The following is a summary of “Exercise oscillatory ventilation in patients with coexisting chronic obstructive pulmonary disease and heart failure: Clinical implications,” published in the OCTOBER 2023 issue of Pulmonology by Goulart, et al.
Exercise oscillatory ventilation (EOV) is a significant predictor of poor prognosis in patients with heart failure (HF) and reduced left ventricular ejection fraction (HFrEF). However, there is a lack of studies evaluating the presence of EOV in individuals with coexisting chronic obstructive pulmonary disease (COPD) and HFrEF. For a study, researchers sought to compare the clinical characteristics of participants with coexisting HFrEF-COPD with and without EOV during cardiopulmonary exercise testing (CPET); and to assess the impact of EOV on mortality during a 35-month follow-up period.
A total of 50 stable HFrEF-COPD participants (EF<50%) underwent CPET and were followed for 35 months. The parametric Student’s t-test, chi-square tests, linear regression model, and Kaplan-Meier analysis were utilized for data analysis.
Among the participants, 13 (26%) had EOV during exercise, while 37 (74%) did not (N-EOV). The EOV group exhibited worse cardiac function (left ventricular ejection fraction [LVEF]: 30 ± 6% vs. N-EOV: 40 ± 9%, P = 0.007) and worse pulmonary function (forced expiratory volume in 1 second [FEV1]: 1.04 ± 0.7 L vs. N-EOV: 1.88 ± 0.7 L, P = 0.007) compared to the N-EOV group. The EOV group also had a higher mortality rate (7 [54%] vs. N-EOV: 8 [27%], P = 0.02), a higher minute ventilation/carbon dioxide production (V̇E/ V̇CO2) slope (42 ± 7 vs. N-EOV: 36 ± 8, P = 0.04), reduced peak ventilation (L/min) (26.2 ± 16.7 vs. N-EOV: 40.3 ± 16.4, P = 0.01), and reduced peak oxygen uptake (mlO2 kg-1 min-1) (11.0 ± 4.0 vs. N-EOV: 13.5 ± 3.4 ml●kg-1●min-1, P = 0.04) compared to the N-EOV group. Furthermore, the EOV group had a higher mortality risk during the follow-up period (long-rank P = 0.001) than the N-EOV group.
EOV was associated with increased severity of coexisting HFrEF and COPD and a worse prognosis. Therefore, assessing EOV in individuals with coexisting HFrEF-COPD may be a clinical status and prognosis biomarker.