Chest
ORIGINAL RESEARCHEXERCISE TESTINGMixed-Expired and End-Tidal CO2 Distinguish Between Ventilation and Perfusion Defects During Exercise Testing in Patients With Lung and Heart Diseases
Section snippets
Subjects
The study was approved by our institutional review board. From our recent files, the authors screened and selected cardiopulmonary exercise test results obtained with informed consent from 25 adults in each of the following four groups: normal, COPD, LVF, and PAH. All normal subjects were considered healthy. All COPD patients had FEV1/FVC ratios < 50% and low or reduced gas transfer index; none had asthma. All LVF patients were New York Heart Association class III or IV left ventricular
Results
Demographics of the subjects are noted in Table 1. Although age and sex distributions were dissimilar, generally reflecting age and sex distributions seen in the respective disease states, disease severities (percentage of predicted peak o2), peak e, and peak co2 for the three disease groups were not significantly different. However, FEV1/VC, Dlco, and breathing reserve were significantly lower and residual volume/total lung capacity significantly higher in the COPD group
Discussion
Discerning the dominant disorder in patients with dyspnea can sometimes be difficult. As previously found in several studies, / inequalities, increased Vd/Vt, and/or decreased Peco2 and Petco2 occur at rest and during exercise in COPD,678910 LVF,1112131415 and PAH.161718 The major hypothesis and finding of this study was that / mismatch caused by airway defects could be differentiated from that of perfusion defects using noninvasive measures of Peco2 and Petco2.
References (23)
- et al.
Metabolic acidosis during exercise in patients with chronic obstructive pulmonary disease
Chest
(1988) - et al.
Exercise performance in chronic obstructive pulmonary disease
Med Clin North Am
(1981) - et al.
Contrasting cardiovascular and respiratory responses to exercise in mitral valve and obstructive pulmonary diseases
Chest
(1983) - et al.
Comparison of end-tidal arterial Pco2gradient during exercise in normal subjects and in patients with severe COPD
Chest
(1995) - et al.
Differential contribution of dead space ventilation and low arterial Pco2to exercise hypernea in patients with chronic heart failure secondary to ischemic or idiopathic dilated cardiomyopathy
Am J Cardiol
(2004) - et al.
End-tidal Pco2abnormality and exercise limitation in patients with primary pulmonary hypertension
Chest
(2005) - Wasserman, K, Hansen, JE, Sue, DY, et al (1987)Principles of exercise testing and interpretation 1st ed. , 50-52 Lea...
- et al.
Principles of exercise testing and interpretation
(2005) - et al.
The lung: clinical physiology and pulmonary function tests
(1962) - et al.
Introduction to statistical analysis
(1969)
Ventilation-perfusion inequality in chronic obstructive pulmonary disease
J Clin Invest
Cited by (86)
Cardiopulmonary Exercise Testing in Pulmonary Arterial Hypertension
2023, Heart Failure ClinicsCardiopulmonary Exercise Testing in Pulmonary Vascular Disease
2021, Encyclopedia of Respiratory Medicine, Second EditionHow to perform and report a cardiopulmonary exercise test in patients with chronic heart failure
2019, International Journal of CardiologyExercise Intolerance in Patients With Heart Failure: JACC State-of-the-Art Review
2019, Journal of the American College of CardiologyCitation Excerpt :Moreover, assessment of partial pressure of end-tidal CO2 can be utilized to differentiate whether V/Q mismatch is caused by airway defects as opposed to perfusion defects. This can be particularly helpful in establishing the dominant mechanism of V/Q mismatch in HF patients with several comorbidities such as pulmonary artery hypertension or chronic obstructive pulmonary disease (47). Ventilatory pattern analysis during symptom-limited CPX allows for the identification of a periodic breathing pattern at rest and during exercise (48).
Influence of dietary nitrate supplementation on lung function and exercise gas exchange in COPD patients
2018, Nitric Oxide - Biology and Chemistry
This work was performed at Los Angeles Biomedical Research Institute, Harbor-UCLA Medical Center.
James E. Hansen has received consultation fees from MET-Test, LLC, and salary support from St. Jude Medical. Dr. Ulubay received support from the Turkish Scientific Research Institute (Tubitak). Dr. Chow reports no conflict of interest. Dr. Sun has received salary support from St. Jude Medical. Dr. Wasserman has received consultation fees from MET-Test, LLC, and salary support from St. Jude Medical.