Cardiopulmonary exercise testing for identification of patients with hyperventilation syndrome

by Kristian Brat, Nela Stastna, Zdenek Merta, Lyle J. Olson, Bruce D. Johnson, Ivan Cundrle Jr.

Measurement of ventilatory efficiency, defined as minute ventilation per unit carbon dioxide production (V_E/VCO₂), by cardiopulmonary exercise testing (CPET) has been proposed as a screen for hyperventilation syndrome (HVS). However, increased V_E/VCO₂ 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.

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.

Twenty-nine patients with HVS were identified and 29 control subjects were selected. At rest, end-tidal carbon dioxide (P_ETCO₂) was 27 mmHg (25–30) for HVS patients vs. 30 mmHg (28–32); in controls (p = 0.05). At peak exercise P_ETCO₂ was also significantly lower (27 ± 4 mmHg vs. 35 ± 4 mmHg; p<0.01) and V_E/VCO₂ 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_ETCO₂ (0.50 ± 5.26 mmHg vs. 6.2 ± 4.6 mmHg; p<0.01) and V_E/VCO₂ ((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/VCO₂ and P_ETCO₂ change during exercise was specific for HVS (83% and 93%, respectively).

Absence of V_E/VCO₂ and P_ETCO₂ change during exercise may identify patients with HVS.