Cardiopulmonary exercise testing for identification of patients with hyperventilation syndrome

Kristian Brat, Nela Stastna, Zdenek Merta, Lyle J. Olson, Bruce David Johnson, Ivan Cundrle

Research output: Contribution to journalArticle

Abstract

Introduction Measurement of ventilatory efficiency, defined as minute ventilation per unit carbon dioxide production (V E /VCO 2 ), by cardiopulmonary exercise testing (CPET) has been proposed as a screen for hyperventilation syndrome (HVS). However, increased V E /VCO 2 may be associated with other disorders which need to be distinguished from HVS. A more specific marker of HVS by CPET would be clinically useful. We hypothesized ventilatory control during exercise is abnormal in patients with HVS. Methods Patients who underwent CPET from years 2015 through 2017 were retrospectively identified and formed the study group. HVS was defined as dyspnea with respiratory alkalosis (pH >7.45) at peak exercise with absence of acute or chronic respiratory, heart or psychiatric disease. Healthy patients were selected as controls. For comparison the Student t-test or Mann-Whitney U test were used. Data are summarized as mean ± SD or median (IQR); p<0.05 was considered significant. Results Twenty-nine patients with HVS were identified and 29 control subjects were selected. At rest, end-tidal carbon dioxide (P ET CO 2 ) was 27 mmHg (25–30) for HVS patients vs. 30 mmHg (28–32); in controls (p = 0.05). At peak exercise P ET CO 2 was also significantly lower (27 ± 4 mmHg vs. 35 ± 4 mmHg; p<0.01) and V E /VCO 2 higher ((38 (35–43) vs. 31 (27–34); p<0.01)) in patients with HVS. In contrast to controls, there were minimal changes of P ET CO 2 (0.50 ± 5.26 mmHg vs. 6.2 ± 4.6 mmHg; p<0.01) and V E /VCO 2 ((0.17 (-4.24–6.02) vs. -6.6 (-11.4-(-2.8)); p<0.01)) during exercise in patients with HVS. The absence of V E /VCO 2 and P ET CO 2 change during exercise was specific for HVS (83% and 93%, respectively). Conclusion Absence of V E /VCO 2 and P ET CO 2 change during exercise may identify patients with HVS.

Original languageEnglish (US)
Article numbere0215997
JournalPloS one
Volume14
Issue number4
DOIs
StatePublished - Apr 1 2019

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exercise test
Hyperventilation
Variable frequency oscillators
Carbon Monoxide
Exercise
exercise
Testing
Carbon Dioxide
Ventilation
dyspnea
Respiratory Alkalosis
Students
Nonparametric Statistics
carbon dioxide
heart
Dyspnea
Psychiatry

ASJC Scopus subject areas

  • Biochemistry, Genetics and Molecular Biology(all)
  • Agricultural and Biological Sciences(all)

Cite this

Cardiopulmonary exercise testing for identification of patients with hyperventilation syndrome. / Brat, Kristian; Stastna, Nela; Merta, Zdenek; Olson, Lyle J.; Johnson, Bruce David; Cundrle, Ivan.

In: PloS one, Vol. 14, No. 4, e0215997, 01.04.2019.

Research output: Contribution to journalArticle

Brat, Kristian ; Stastna, Nela ; Merta, Zdenek ; Olson, Lyle J. ; Johnson, Bruce David ; Cundrle, Ivan. / Cardiopulmonary exercise testing for identification of patients with hyperventilation syndrome. In: PloS one. 2019 ; Vol. 14, No. 4.
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abstract = "Introduction Measurement of ventilatory efficiency, defined as minute ventilation per unit carbon dioxide production (V E /VCO 2 ), by cardiopulmonary exercise testing (CPET) has been proposed as a screen for hyperventilation syndrome (HVS). However, increased V E /VCO 2 may be associated with other disorders which need to be distinguished from HVS. A more specific marker of HVS by CPET would be clinically useful. We hypothesized ventilatory control during exercise is abnormal in patients with HVS. Methods Patients who underwent CPET from years 2015 through 2017 were retrospectively identified and formed the study group. HVS was defined as dyspnea with respiratory alkalosis (pH >7.45) at peak exercise with absence of acute or chronic respiratory, heart or psychiatric disease. Healthy patients were selected as controls. For comparison the Student t-test or Mann-Whitney U test were used. Data are summarized as mean ± SD or median (IQR); p<0.05 was considered significant. Results Twenty-nine patients with HVS were identified and 29 control subjects were selected. At rest, end-tidal carbon dioxide (P ET CO 2 ) was 27 mmHg (25–30) for HVS patients vs. 30 mmHg (28–32); in controls (p = 0.05). At peak exercise P ET CO 2 was also significantly lower (27 ± 4 mmHg vs. 35 ± 4 mmHg; p<0.01) and V E /VCO 2 higher ((38 (35–43) vs. 31 (27–34); p<0.01)) in patients with HVS. In contrast to controls, there were minimal changes of P ET CO 2 (0.50 ± 5.26 mmHg vs. 6.2 ± 4.6 mmHg; p<0.01) and V E /VCO 2 ((0.17 (-4.24–6.02) vs. -6.6 (-11.4-(-2.8)); p<0.01)) during exercise in patients with HVS. The absence of V E /VCO 2 and P ET CO 2 change during exercise was specific for HVS (83{\%} and 93{\%}, respectively). Conclusion Absence of V E /VCO 2 and P ET CO 2 change during exercise may identify patients with HVS.",
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AU - Brat, Kristian

AU - Stastna, Nela

AU - Merta, Zdenek

AU - Olson, Lyle J.

AU - Johnson, Bruce David

AU - Cundrle, Ivan

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N2 - Introduction Measurement of ventilatory efficiency, defined as minute ventilation per unit carbon dioxide production (V E /VCO 2 ), by cardiopulmonary exercise testing (CPET) has been proposed as a screen for hyperventilation syndrome (HVS). However, increased V E /VCO 2 may be associated with other disorders which need to be distinguished from HVS. A more specific marker of HVS by CPET would be clinically useful. We hypothesized ventilatory control during exercise is abnormal in patients with HVS. Methods Patients who underwent CPET from years 2015 through 2017 were retrospectively identified and formed the study group. HVS was defined as dyspnea with respiratory alkalosis (pH >7.45) at peak exercise with absence of acute or chronic respiratory, heart or psychiatric disease. Healthy patients were selected as controls. For comparison the Student t-test or Mann-Whitney U test were used. Data are summarized as mean ± SD or median (IQR); p<0.05 was considered significant. Results Twenty-nine patients with HVS were identified and 29 control subjects were selected. At rest, end-tidal carbon dioxide (P ET CO 2 ) was 27 mmHg (25–30) for HVS patients vs. 30 mmHg (28–32); in controls (p = 0.05). At peak exercise P ET CO 2 was also significantly lower (27 ± 4 mmHg vs. 35 ± 4 mmHg; p<0.01) and V E /VCO 2 higher ((38 (35–43) vs. 31 (27–34); p<0.01)) in patients with HVS. In contrast to controls, there were minimal changes of P ET CO 2 (0.50 ± 5.26 mmHg vs. 6.2 ± 4.6 mmHg; p<0.01) and V E /VCO 2 ((0.17 (-4.24–6.02) vs. -6.6 (-11.4-(-2.8)); p<0.01)) during exercise in patients with HVS. The absence of V E /VCO 2 and P ET CO 2 change during exercise was specific for HVS (83% and 93%, respectively). Conclusion Absence of V E /VCO 2 and P ET CO 2 change during exercise may identify patients with HVS.

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