Circulation, Vol 77, 552-559, Copyright © 1988 by American Heart Association
MJ Sullivan, MB Higginbotham and FR Cobb
This study was designed to determine the pathophysiologic basis of
increased exercise ventilation in the presence of chronic heart failure.
Sixty-four ambulatory patients with chronic heart failure and 38
age-matched normal control subjects performed exercise according to
identical staged, symptom-limited bicycle exercise protocols with
measurement of hemodynamic, ventilatory, and metabolic responses. Compared
with normal subjects, ventilation and the ratio of ventilation to CO2
production (Ve/VCO2), and pulmonary capillary wedge pressure were elevated
in patients at rest and during exercise. The ratio of pulmonary dead space
to tidal volume (Vd/Vt) also was elevated in the heart failure group at
rest and during exercise and was closely related to Ve/VCO2 (all r greater
than .72, p less than .001). Rest and exercise arterial PCO2 regulation was
normal in patients. Peak exercise Ve/VCO2 did not correlate with pulmonary
vascular pressures, but was inversely related to cardiac output (r = -.49,
p less than .001). Thus, neurohumoral ventilatory control mechanisms are
intact in patients with chronic heart failure and act to maintain normal
PaCO2 levels in the face of increased pulmonary dead space. Activation of
abnormal reflexes due to hemodynamic derangements during exercise are not
important in determining ventilation in the presence of chronic heart
failure. The demonstration of a correlation between decreased cardiac
output and increased ventilation in the patient group suggests that
attenuated pulmonary perfusion may play a role in causing exercise
hyperpnea in the presence of chronic heart failure by producing ventilation
perfusion abnormalities and thereby increasing physiologic pulmonary dead
space.
ARTICLES
Increased exercise ventilation in patients with chronic heart failure: intact ventilatory control despite hemodynamic and pulmonary abnormalities
Department of Medicine, Duke University Medical Center, Durham, NC 27710.
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