Mixed-expired and end-tidal CO2 distinguish between ventilation and perfusion defects during exercise testing in patients with lung and heart diseases

Chest. 2007 Sep;132(3):977-83. doi: 10.1378/chest.07-0619. Epub 2007 Jun 15.


Background: Mismatching of ventilation to perfusion is found in patients with COPD, left ventricular failure (LVF), and pulmonary vascular diseases. Such mismatching may be due to ventilation or perfusion defects or both. Our primary hypothesis was that pressures of mixed-expired CO2 pressure (Peco(2)), end-tidal Pco(2) pressure (Petco(2)), and their ratios would differ between groups during exercise testing, depending on whether the ventilation/perfusion (V/Q) abnormality was dominantly caused by airways or perfusion defects.

Methods: We administered incremental cycle ergometry tests to 25 normal subjects and three groups of 25 patients, each group with uncomplicated COPD, LVF, or primary pulmonary arterial hypertension (PAH). We compared Peco(2), Petco(2), and their ratios at rest, unloaded pedaling, anaerobic threshold, and peak exercise.

Results: Although each patient group had mean peak O(2) uptake of approximately 50% of predicted normal, the levels and patterns of change for each group for Peco(2), Petco(2), and their ratios were surprisingly distinctive. As hypothesized, the COPD group always had markedly lower Peco(2)/Petco(2) ratios than all other groups (p < 0.001). In addition, patients with LVF had slightly lower Peco(2)/Petco(2) ratios at heavy exercise than normal subjects (p < 0.05). At all times, except for COPD group Petco(2) at peak exercise, each group had significantly lower Petco(2) and Peco(2) than normal subjects (p < 0.001). In patients with PAH, the Petco(2) decline with exercise was distinctive.

Conclusions: The levels and changes in Peco(2), Petco(2), and their ratios during cardiopulmonary exercise testing are distinctive and explained by the differing pathophysiologies of V/Q mismatching in these disorders.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Breath Tests
  • Carbon Dioxide / physiology*
  • Case-Control Studies
  • Exercise / physiology*
  • Exhalation / physiology
  • Female
  • Humans
  • Hypertension, Pulmonary / physiopathology*
  • Male
  • Middle Aged
  • Pulmonary Disease, Chronic Obstructive / physiopathology*
  • Tidal Volume / physiology
  • Ventilation-Perfusion Ratio / physiology*
  • Ventricular Dysfunction, Left / physiopathology*


  • Carbon Dioxide