Circulation, Vol 65, 1213-1223, Copyright © 1982 by American Heart Association
KT Weber, GT Kinasewitz, JS Janicki and AP Fishman
Muscular work requires the integration of cardiopulmonary mechanisms for
gas exchange and O2 delivery. In patients with chronic cardiac failure, the
response of these mechanisms may be impaired, and the pattern of O2
utilization (VO2) and gas exchange during exercise would thus provide an
objective assessment of the severity of heart failure. Accordingly, rates
of air flow, O2 uptake, CO2 elimination and minute ventilation were
determined during progressive treadmill exercise in 62 patients with stable
heart failure. Exercise cardiac output, systemic O2 extraction and lactate
production were measured directly in 40 patients with heart failure of
varying severity. As the severity of heart failure increased from class A
to D, there was a progressive decrease in exercise capacity (from 1157 +/-
154 to 373 +/- 157 seconds) and maximum VO2 (23 +/- 3.2 to 8.4 +/- 1.5
ml/min/kg). These decreases corresponded with the reduced maximum cardiac
output and stroke volume during exercise. The appearance of anaerobic
metabolism (580 +/- 17 to 157 +/- 7 seconds of exercise) and the
corresponding anaerobic threshold (17 +/- 0.34 to 7.1 +/- 1.5 ml/min/kg),
determined noninvasively, were reproducible and correlated with the rise in
mixed venous lactate concentration. No apparent untoward effects were
experienced during or after the progressive exercise test. We conclude that
the measurement of respiratory gas exchange and air flow during exercise is
an objective, reproducible and safe noninvasive method for characterizing
cardiac reserve and functional status in patients with chronic cardiac
failure.
ARTICLES
Oxygen utilization and ventilation during exercise in patients with chronic cardiac failure
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D.P. Francis, W. Shamim, L.C. Davies, M.F. Piepoli, P. Ponikowski, S.D. Anker, and A.J.S. Coats Cardiopulmonary exercise testing for prognosis in chronic heart failure: continuous and independent prognostic value from VE/VCO2slope and peak VO2 Eur. Heart J., January 2, 2000; 21(2): 154 - 161. [Abstract] [PDF]
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H. P. B.-L. Rocca, D. Weilenmann, H. Rickli, F. Follath, and W. Kiowski Is Blood Pressure Response to the Valsalva Maneuver Related to Neurohormones, Exercise Capacity, and Clinical Findings in Heart Failure? Chest, October 1, 1999; 116(4): 861 - 867. [Abstract] [Full Text] [PDF]
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L. Pavia, J. Myers, and R. Cesare Recovery Kinetics of Oxygen Uptake and Heart Rate in Patients With Coronary Artery Disease and Heart Failure Chest, September 1, 1999; 116(3): 808 - 813. [Abstract] [Full Text] [PDF]
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S. Nanas, J. Nanas, C. Kassiotis, G. Alexopoulos, A. Samakovli, J. Kanakakis, E. Tsolakis, and C. Roussos Respiratory Muscles Performance Is Related to Oxygen Kinetics During Maximal Exercise and Early Recovery in Patients With Congestive Heart Failure Circulation, August 3, 1999; 100(5): 503 - 508. [Abstract] [Full Text] [PDF]
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 D J Wright and L B Tan Classic techniques in medicine: The role of exercise testing in the evaluation and management of heart failure Postgrad. Med. J., August 1, 1999; 75(886): 453 - 458. [Abstract] [Full Text]
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 I. A Paraskevaidis, D. P Tsiapras, S. Adamopoulos, and D. T. Kremastinos Assessment of the functional status of heart failure in non ischemic dilated cardiomyopathy: an echo-dobutamine study Cardiovasc Res, July 1, 1999; 43(1): 58 - 66. [Abstract] [Full Text] [PDF]
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J. R. Wilson, S. Hanamanthu, D. B. Chomsky, and S. F. Davis Relationship between exertional symptoms and functional capacity in patients with heart failure J. Am. Coll. Cardiol., June 1, 1999; 33(7): 1943 - 1947. [Abstract] [Full Text] [PDF]
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M. Metra, P. Faggiano, A. D'Aloia, S. Nodari, A. Gualeni, D. Raccagni, and L. Dei Cas Use of cardiopulmonary exercise testing with hemodynamic monitoring in the prognostic assessment of ambulatory patients with chronic heart failure J. Am. Coll. Cardiol., March 15, 1999; 33(4): 943 - 950. [Abstract] [Full Text] [PDF]
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A. Cohen-Solal, Y. Esanu, D. Logeart, F. Pessione, C. Dubois, G. Dreyfus, R. Gourgon, and P. Merlet Cardiac metaiodobenzylguanidine uptake in patients with moderate chronic heart failure: relationship with peak oxygen uptake and prognosis J. Am. Coll. Cardiol., March 1, 1999; 33(3): 759 - 766. [Abstract] [Full Text] [PDF]
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 N. Francis, A. Cohen-Solal, and D. Logeart Peripheral muscle ergoreceptors and ventilatory response during exercise recovery in heart failure Am J Physiol Heart Circ Physiol, March 1, 1999; 276(3): H913 - H917. [Abstract] [Full Text] [PDF]
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A. JUBRAN, M. MATHRU, D. DRIES, and M. J. TOBIN Continuous Recordings of Mixed Venous Oxygen Saturation during Weaning from Mechanical Ventilation and the Ramifications Thereof Am. J. Respir. Crit. Care Med., December 1, 1998; 158(6): 1763 - 1769. [Abstract] [Full Text] [PDF]
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D. Mancini, R. Goldsmith, H. Levin, A. Beniaminovitz, E. Rose, K. Catanese, M. Flannery, and M. Oz Comparison of Exercise Performance in Patients With Chronic Severe Heart Failure Versus Left Ventricular Assist Devices Circulation, September 22, 1998; 98(12): 1178 - 1183. [Abstract] [Full Text] [PDF]
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A Cohen-Solal, P Barnier, F Pessione, P Seknadji, D Logeart, T Laperche, and R Gourgon Comparison of the long term prognostic value of peak exercise oxygen pulse and peak oxygen uptake in patients with chronic heart failure Heart, December 1, 1997; 78(6): 572 - 576. [Abstract] [Full Text] [PDF]
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K. Wasserman, Y.-Y. Zhang, A. Gitt, R. Belardinelli, A. Koike, L. Lubarsky, and P. G. Agostoni Lung Function and Exercise Gas Exchange in Chronic Heart Failure Circulation, October 7, 1997; 96(7): 2221 - 2227. [Abstract] [Full Text]
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A. A. Kouatli, J. A. Garcia, T. M. Zellers, E. M. Weinstein, and L. Mahony Enalapril Does Not Enhance Exercise Capacity in Patients After Fontan Procedure Circulation, September 2, 1997; 96(5): 1507 - 1512. [Abstract] [Full Text]
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B. E. Jaski, J. Kim, R. S. Maly, K. R. Branch, R. Adamson, L. K. Favrot, S. C. Smith Jr, and W. P. Dembitsky Effects of Exercise During Long-term Support With a Left Ventricular Assist Device : Results of the Experience With Left Ventricular Assist Device With Exercise (EVADE) Pilot Trial Circulation, May 20, 1997; 95(10): 2401 - 2406. [Abstract] [Full Text]
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M. Guazzi, G. Marenzi, M. Alimento, M. Contini, and P. Agostoni Improvement of Alveolar–Capillary Membrane Diffusing Capacity With Enalapril in Chronic Heart Failure and Counteracting Effect of Aspirin Circulation, April 1, 1997; 95(7): 1930 - 1936. [Abstract] [Full Text]
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C. C. Lang, D. B. Chomsky, G. Rayos, T. K. Yeoh, and J. R. Wilson Skeletal muscle mass and exercise performance in stable ambulatory patients with heart failure J Appl Physiol, January 1, 1997; 82(1): 257 - 261. [Abstract] [Full Text] [PDF]
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D. Mancini, S. Katz, L. Donchez, and K. Aaronson Coupling of Hemodynamic Measurements With Oxygen Consumption During Exercise Does Not Improve Risk Stratification in Patients With Heart Failure Circulation, November 15, 1996; 94(10): 2492 - 2496. [Abstract] [Full Text]
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 P. Agostoni, G. Marenzi, M. Guazzi, and M. D. Guazzi Influence of ACE Inhibition on Fluid Metabolism in Chronic Heart Failure and Its Pathophysiologic Relevance Journal of Cardiovascular Pharmacology and Therapeutics, October 1, 1996; 1(4): 279 - 286. [Abstract] [PDF]
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J. R. Wilson, J. Groves, and G. Rayos Circulatory Status and Response to Cardiac Rehabilitation in Patients With Heart Failure Circulation, October 1, 1996; 94(7): 1567 - 1572. [Abstract] [Full Text]
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 A. Simonini, C. S. Long, G. A. Dudley, P. Yue, J. McElhinny, and B. M. Massie Heart Failure in Rats Causes Changes in Skeletal Muscle Morphology and Gene Expression That Are Not Explained by Reduced Activity Circ. Res., July 1, 1996; 79(1): 128 - 136. [Abstract] [Full Text]
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 R. Tominaga, W. Smith, A. Massiello, H. Harasaki, and L. A. R. Golding CHRONIC NONPULSATILE BLOOD FLOW. III. EFFECTS OF PUMP FLOW RATE ON OXYGEN TRANSPORT AND UTILIZATION IN CHRONIC NONPULSATILE BIVENTRICULAR BYPASS J. Thorac. Cardiovasc. Surg., April 1, 1996; 111(4): 863 - 872. [Abstract] [Full Text]
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M. Volpe, M. A.E. Rao, A. Cuocolo, R. Russo, A. Nappi, A. F. Mele, I. Enea, B. Trimarco, and M. Condorelli Radionuclide Monitoring of Cardiac Adaptations to Volume Loading in Patients With Dilated Cardiomyopathy and Mild Heart Failure : Effects of Angiotensin-Converting Enzyme Inhibition Circulation, November 1, 1995; 92(9): 2511 - 2518. [Abstract] [Full Text]
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J. R. Wilson, G. Rayos, T. K. Yeoh, P. Gothard, and K. Bak Dissociation Between Exertional Symptoms and Circulatory Function in Patients With Heart Failure Circulation, July 1, 1995; 92(1): 47 - 53. [Abstract] [Full Text]
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