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. 2021 Feb 2;30(159):200141.
doi: 10.1183/16000617.0141-2020. Print 2021 Mar 31.

Minute ventilation/carbon dioxide production in chronic heart failure

Piergiuseppe Agostoni  1   2 , Susanna Sciomer  3 , Pietro Palermo  4 , Mauro Contini  4 , Beatrice Pezzuto  4 , Stefania Farina  4 , Alessandra Magini  4 , Fabiana De Martino  4 , Damiano Magrì  5 , Stefania Paolillo  6   7 , Gaia Cattadori  8 , Carlo Vignati  4   2 , Massimo Mapelli  4   2 , Anna Apostolo  4 , Elisabetta Salvioni  4
Affiliations

Minute ventilation/carbon dioxide production in chronic heart failure

Piergiuseppe Agostoni et al. Eur Respir Rev. .

Abstract

In chronic heart failure, minute ventilation (V'E) for a given carbon dioxide production (V'CO2 ) might be abnormally high during exercise due to increased dead space ventilation, lung stiffness, chemo- and metaboreflex sensitivity, early metabolic acidosis and abnormal pulmonary haemodynamics. The V'E versus V'CO2 relationship, analysed either as ratio or as slope, enables us to evaluate the causes and entity of the V'E/perfusion mismatch. Moreover, the V'E axis intercept, i.e. when V'CO2 is extrapolated to 0, embeds information on exercise-induced dead space changes, while the analysis of end-tidal and arterial CO2 pressures provides knowledge about reflex activities. The V'E versus V'CO2 relationship has a relevant prognostic power either alone or, better, when included within prognostic scores. The V'E versus V'CO2 slope is reported as an absolute number with a recognised cut-off prognostic value of 35, except for specific diseases such as hypertrophic cardiomyopathy and idiopathic cardiomyopathy, where a lower cut-off has been suggested. However, nowadays, it is more appropriate to report V'E versus V'CO2 slope as percentage of the predicted value, due to age and gender interferences. Relevant attention is needed in V'E versus V'CO2 analysis in the presence of heart failure comorbidities. Finally, V'E versus V'CO2 abnormalities are relevant targets for treatment in heart failure.

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Conflict of interest statement

Conflict of interest: P. Agostoni reports non-financial support from Menarini, grants from Daiichi Sankyo and Bayer; non-financial support from Novartis and Boehringer; and grants and non-financial support from Actelion, outside the submitted work. Conflict of interest: S. Sciomer has nothing to disclose. Conflict of interest: P. Palermo reports personal fees from Novartis and Malesci, outside the submitted work. Conflict of interest: M. Contini reports personal fees and non-financial support from Dompé Farmaceutici S.p.A. and personal fees from Novartis, outside the submitted work. Conflict of interest: B. Pezzuto has nothing to disclose. Conflict of interest: S. Farina has nothing to disclose. Conflict of interest: A. Magini has nothing to disclose. Conflict of interest: F. De Martino has nothing to disclose. Conflict of interest: D. Magrì has nothing to disclose. Conflict of interest: S. Paolillo has nothing to disclose. Conflict of interest: G. Cattadori has nothing to disclose. Conflict of interest: C. Vignati has nothing to disclose. Conflict of interest: M. Mapelli has nothing to disclose. Conflict of interest: A. Apostolo has nothing to disclose. Conflict of interest: E. Salvioni has nothing to disclose.

Figures

FIGURE 1
FIGURE 1
A few cardiopulmonary exercise parameters during a ramp exercise protocol. AT: anaerobic threshold; RCP: respiratory compensation point; PETO2: end-tidal oxygen pressure; PETCO2: end-tidal carbon dioxide pressure; V′E: ventilation; V′O2: oxygen uptake; V′CO2: carbon dioxide production. Reproduced from [3] with permission.
FIGURE 2
FIGURE 2
Cardiopulmonary exercise parameters during a ramp exercise protocol: oxygen uptake (V′O2) and carbon dioxide production (V′CO2) a) at sea level and b) at high altitude (Capanna Regina Margherita, Monte Rosa, Italian Alps, 4559 m) and end-tidal oxygen pressure (PETO2) and end-tidal carbon dioxide pressure (PETCO2) c) at sea level and d) at high altitude. V′E: ventilation; RC: respiratory compensation point; AT: anaerobic threshold. Reproduced from [6] with permission.
FIGURE 3
FIGURE 3
5-year survival analysis in heart failure patients in whom anaerobic threshold (AT) and respiratory compensation point (RCP) were not identified (n=292), in whom only AT was identified (n=920) and in whom both AT and RCP (n=783) were identified. HT: heart transplant; LVAD: left ventricular assist device. Reproduced from [8] with permission.
FIGURE 4
FIGURE 4
Schematic representation of ventilation (V′E) and carbon dioxide changes (V′CO2) during exercise in five different conditions: a) normal subject; b) normal subject with added external dead space; c) COPD; d) heart failure; e) pulmonary arterial hypertension. Dead space (V′D) and alveolar (V′A) ventilation are also reported. Reproduced from [12] with permission.
FIGURE 5
FIGURE 5
Minute ventilation (V′E)/oxygen uptake (V′O2) and V′E/carbon dioxide production (V′CO2) ratio behaviour in a ramp exercise protocol in a) normal subjects; b) in case of pre-test hyperventilation; c) in COPD; d) in heart failure; and e) in pulmonary arterial hypertension.
FIGURE 6
FIGURE 6
Linear regression between minute ventilation (V′E)/carbon dioxide production (V′CO2) slope and age in a) normal subjects (n=1136); b) males (n=773); and c) females (n=363). Reproduced from [29] with permission.
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Comment in

  • doi: 10.1183/16000617.0244-2020

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