Figures
- Figure 1
Chest radiograph clearly showing the presence of lung vascular congestion and pleural effusion.
- Figure 2
AT identification by a V-slope (V′CO2 versus V′O2) graph. The change in the slope (dotted line) identifies the appearance of V′CO2 surplus by anaerobic metabolism. The threshold is clearly anticipated in a) the test performed close to acute cardiac decompensation versus b) the pre-discharge test. Dotted lines show a) AT=9.3 mL·Kg−1·min−1 (32% V′O2max predicted) and b) AT=11.8 mL·Kg−1·min−1 (46% V′O2max predicted).
- Figure 3
a) Pre- and b) post-heart failure treatment O2 pulse curves showing no change in slope morphology. Of note in (a), pre-treatment CPET showed a shorter exercise due to ventilatory limitation.
- Figure 4
V′E/V′CO2 slope a) pre- and b) post-heart failure treatment tests. In the first test, both a higher slope and y-intercept value are detectable. a) Slope=33, y=7.6 L. b) Slope=28, y=5.6 L.
- Figure 5
a) The resting maximal expiratory flow–volume loops in acute conditions (line a) and at the pre-discharge evaluation (line b) are shown. At the first evaluation, an obvious reduction in FVC was recorded. b) The relationship between increase in VT and V′E during exercise is reported. Solid lines indicate points with the same RR. In the first CPET (1) there is an almost complete lack of increase in VT, and V′E increase is entirely due to increase in RR. This pattern greatly improved in the pre-discharge test (2).
Tables
- Table 1
Main CPET and PFT results from tests performed
Variables Pre-heart failure treatment Post-heart failure treatment CPET Peak V′O2 mL·Kg−1·min−1 11.4 19.4 Peak V′O2 % predicted 48 76 ΔV′O2/ΔWork mL·min−1·W−1 10.3 10.4 Peak O2 pulse mL·beats−1 9.4 13.4 Max workload W 54 121 V′E/V′CO2 slope 33 28 V′E/V′CO2 at AT 45 33 V′E/V′CO2 nadir 41 31 Peak V′E L·min−1 50 78 Peak respiratory rate breaths·min−1 54 42 Breathing reserve % 3 14 Peak SpO2 % 89 95 Peak RER 0.91 1.24 PFT FVC L 1.72 3.23 FVC % predicted 42 77 FEV1 L 1.50 2.59 FEV1 % predicted 47 81 FEV1/FVC 0.87 0.80 DLCO mL·mmHg−1·min−1 13.4 22.4 DLCO % predicted 49 82 DLCOadj mL·mmHg−1·min−1 12.6 21.0 DLCOadj % predicted 46 77 DLCOadj/VA mL·mmHg−1·min−1·L−1 5.22 5.04 DLCOadj/VA % predicted 119 117 VA L 2.56 4.44 VA % predicted 38 67 SpO2: arterial oxygen saturation measured by pulse oximetry; RER: respiratory exchange ratio; DLCOadj: DLCO adjusted after correction for haemoglobin level.
