{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,22]],"date-time":"2026-07-22T14:48:52Z","timestamp":1784731732344,"version":"3.55.0"},"reference-count":25,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"5","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["Circ: Heart Failure"],"published-print":{"date-parts":[[2014,9]]},"abstract":"<jats:sec>\n            <jats:title>Background\u2014<\/jats:title>\n            <jats:p>\n              Several cardiovascular diseases are characterized by an impaired O\n              <jats:sub>2<\/jats:sub>\n              kinetic during exercise. The lack of a linear increase of \u0394oxygen consumption (V\n              <jats:sc>O<\/jats:sc>\n              <jats:sub>2<\/jats:sub>\n              )\/\u0394Work Rate (WR) relationship, as assessed by expired gas analysis, is considered an indicator of abnormal cardiovascular efficiency. We aimed at describing the frequency of \u0394VO\n              <jats:sub>2<\/jats:sub>\n              \/\u0394WR flattening in a symptomatic population of cardiac patients, characterizing its functional profile, and testing the hypothesis that dynamic pulmonary hypertension and right ventricular contractile reserve play a major role as cardiac determinants.\n            <\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Methods and Results\u2014<\/jats:title>\n            <jats:p>\n              We studied 136 patients, with different cardiovascular diseases, referred for exertional dyspnoea. Cardiopulmonary exercise test combined with simultaneous exercise echocardiography was performed using a symptom-limited protocol. \u0394VO\n              <jats:sub>2<\/jats:sub>\n              \/\u0394WR flattening was observed in 36 patients (group A, 26.5% of population) and was associated with a globally worse functional profile (reduced peak V\n              <jats:sc>O<\/jats:sc>\n              <jats:sub>2<\/jats:sub>\n              , anaerobic threshold, O\n              <jats:sub>2<\/jats:sub>\n              pulse, impaired VE\/VCO\n              <jats:sub>2<\/jats:sub>\n              ). At univariate analysis, exercise ejection fraction, exercise mitral regurgitation, rest and exercise tricuspid annular plane systolic excursion, exercise systolic pulmonary artery pressure, and exercise cardiac output were all significantly (\n              <jats:italic>P<\/jats:italic>\n              &lt;0.05) impaired in group A. The multivariate analysis identified exercise systolic pulmonary artery pressure (odds ratio, 1.06; confidence interval, 1.01\u20131.11;\n              <jats:italic>P<\/jats:italic>\n              =0.01) and exercise tricuspid annular plane systolic excursion (odds ratio, 0.88; confidence interval, 0.80\u20130.97;\n              <jats:italic>P<\/jats:italic>\n              =0.01) as main cardiac determinants of \u0394VO\n              <jats:sub>2<\/jats:sub>\n              \/\u0394WR flattening; female sex was strongly associated (odds ratio, 6.10; confidence interval, 2.11\u201317.7;\n              <jats:italic>P<\/jats:italic>\n              &lt;0.01).\n            <\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Conclusions\u2014<\/jats:title>\n            <jats:p>\n              In patients symptomatic for dyspnea, the occurrence of \u0394VO\n              <jats:sub>2<\/jats:sub>\n              \/\u0394WR flattening reflects a significantly impaired functional phenotype whose main cardiac determinants are the excessive systolic pulmonary artery pressure increase and the reduced peak right ventricular longitudinal systolic function.\n            <\/jats:p>\n          <\/jats:sec>","DOI":"10.1161\/circheartfailure.113.001061","type":"journal-article","created":{"date-parts":[[2014,6,27]],"date-time":"2014-06-27T04:34:40Z","timestamp":1403843680000},"page":"782-790","update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":49,"title":["Role of Right Ventricle and Dynamic Pulmonary Hypertension on Determining \u0394VO\n            <sub>2<\/sub>\n            \/\u0394Work Rate Flattening"],"prefix":"10.1161","volume":"7","author":[{"given":"Francesco","family":"Bandera","sequence":"first","affiliation":[{"name":"From the Heart Failure Unit, IRCCS Policlinico San Donato, University of Milano, Milano, Italy (F.B., G.G., M.P., V.D., E.A., M.G.); and Unit of Biostatistics and Clinical Epidemiology, Department of Public Health, Experimental and Forensic Medicine, University of Pavia, Pavia, Italy (M.G., S.V.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Greta","family":"Generati","sequence":"additional","affiliation":[{"name":"From the Heart Failure Unit, IRCCS Policlinico San Donato, University of Milano, Milano, Italy (F.B., G.G., M.P., V.D., E.A., M.G.); and Unit of Biostatistics and Clinical Epidemiology, Department of Public Health, Experimental and Forensic Medicine, University of Pavia, Pavia, Italy (M.G., S.V.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marta","family":"Pellegrino","sequence":"additional","affiliation":[{"name":"From the Heart Failure Unit, IRCCS Policlinico San Donato, University of Milano, Milano, Italy (F.B., G.G., M.P., V.D., E.A., M.G.); and Unit of Biostatistics and Clinical Epidemiology, Department of Public Health, Experimental and Forensic Medicine, University of Pavia, Pavia, Italy (M.G., S.V.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Valeria","family":"Donghi","sequence":"additional","affiliation":[{"name":"From the Heart Failure Unit, IRCCS Policlinico San Donato, University of Milano, Milano, Italy (F.B., G.G., M.P., V.D., E.A., M.G.); and Unit of Biostatistics and Clinical Epidemiology, Department of Public Health, Experimental and Forensic Medicine, University of Pavia, Pavia, Italy (M.G., S.V.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eleonora","family":"Alfonzetti","sequence":"additional","affiliation":[{"name":"From the Heart Failure Unit, IRCCS Policlinico San Donato, University of Milano, Milano, Italy (F.B., G.G., M.P., V.D., E.A., M.G.); and Unit of Biostatistics and Clinical Epidemiology, Department of Public Health, Experimental and Forensic Medicine, University of Pavia, Pavia, Italy (M.G., S.V.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maddalena","family":"Gaeta","sequence":"additional","affiliation":[{"name":"From the Heart Failure Unit, IRCCS Policlinico San Donato, University of Milano, Milano, Italy (F.B., G.G., M.P., V.D., E.A., M.G.); and Unit of Biostatistics and Clinical Epidemiology, Department of Public Health, Experimental and Forensic Medicine, University of Pavia, Pavia, Italy (M.G., S.V.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Simona","family":"Villani","sequence":"additional","affiliation":[{"name":"From the Heart Failure Unit, IRCCS Policlinico San Donato, University of Milano, Milano, Italy (F.B., G.G., M.P., V.D., E.A., M.G.); and Unit of Biostatistics and Clinical Epidemiology, Department of Public Health, Experimental and Forensic Medicine, University of Pavia, Pavia, Italy (M.G., S.V.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marco","family":"Guazzi","sequence":"additional","affiliation":[{"name":"From the Heart Failure Unit, IRCCS Policlinico San Donato, University of Milano, Milano, Italy (F.B., G.G., M.P., V.D., E.A., M.G.); and Unit of Biostatistics and Clinical Epidemiology, Department of Public Health, Experimental and Forensic Medicine, University of Pavia, Pavia, Italy (M.G., S.V.)."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"key":"e_1_3_2_2_2","volume-title":"Principles of Exercise Testing and Interpretation","author":"Wasserman K","year":"2005","unstructured":"Wasserman K, Hansen JE, Sue DY, Stringer WW, Whipp BJPrinciples of Exercise Testing and Interpretation. 4th ed. 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Textbook of Clinical Echocardiography. Chapter 6. 5th ed. The Netherlands: Elsevier Ed; 2013.","edition":"5"},{"key":"e_1_3_2_18_2","doi-asserted-by":"publisher","DOI":"10.1161\/01.CIR.70.4.657"},{"key":"e_1_3_2_19_2","doi-asserted-by":"publisher","DOI":"10.1378\/chest.12-0071"},{"key":"e_1_3_2_20_2","doi-asserted-by":"publisher","DOI":"10.1002\/9781118548387"},{"key":"e_1_3_2_21_2","first-page":"55","volume-title":"Exercise Gas Exchange in Heart Disease","author":"Weber KT","year":"1996","unstructured":"Weber KT. Cardiopulmonary exercise testing and the evaluation of systolic dysfunction. In: , Wasserman K Exercise Gas Exchange in Heart Disease. Armonk, NY: Futura Publishing Company. 1996;55\u201362."},{"key":"e_1_3_2_22_2","doi-asserted-by":"publisher","DOI":"10.1161\/circulationaha.107.686576"},{"key":"e_1_3_2_23_2","doi-asserted-by":"publisher","DOI":"10.1093\/oxfordjournals.eurheartj.a014942"},{"key":"e_1_3_2_24_2","doi-asserted-by":"publisher","DOI":"10.1161\/circulationaha.111.085761"},{"key":"e_1_3_2_25_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.echo.2008.11.023"},{"key":"e_1_3_2_26_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00421-011-1992-2"}],"container-title":["Circulation: Heart Failure"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ahajournals.org\/doi\/full\/10.1161\/CIRCHEARTFAILURE.113.001061","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,5,13]],"date-time":"2024-05-13T01:13:04Z","timestamp":1715562784000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ahajournals.org\/doi\/10.1161\/CIRCHEARTFAILURE.113.001061"}},"subtitle":["Insights From Cardiopulmonary Exercise Test Combined With Exercise Echocardiography"],"short-title":[],"issued":{"date-parts":[[2014,9]]},"references-count":25,"journal-issue":{"issue":"5","published-print":{"date-parts":[[2014,9]]}},"alternative-id":["10.1161\/CIRCHEARTFAILURE.113.001061"],"URL":"https:\/\/doi.org\/10.1161\/circheartfailure.113.001061","relation":{},"ISSN":["1941-3289","1941-3297"],"issn-type":[{"value":"1941-3289","type":"print"},{"value":"1941-3297","type":"electronic"}],"subject":[],"published":{"date-parts":[[2014,9]]},"assertion":[{"value":"2013-11-05","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2014-06-13","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2014-06-26","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}