant Edi until an inflection point or breakpoint (BrP) is reached, at which time the PIP plateaus and the Edi signal decreases...
December 2016: Journal of Perinatology: Official Journal of the California Perinatal Association
https://www.readbyqxmd.com/read/27332771/effect-of-exercise-training-on-ventilatory-efficiency-in-patients-with-heart-disease-a-review
#17
REVIEW
D M L Prado, E A Rocco, A G Silva, D F Rocco, M T Pacheco, V Furlan
The analysis of ventilatory efficiency in cardiopulmonary exercise testing has proven useful for assessing the presence and severity of cardiorespiratory diseases. During exercise, efficient pulmonary gas exchange is characterized by uniform matching of lung ventilation with perfusion. By contrast, mismatching is marked by inefficient pulmonary gas exchange, requiring increased ventilation for a given CO2 production. The etiology of increased and inefficient ventilatory response to exercise in heart disease is multifactorial, involving both peripheral and central mechanisms...
June 20, 2016: Brazilian Journal of Medical and Biological Research, Revista Brasileira de Pesquisas Médicas e Biológicas
https://www.readbyqxmd.com/read/27172093/exercise-ventilation-in-copd-influence-of-systolic-heart-failure
#18
Flavio F Arbex, Maria Clara Alencar, Aline Souza, Adriana Mazzuco, Priscila A Sperandio, Alcides Rocha, Daniel M Hirai, Frederico Mancuso, Danilo C Berton, Audrey Borghi-Silva, Dirceu R Almeida, Denis E O'Donnell, J Alberto Neder
Systolic heart failure is a common and disabling co-morbidity of chronic obstructive pulmonary disease (COPD) which may increase exercise ventilation due to heightened neural drive and/or impaired pulmonary gas exchange efficiency. The influence of heart failure on exercise ventilation, however, remains poorly characterized in COPD. In a prospective study, 98 patients with moderate to very severe COPD [41 with coexisting heart failure; 'overlap' (left ventricular ejection fraction < 50%)] underwent an incremental cardiopulmonary exercise test (CPET)...
December 2016: COPD
https://www.readbyqxmd.com/read/27165419/the-prognostic-role-of-ventilatory-inefficiency-and-exercise-capacity-in-idiopathic-pulmonary-fibrosis
#19
Baruch Vainshelboim, Jose Oliveira, Benjamin Daniel Fox, Mordechai Reuven Kramer
BACKGROUND: Idiopathic pulmonary fibrosis (IPF) is a chronic, progressive, and fatal interstitial lung disease associated with poor prognosis and limited effective treatment options. Reliable predictors of outcome in daily clinical practice are needed to determine high-risk patients for urgent lung transplantation referral. This study aimed to identify practical prognostic predictors of mortality using cardiopulmonary exercise testing (CPET) in IPF subjects. METHODS: Thirty-four subjects with IPF (22 men and 12 women), median age 68 (range 50-81) y were prospectively studied...
August 2016: Respiratory Care
https://www.readbyqxmd.com/read/27077955/exercise-ventilatory-inefficiency-adds-to-lung-function-in-predicting-mortality-in-copd
#20
J Alberto Neder, Abdullah Alharbi, Danilo C Berton, Maria Clara N Alencar, Flavio F Arbex, Daniel M Hirai, Katherine A Webb, Denis E O'Donnell
Severity of resting functional impairment only partially predicts the increased risk of death in chronic obstructive pulmonary disease (COPD). Increased ventilation during exercise is associated with markers of disease progression and poor prognosis, including emphysema extension and pulmonary vascular impairment. Whether excess exercise ventilation would add to resting lung function in predicting mortality in COPD, however, is currently unknown. After an incremental cardiopulmonary exercise test, 288 patients (forced expiratory volume in one second ranging from 18% to 148% predicted) were followed for a median (interquartile range) of 57 (47) months...
August 2016: COPD
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