Breathing pattern and pulmonary gas exchange in elderly patients with and without left ventricular dysfunction-modification with exercise-based cardiac rehabilitation and prognostic value

Prisca Eser; Thimo Marcin; Eva Prescott; Leonie F Prins; Evelien Kolkman; Wendy Bruins; Astrid E van der Velde; Carlos Peña Gil; Marie-Christine Iliou; Diego Ardissino; Uwe Zeymer; Esther P Meindersma; Arnoud W J Van't Hof; Ed P de Kluiver; Matthias Wilhelm

doi:10.3389/fcvm.2023.1219589

Breathing pattern and pulmonary gas exchange in elderly patients with and without left ventricular dysfunction-modification with exercise-based cardiac rehabilitation and prognostic value

Front Cardiovasc Med. 2023 Sep 1:10:1219589. doi: 10.3389/fcvm.2023.1219589. eCollection 2023.

Authors

Prisca Eser¹, Thimo Marcin¹, Eva Prescott², Leonie F Prins³, Evelien Kolkman³, Wendy Bruins⁴, Astrid E van der Velde⁴, Carlos Peña Gil⁵, Marie-Christine Iliou⁶, Diego Ardissino⁷, Uwe Zeymer⁸, Esther P Meindersma⁹, Arnoud W J Van't Hof^{4

10

11}, Ed P de Kluiver⁴, Matthias Wilhelm¹

Affiliations

¹ Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
² Department of Cardiology, Bispebjerg Frederiksberg University Hospital, Copenhagen, Denmark.
³ Diagram B.V., Zwolle, Netherlands.
⁴ Isala Heart Centre, Zwolle, Netherlands.
⁵ Department of Cardiology, Hospital Clínico Universitario de Santiago, University of Santiago de Compostela, Santiago de Compostela, Spain.
⁶ Department of Cardiac Rehabilitation, Assistance Publique Hopitaux de Paris, Paris, France.
⁷ Department of Cardiology, Parma University Hospital, Parma, Italy.
⁸ Klinikum Ludwigshafen and Institut für Herzinfarktforschung Ludwigshafen, Ludwigshafen, Germany.
⁹ Department of Cardiology, Radboud University, Nijmegen, Netherlands.
¹⁰ Department of Cardiology, Maastricht University Medical Center, Maastricht, Netherlands.
¹¹ Department of Cardiology, Zuyderland Medical Center, Heerlen, Netherlands.

Abstract

Background: Inefficient ventilation is an established prognostic marker in patients with heart failure. It is not known whether inefficient ventilation is also linked to poor prognosis in patients with left ventricular dysfunction (LVD) but without overt heart failure.

Objectives: To investigate whether inefficient ventilation in elderly patients with LVD is more common than in patients without LVD, whether it improves with exercise-based cardiac rehabilitation (exCR), and whether it is associated with major adverse cardiovascular events (MACE).

Methods: In this large multicentre observational longitudinal study, patients aged ≥65 years with acute or chronic coronary syndromes (ACS, CCS) without cardiac surgery who participated in a study on the effectiveness of exCR in seven European countries were included. Cardiopulmonary exercise testing (CPET) was performed before, at the termination of exCR, and at 12 months follow-up. Ventilation (VE), breathing frequency (BF), tidal volume (VT), and end-expiratory carbon dioxide pressure (P_ETCO₂) were measured at rest, at the first ventilatory threshold, and at peak exercise. Ventilatory parameters were compared between patients with and without LVD (based on cardio-echography) and related to MACE at 12 month follow-up.

Results: In 818 patients, age was 72.5 ± 5.4 years, 21.9% were women, 79.8% had ACS, and 151 (18%) had LVD. Compared to noLVD, in LVD resting VE was increased by 8%, resting BF by 6%, peak VE_, peak VT, and peak P_ETCO₂ reduced by 6%, 8%, and 5%, respectively, and VE/VCO₂ slope increased by 11%. From before to after exCR, resting VE decreased and peak P_ETCO₂ increased significantly more in patients with compared to without LVD. In LVD, higher resting BF, higher nadir VE/VCO₂, and lower peak P_ETCO₂ at baseline were associated with MACE.

Conclusions: Similarly to patients with HF, in elderly patients with ischemic LVD, inefficient resting and exercise ventilation was associated with worse outcomes, and ExCR alleviated abnormal breathing patterns and gas exchange parameters.

Keywords: breathing frequency; cardiopulmonary exercise testing (CPET); coronary artery disease; exercise training; heart failure; respiration.

Grants and funding

The study was funded by the European Union's Horizon 2020 research and innovation program under grant agreement number 634439 and by the Swiss State Secretariat for Education, Research, and Innovation for the Swiss consortium partner.