Key result
Patients with chronic heart failure stopped by fatigue versus breathlessness during exercise testing showed no significant difference in peak oxygen consumption (15.66 vs 15.13 ml/kg/min; P=ns).
Why the study?
Are there differences in exercise performance, ventilatory response, or left ventricular parameters between chronic heart failure patients whose exercise is limited by fatigue versus breathlessness?
Observational (n=222)
Are there differences in exercise performance, ventilatory response, or left ventricular parameters between chronic heart failure patients whose exercise is limited by fatigue versus breathlessness?
Absolute Event Rate: 15.66% vs 15.13%
p-value: p=ns
In patients with chronic heart failure, exercise limitation due to fatigue versus breathlessness is not associated with differences in exercise performance, ventilatory response, or left ventricular function, suggesting a unified pathophysiology for these symptoms.
Fatigue- versus breathlessness-limited HF patients show similar exercise capacity; hypothesis-generating for unified mechanisms, should not yet change practice.
The pathogenesis of the limiting symptoms in patients with chronic heart failure, shortness of breath and fatigue on exercise, are poorly understood. We analysed data from 222 incremental symptom limited exercise tests to determine whether there were differences between patients stopped by breathlessness or fatigue. One hundred and sixty patients were stopped by breathlessness and 62 by fatigue. There was no differences between the two groups in underlying diagnosis or in exercise performance (peak oxygen consumption 15.66 (+/- 5.62) ml.kg-1.min-1 in the fatigue group, 15.13 (+/- 4.64) in the breathless group). The ventilatory response as assessed by ventilatory response to carbon dioxide production (VE/VCO2 slope) was not different between the two groups (2.61 (+/- 0.96) in the fatigue group, 3.03 (+/- 1.23) in the breathless group: P = ns). There were no differences between the two groups in left ventricular dimensions, left ventricular ejection fraction or left ventricular end-diastolic pressure. The limiting symptoms of breathlessness and fatigue in chronic heart failure are two sides of the same coin. Any pathophysiological explanation of exercise limitation in chronic heart failure must unify these two symptoms.
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Clark et al. (1995) conducted an observational in chronic heart failure (n=222). Exercise limitation by fatigue vs. Exercise limitation by breathlessness was evaluated on peak oxygen consumption (ml.kg-1.min-1) (p=ns). Patients with chronic heart failure stopped by fatigue versus breathlessness during exercise testing showed no significant difference in peak oxygen consumption (15.66 vs 15.13 ml/kg/min; P=ns).
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