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Prognostic significance of different measures of the ventilation-carbon dioxide relation in patients with suspected heart failure

Ingle, Lee; Sloan, Rebecca; Carroll, Sean; Goode, Kevin; Cleland, John G.; Clark, Andrew L.


Rebecca Sloan

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Dr Kevin Goode
Research Systems Project Manager / Business Analyst

John G. Cleland

Andrew L. Clark


Aims We studied the prognostic significance of the ventilatory equivalent of carbon dioxide production (VEqCO 2 ) at different time-points of a maximal cardiopulmonary exercise test (CPET) in patients with suspected heart failure (HF). Methods and resultsThe VEqCO 2 was calculated at three different time-points; VEqCO 2 (rest) was calculated following 30 s of resting data immediately prior to the start of exercise; VEqCO 2 (nadir) was the lowest 30-s average over the duration of the test; VEqCO 2 (peak) was calculated using the mean value of the final 30 s of exercise. We included a healthy control group who had no evidence of cardiorespiratory disease. Four hundred and twenty-three patients with suspected HF (mean age 63 ± 12 years; 80 males; left ventricular ejection fraction 36 ± 6 ; peak oxygen uptake 22.3 ± 8.1 mL kg -1 min -1 ; VE/VCO2 slope 34 ± 8) were included in the study. Seventy-eight healthy participants (62 males; age 61 ± 11 years) were recruited as controls. One hundred and eighteen patients died during follow-up with a median follow-up of 8.6 ± 2.1 years in survivors. The strongest univariable predictors of all-cause mortality were VEqCO 2 (nadir) (χ 2 47.9), peak oxygen uptake (χ 2 53.0), and the VE/VCO2 slope (χ 2 31.7). In a Cox multivariable proportional hazards model, VEqCO 2 (nadir) (χ 2 8.8), peak systolic blood pressure (χ 2 6.0), and age (χ 2 6.6) were the most potent independent predictors of all-cause mortality. Conclusion The VEqCO 2 (nadir) provides greater prognostic value than other related ventilatory variables in patients with suspected HF. Further work in other populations is required to confirm our Conclusion s. © 2011 The Author.


Ingle, L., Sloan, R., Carroll, S., Goode, K., Cleland, J. G., & Clark, A. L. (2011). Prognostic significance of different measures of the ventilation-carbon dioxide relation in patients with suspected heart failure. European journal of heart failure, 13(5), 537-542.

Journal Article Type Article
Acceptance Date Nov 11, 2010
Online Publication Date Feb 18, 2014
Publication Date 2011-05
Deposit Date Nov 13, 2014
Publicly Available Date
Journal European Journal Of Heart Failure
Print ISSN 1388-9842
Electronic ISSN 1879-0844
Publisher Wiley
Peer Reviewed Peer Reviewed
Volume 13
Issue 5
Pages 537-542
Keywords VE/VCO2 slope; Peak oxygen uptake; VEqCO(2) (rest); VEqCO(2) (nadir); VEqCO(2) (peak); VEqCO(2) (rest/peak ratio); VEqCO(2) (nadir/peak ratio); VEqCO(2) (rest/nadir ratio); Gas-exchange exercise efficiency mortality slope
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