Key result
Prolonged oxygen pulse oscillation on CPET detects subclinical pulmonary congestion with ~92% sensitivity across HF phenotypes.
Why the study?
Subclinical pulmonary congestion in HF often goes undetected at rest, and whether the duration of significant oxygen pulse oscillations during CPET identifies pulmonary congestion detected by lung ultrasound was evaluated.
Does the duration of significant oxygen pulse oscillations during cardiopulmonary exercise testing identify subclinical pulmonary congestion detected by lung ultrasound in patients with heart failure?
Observational (n=104)
Does the duration of significant oxygen pulse oscillations during cardiopulmonary exercise testing identify subclinical pulmonary congestion detected by lung ultrasound in patients with heart failure?
Quantifying the proportion of exercise time with significant oxygen pulse oscillations (>42% of CPET duration) provides a highly sensitive and specific non-invasive method to detect subclinical pulmonary congestion across all heart failure phenotypes.
Answers are grounded in this paper and cite their sources.
May support CPET oxygen pulse analysis to detect subclinical congestion in HF; leaves open prospective validation before clinical use.
Abstract Subclinical pulmonary congestion is common in heart failure (HF) and often remains undetected at rest. Oxygen pulse (VO2/HR), a surrogate of stroke volume, may exhibit oscillatory behavior during exercise reflecting hemodynamic instability. We evaluated whether the duration of significant oxygen pulse oscillations during CPET identifies pulmonary congestion detected by lung ultrasound (LUS). We studied 104 patients with heart failure across the spectrum of left ventricular ejection fraction (preserved, mildly reduced, and reduced). During CPET, oxygen pulse oscillations were analyzed in the Wasserman panel, defining significant oscillations as fluctuations >10%. The primary variable was the percentage of total exercise time exhibiting significant oscillations. Pulmonary congestion was assessed by LUS using a 12-zone protocol. Congestion was defined as ≥5 bilateral B-lines present in at least 3 zones. Correlation between oscillation time and congestion was assessed using Spearman analysis. Diagnostic performance was evaluated by ROC analysis. Results Patients exhibiting significant oxygen pulse oscillations during >42% of total CPET duration showed evidence of pulmonary congestion on LUS. The 42% threshold demonstrated:vStrong correlation with subclinical congestion (Spearman analysis)Sensitivity: 92%Specificity: 94% This pattern was observed across HF phenotypes irrespective of baseline ejection fraction. Conclusions Prolonged oxygen pulse oscillation during exercise is a powerful marker of subclinical pulmonary congestion in heart failure. Quantifying the proportion of exercise time with significant oscillations provides a non-invasive, effort-based method for congestion detection and may enhance risk stratification during CPET.
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Radillo et al. (2026) conducted an observational in Heart failure (n=104). Prolonged oxygen pulse oscillation (>10% fluctuation) during >42% of total CPET duration vs. Oxygen pulse oscillation during ≤42% of total CPET duration was evaluated on Subclinical pulmonary congestion on lung ultrasound (≥5 bilateral B-lines in at least 3 zones) (Sensitivity 92%, Specificity 94%). Prolonged oxygen pulse oscillation (>42% of CPET duration) identified subclinical pulmonary congestion on lung ultrasound with 92% sensitivity and 94% specificity across HF phenotypes.
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