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November 19, 2008Cardiology

Cardiopulmonary Exercise Response in Patients with Left Ventricular Dysfunction or Heart Failure: A Noninvasive Study by Gas Exchange and Impedance Cardiography Monitoring

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Key result

Heart failure patients exhibit flat heart rate, unchanged stroke volume, and higher VE/VCO2 at peak exercise.

  • n=28

Why the study?

Different determinants of cardiopulmonary exercise response in patients with left ventricular dysfunction with mild or symptomatic chronic heart failure were not fully characterized.

How do cardiopulmonary and hemodynamic responses to exercise differ between patients with asymptomatic left ventricular dysfunction, symptomatic heart failure, and healthy controls?

Comparison

Patients with LVD or HF vs sedentary healthy male controls

Design

Cross-sectional study with upright bicycle exercise and noninvasive gas exchange and impedance cardiography monitoring

Authors

IMIda MonteforteSCStefania CardeiALAnna Lerro

Discussion

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Overview

May distinguish symptomatic HF from asymptomatic LVD via exercise hemodynamics; hypothesis-generating and requires prospective validation before clinical use.

Key Points

  • To noninvasively evaluate cardiopulmonary and hemodynamic exercise determinants in patients with asymptomatic left ventricular dysfunction compared to those with symptomatic heart failure.
  • Assessed 20 patients with post-infarction left ventricular dysfunction (10 asymptomatic NYHA class I without treatment; 10 symptomatic NYHA class II-III heart failure on treatment) and 8 sedentary male controls.
  • Performed upright bicycle stress testing combining gas exchange analysis (Peak VO2, anaerobic ventilatory threshold, VE/VCO2) with noninvasive impedance cardiography for stroke volume and auscultatory systemic vascular resistance.
  • In healthy controls, oxygen uptake increases from rest to peak exercise via combined increases in heart rate and stroke volume alongside continuous reductions in systemic vascular resistance.
  • Patients with heart failure increased oxygen uptake to the anaerobic threshold via elevated heart rate alone with fixed stroke volume, showing minimal subsequent oxygen uptake rise to peak and an unchanged vascular resistance.
  • Asymptomatic left ventricular dysfunction patients increased both heart rate and stroke volume up to the anaerobic threshold with normal vascular resistance decline, but relied solely on heart rate increases above the threshold; peak VE/VCO2 was elevated in heart failure.

Study Design

Type

Cross-Sectional (n=28)

Structured PICO

How do cardiopulmonary and hemodynamic responses to exercise differ between patients with asymptomatic left ventricular dysfunction, symptomatic heart failure, and healthy controls?

P
Population
28 participants, including 20 patients with left ventricular dysfunction (10 asymptomatic, 10 with heart failure) and 8 sedentary male controls, undergoing upright bicycle exercise testing.
E
Exposure
Upright bicycle exercise stress testing with gas exchange assessment and noninvasive monitoring of stroke volume by impedance cardiography.
C
Comparator
Sedentary healthy male controls.
O
Outcome
Cardiopulmonary response (VO2, heart rate, stroke volume, total systemic vascular resistance, and VE/VCO2 ratio) during submaximal (anaerobic threshold) and maximal (peak VO2) exercise.surrogate

Noninvasive monitoring with impedance cardiography and gas exchange reveals that symptomatic heart failure patients fail to augment stroke volume or decrease systemic vascular resistance during exercise, unlike asymptomatic patients with similar left ventricular dysfunction.

Cite This Study

Monteforte et al. (2008) conducted a cross-sectional in Left ventricular dysfunction or heart failure (n=28). Left ventricular dysfunction or heart failure vs. Sedentary male controls was evaluated on Cardiopulmonary response including VO2, heart rate, stroke volume, and VE/VCO2 ratio. Patients with heart failure exhibited a flat heart rate increase, unchanged stroke volume, and higher VE/VCO2 ratio at peak exercise compared to controls during upright bicycle testing.

synapsesocial.com/papers/6aaf61908fea992f193999f3https://doi.org/10.1159/000177078
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Also Consider

Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context:

  1. 1Ventilatory responses to exercise in patients with asymptomatic left ventricular dysfunction1999 · 3 citations
  2. 2The increased ventilatory response to exercise in chronic heart failure: relation to pulmonary pathology.1997 · 77 citations
  3. 3Oxygen utilization and ventilation during exercise in patients with chronic cardiac failure.1982 · 920 citations
  4. 4Ventilatory Capacity and Exercise Tolerance in Patients with Chronic Stable Heart Failure2000 · 25 citations
  5. 5Lung Function and Exercise Gas Exchange in Chronic Heart Failure1997 · 401 citations