Increased physiological dead space at exercise is a marker of mild pulmonary or cardiovascular disease in dyspneic subjects

Abstract

Background: The characteristics of cardiopulmonary exercise testing (CPET)-derived parameters for the differential diagnosis of exertional dyspnea are not well known. Objectives: We hypothesized that increased physiological dead space ventilation (VD/Vt) is a marker for mild pulmonary or cardiovascular disease in patients with exertional dyspnea. Design: We used receiver operating characteristic analysis to determine the performance of individual CPET parameters for identifying subjects with either mild pulmonary or cardiovascular disease, among 77 subjects with mild-to-moderate exertional dyspnea (modified Medical Research Council scale 1-2). Results: In comparison with subjects without disease, subjects with pulmonary disease (n = 31) had higher VE/V'CO₂ slope, higher VD/Vt, and lower ventilatory reserve. Subjects with cardiovascular disease (n = 14) had lower heart rate and cardiovascular double product and higher VD/Vt at peak exercise. At a threshold of 28%, the sensitivity and specificity of VD/Vt at peak exercise for identifying pulmonary or cardiovascular disease were 89% (95% CI: 64-98%) and 72% (95% CI: 46-89%), respectively. Conclusions: Increased physiological VD/Vt at exercise is a sensitive and specific marker of mild pulmonary or cardiovascular disease in dyspneic subjects.

Keywords: Dead space; cardiopulmonary exercise testing; cardiovascular disease; efficiency; exercise; lung disease.

Figure 1.

ROC curves of physiological VD/Vt for the diagnosis of pulmonary (left panel) or cardiovascular disease (right panel) disease in dyspneic subjects. Gray lines: upper and lower 95% confidence intervals.