| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
(Circulation. 1995;91:2924-2932.)
© 1995 American Heart Association, Inc.
Articles |
Prolonged Kinetics of Recovery of Oxygen Consumption After Maximal Graded Exercise in Patients With Chronic Heart Failure
Analysis With Gas Exchange Measurements and NMR Spectroscopy
Presented in part at the 66th Scientific Sessions of the American Heart Association, Atlanta, Ga, November 8-11, 1993.
From the Service de Cardiologie, Hôpital Beaujon, Clichy, and Service de Biophysique, Hôpital Cochin, Paris (D.M.), France.
Correspondence to A. Cohen-Solal, Service de Cardiologie, Hôpital Beaujon, 100 Blvd du General Leclerc, 92110 Clichy, France.
Background Patients with chronic heart failure (CHF) often complain of prolonged dyspnea after exercise. The determinants of oxygen consumption after exercise in these patients are unknown. We hypothesized that the kinetics of oxygen consumption recovery after graded exercise was prolonged in parallel with the recovery of muscle energy stores, was not affected by the exercise level, and could be used to assess the circulatory response to exercise.
Methods and Results Seventy-two patients with CHF in Weber's
class A (n=28), B (n=21), and C/D (n=23) and 13 healthy
subjects
performed maximal upright bicycle exercise with breath-by-breath
respiratory gas analysis. Kinetics of recovery of ventilation
(
E), oxygen consumption
(O2), and CO2
production
(CO2) after exercise were
characterized by T1/2, the time to reach 50% of the
peak value. T1/2
O2
(seconds) increased with the severity of CHF (97±17 for CHF A
[P<.05 versus CHF B, P<.05 versus CHF C/D],
119±22 for CHF B [P<.05 versus control subjects,
P<.05 versus CHF A, and P<.05 versus CHF C/D],
155±55 for CHF C/D [P<.05 versus control subjects,
P<.05 versus CHF A, and P<.05 versus CHF B]
compared with 77±17 for control subjects). T1/2
CO2 and T1/2
E also increased similarly with the
worsening of
CHF. T1/2 O2 was
correlated negatively with peak
O2
(r=.65) and was reproducible (r=.96). To study
the relation between T1/2
O2 and the duration of
exercise, 10
healthy subjects and 22 patients underwent a second graded test at 75%
and/or 50% of peak workload. T1/2
O2 was minimally shortened,
at only
50% of peak workload (P=.02). Finally, 19 patients
underwent 31P nuclear magnetic resonance spectroscopy of
the anterior compartment of the leg during exercise; the half-time of
recovery of the ratio of inorganic phosphate to creatine phosphate
(T1/2 Pi/PCr), reflecting the level of
involvement of oxidative metabolism in the restoration of energetic
metabolites after exercise, was linearly correlated with the half-time
of O2 recovery
(r=.70,
P<.01).
Conclusions Postexercise T1/2
O2 increases when CHF
worsens, perhaps
in part a result of slower kinetics of recovery of muscle energy
stores. The time course of oxygen consumption recovery may
represent a simple new criterion for measuring the impairment
of the circulatory response to exercise in CHF, even submaximal
exercise.
Key Words: oxygen consumption • exercise • heart failure • magnetic resonance spectroscopy
This article has been cited by other articles:
 |
|
 |
|
  W. J. Paulus, C. Tschope, J. E. Sanderson, C. Rusconi, F. A. Flachskampf, F. E. Rademakers, P. Marino, O. A. Smiseth, G. De Keulenaer, A. F. Leite-Moreira, et al. How to diagnose diastolic heart failure: a consensus statement on the diagnosis of heart failure with normal left ventricular ejection fraction by the Heart Failure and Echocardiography Associations of the European Society of Cardiology Eur. Heart J., October 2, 2007; 28(20): 2539 - 2550. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 S. H. Mitchell, N. P. Steele, K. M. Leclerc, M. Sullivan, and W. C. Levy Oxygen Cost of Exercise Is Increased in Heart Failure After Accounting for Recovery Costs Chest, August 1, 2003; 124(2): 572 - 579. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 D. M. Mancini, S. D. Katz, C. C. Lang, J. LaManca, A. Hudaihed, and A.-S. Androne Effect of Erythropoietin on Exercise Capacity in Patients With Moderate to Severe Chronic Heart Failure Circulation, January 21, 2003; 107(2): 294 - 299. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. Cohen-Solal, J.Y. Tabet, D. Logeart, P. Bourgoin, M. Tokmakova, and M. Dahan A non-invasively determined surrogate of cardiac power ('circulatory power') at peak exercise is a powerful prognostic factor in chronic heart failure Eur. Heart J., May 2, 2002; 23(10): 806 - 814. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. Myers, R. Gianrossi, J. Schwitter, D. Wagner, and P. Dubach Effect of Exercise Training on Postexercise Oxygen Uptake Kinetics in Patients With Reduced Ventricular Function Chest, October 1, 2001; 120(4): 1206 - 1211. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S.G Williams, G.A Cooke, D.J Wright, W.J Parsons, R.L Riley, P Marshall, and L-B Tan Peak exercise cardiac power output; a direct indicator of cardiac function strongly predictive of prognosis in chronic heart failure Eur. Heart J., August 2, 2001; 22(16): 1496 - 1503. [Abstract] [PDF]
|
|
|
|
|
|
E. Pouliou, S. Nanas, A. Papamichalopoulos, T. Kyprianou, G. Perpati, I. Mavrou, and C. Roussos Prolonged Oxygen Kinetics During Early Recovery From Maximal Exercise in Adult Patients With Cystic Fibrosis Chest, April 1, 2001; 119(4): 1073 - 1078. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. J. MacDonald, H. L. Naylor, M. E. Tschakovsky, and R. L. Hughson Peripheral circulatory factors limit rate of increase in muscle O2 uptake at onset of heavy exercise J Appl Physiol, January 1, 2001; 90(1): 83 - 89. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J.-Y. Tabet, D. Logeart, C. Geyer, C. Guiti, P.V. Ennezat, M. Dahan, and A. Cohen-Solal Comparison of the prognostic value of left ventricular filling and peak oxygen uptake in patients with systolic heart failure Eur. Heart J., November 2, 2000; 21(22): 1864 - 1871. [Abstract] [PDF]
|
|
|
|
 |
|
 Y. Tanabe, M. Takahashi, Y. Hosaka, M. Ito, E. Ito, and K. Suzuki Prolonged recovery of cardiac output after maximal exercise in patients with chronic heart failure J. Am. Coll. Cardiol., April 1, 2000; 35(5): 1228 - 1236. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 N M Picozzi, A L Clark, K A Lindsay, G P McCann, and W S Hillis Responses to constant work exercise in patients with chronic heart failure Heart, October 1, 1999; 82(4): 482 - 485. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
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]
|
|
|
|
|
|
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]
|
|
|
|
|
|
C. W. Lee, J.-H. Lee, J.-J. Kim, S.-W. Park, M.-K. Hong, S.-T. Kim, T.-H. Lim, and S.-J. Park Cerebral metabolic abnormalities in congestive heart failure detected by proton magnetic resonance spectroscopy J. Am. Coll. Cardiol., April 1, 1999; 33(5): 1196 - 1202. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 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]
|
|