The Impact of Oxygen Pulse and Its Curve Patterns on Male Patients with Heart Failure, Chronic Obstructive Pulmonary Disease, and Healthy Controls-Ejection Fractions, Related Factors and Outcomes

Ming-Lung Chuang, Chin-Feng Tsai, Kwo-Chang Ueng, Jui-Hung Weng, Ming-Fong Tsai, Chien-Hsien Lo, Gang-Bin Chen, Sung-Kien Sia, Yao-Tsung Chuang, Tzu-Chin Wu, Pan-Fu Kao, Meng-Jer Hsieh, Ming-Lung Chuang, Chin-Feng Tsai, Kwo-Chang Ueng, Jui-Hung Weng, Ming-Fong Tsai, Chien-Hsien Lo, Gang-Bin Chen, Sung-Kien Sia, Yao-Tsung Chuang, Tzu-Chin Wu, Pan-Fu Kao, Meng-Jer Hsieh

Abstract

Oxygen pulse (O2P) is a function of stroke volume and cellular oxygen extraction and O2P curve pattern (O2PCP) can provide continuous measurements of O2P. However, measurements of these two components are difficult during incremental maximum exercise. As cardiac function is evaluated using ejection fraction (EF) according to the guidelines and EF can be obtained using first-pass radionuclide ventriculography, the aim of this study was to investigate associations of O2P%predicted and O2PCP with EF in patients with heart failure with reduced or mildly reduced ejection fraction (HFrEF/HFmrEF) and chronic obstructive pulmonary disease (COPD), and also in normal controls. This was a prospective observational cross-sectional study. Correlations of resting left ventricular EF, dynamic right and left ventricular EFs and outcomes with O2P% and O2PCP across the three participant groups were analyzed. A total of 237 male subjects were screened and 90 were enrolled (27 with HFrEF/HFmrEF, 30 with COPD and 33 normal controls). O2P% and the proportions of the three types of O2PCP were similar across the three groups. O2P% reflected dynamic right and left ventricular EFs in the control and HFrEF/HFmrEF groups, but did not reflect resting left ventricular EF in all participants. O2PCP did not reflect resting or dynamic ventricular EFs in any of the subjects. A decrease in O2PCP was significantly related to nonfatal cardiac events in the HFrEF/HFmrEF group (log rank test, p = 0.01), whereas O2P% and O2PCP did not predict severe acute exacerbations of COPD. The findings of this study may clarify the utility of O2P and O2PCP, and may contribute to the currently used interpretation algorithm and the strategy for managing patients, especially those with HFrEF/HFmrEF. (Trial registration number NCT05189301.).

Keywords: chronic obstructive pulmonary disease; ejection fraction; exercise testing; heart failure with reduced or mildly reduced ejection fraction.

Conflict of interest statement

The authors declare no competing interests.

Figures

Figure 1
Figure 1
Flow chart. A total of 237 subjects were assessed for eligibility. Thirty subjects had chronic obstructive pulmonary disease (COPD), 27 had heart failure with reduced or mildly impaired ejection fraction (HFrEF/HFmrEF), and 33 healthy subjects were enrolled. Participants with HFrEF/HFmrEF were enrolled if they had New York Heart Association functional class (NYHA) I-III and relevant risk factors. A left ventricular ejection fraction using two-dimensional echocardiography (2DLVEF) 1)/forced vital capacity (FVC) of <0.7 without a significant post-bronchodilator effect. Healthy subjects were recruited among the hospital staff and the local community through personal contacts. They were free of known significant diseases. A total of 147 subjects were excluded due to the reasons shown. Participants with diabetes mellitus, uncontrolled hypertension, arrhythmia, cancer, liver, renal or autoimmune diseases, or anemia were excluded. However, participants with well controlled diabetes mellitus were included in the HFrEF/HFmrEF group as these conditions often co-exist. For details about the inclusion and exclusion criteria of the participants, please refer to the text. CPET: cardiopulmonary exercise testing; 2D: 2-dimensional echocardiography; NM: nuclear medicine for 1st pass right ventriculography. Cardiac events did not include cerebrovascular accidents.
Figure 2
Figure 2
Oxygen pulse curve patterns. (A) A representative image of the increasing pattern. (B) A representative image of the plateau pattern. (C) A representative image of the decreasing pattern. HR: heart rate, watts: workload, O2P: oxygen pulse.
Figure 3
Figure 3
Forest plots of risk factors for non-fatal cardiac events in the chronic heart failure (CHF) group (upper panel, n = 27) and for severe acute exacerbations of chronic obstructive pulmonary disease (SAECOPD) in the COPD group (lower panel, n = 30) using Cox regression analysis and the range of LCL and UCL ≥1 or ≤1 indicates significance. HR: hazard ratio; O2PCP: oxygen pulse curve pattern; D versus P-I: type decreasing versus types plateau and increasing; CAT: COPD assessment test; no. of coronary artery: number of diseased coronary artery; NYHA: New York Heart Association; mMRC: modified medical research council; DLCO: diffusing capacity of lung for carbon monoxide; V’O2peak: oxygen uptake at peak exercise; HRpeak: heart rate at peak exercise; WRpeak: work rate at peak exercise; breathing frequency: breathing frequency at peak exercise.
Figure 4
Figure 4
Kaplan–Meier survival curves of cardiac events are constructed and the log-rank test is used according to the following: O2PCP: oxygen pulse curve patterns (solid line indicates the decreasing pattern and dashed line indicates the increasing and plateau patterns, log rank, p = 0.012); CAT: COPD assessment test (p = 0.01); No. of CAD: the number of diseased coronary artery (p = 0.05) were related to nonfatal cardiac events.
Figure 5
Figure 5
Kaplan–Meier survival curves of severe acute exacerbation of chronic obstructive pulmonary disease (SAECOPD) are constructed and the log-rank test is used according to SAECOPD in the previous 12 months (p = 0.0001), modified Medical Research Council score (mMRC) (p = 0.003), NYHA (p = 0.01), and COPD assessment test score (CAT) (p = 0.03).

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