Hemodynamic basis of the reduced oxygen uptake relative to work rate during incremental exercise in patients with chronic heart failure

Tanabe, Yuji; Nakagawa, Iwao; Ito, Eiichi; Suzuki, Kaoru

doi:10.1016/s0167-5273(02)00013-x

Cited by 35 publications

(29 citation statements)

References 18 publications

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“…Abnormal function in any 1 of these systems diminishes peak V O 2 and increases ventilatory equivalents. [131][132][133][134][135][136][137] Although these abnormal indices provide important quantifications, they do not distinguish between underlying physiological components. Diagnostic ambiguity is often further exacerbated by deconditioning.…”

Section: Cpx In Patients With Skeletal Muscle Fiber and Mitochondrialmentioning

confidence: 99%

Clinician’s Guide to Cardiopulmonary Exercise Testing in Adults

Balady¹,

Arena

Sietsema³

et al. 2010

Circulation

1,638

925

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E xercise testing remains a remarkably durable and versatile tool that provides valuable diagnostic and prognostic information regarding patients with cardiovascular and pulmonary disease. Exercise testing has been available for more than a half century and, like many other cardiovascular procedures, has evolved in its technology and scope. When combined with exercise testing, adjunctive imaging modalities offer greater diagnostic accuracy, additional information regarding cardiac structure and function, and additional prognostic information. Similarly, the addition of ventilatory gas exchange measurements during exercise testing provides a wide array of unique and clinically useful incremental information that heretofore has been poorly understood and underutilized by the practicing clinician. The reasons for this are many and include the requirement for additional equipment (cardiopulmonary exercise testing [CPX] systems), personnel who are proficient in the administration and interpretation of these tests, limited or absence of training of cardiovascular specialists and limited training by pulmonary specialists in this technique, and the lack of understanding of the value of CPX by practicing clinicians.Modern CPX systems allow for the analysis of gas exchange at rest, during exercise, and during recovery and yield breath-by-breath measures of oxygen uptake (V O 2 ), carbon dioxide output (V CO 2 ), and ventilation (V E). These advanced computerized systems provide both simple and complex analyses of these data that are easy to retrieve and store, which makes CPX available for widespread use. These data can be readily integrated with standard variables measured during exercise testing, including heart rate, blood pressure, work rate, electrocardiography findings, and symptoms, to provide a comprehensive assessment of exercise tolerance and exercise responses. CPX can even be performed with adjunctive imaging modalities for additional diagnostic assessment. Hence, CPX offers the clinician the ability to obtain a wealth of information beyond standard exercise electrocardiography testing that when appropriately applied and interpreted can assist in the management of complex cardiovascular and pulmonary disease.

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Section: Cpx In Patients With Skeletal Muscle Fiber and Mitochondrialmentioning

confidence: 99%

Clinician’s Guide to Cardiopulmonary Exercise Testing in Adults

Balady¹,

Arena

Sietsema³

et al. 2010

Circulation

1,638

925

View full text Add to dashboard Cite

show abstract

“…The SVI demonstrated markedly blunted kinetics during exercise, whereas HR kinetics was relatively preserved. Although abnormal cardiac output kinetics has been previously implicated in the decreased VO 2 kinetics during incremental exercise (7,8), we believe that the present methodological strategy provides evidence for the role of CI-mediated VO 2 kinetics reduction in heart failure. First, cardiac output was directly and continuously measured in the aortic ascending portion on a beat-to-beat basis in exercising heart failure rats.…”

Section: Discussionmentioning

confidence: 66%

“…between ischemic heart failure rats and normal control rats suggests that the oxygen uptake from the blood vessels is not implicated in the reduced VO 2 kinetics during exercise in rats with ischemia-induced heart failure. Tanabe et al (8) showed that the rate of O 2 extraction by peripheral muscle relative to work rate increment increased with decreasing cardiac output response to exercise. But the decreased O 2 supply due to severely reduced cardiac output could not be fully compensated for by the increased O 2 extraction in advanced congestive heart failure (7).…”

Section: Discussionmentioning

confidence: 99%

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<a name="home"></a>The decreased oxygen uptake during progressive exercise in ischemia-induced heart failure is due to reduced cardiac output rate

Rolim

Mattos

Brum

et al. 2006

Braz J Med Biol Res

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We tested the hypothesis that the inability to increase cardiac output during exercise would explain the decreased rate of oxygen uptake (VO 2 ) in recent onset, ischemia-induced heart failure rats. Nine normal control rats and 6 rats with ischemic heart failure were studied. Myocardial infarction was induced by coronary ligation. VO 2 was measured during a ramp protocol test on a treadmill using a metabolic mask. Cardiac output was measured with a flow probe placed around the ascending aorta. Left ventricular end-diastolic pressure was higher in ischemic heart failure rats compared with normal control rats (17 ± 0.4 vs 8 ± 0.8 mmHg, P = 0.0001). Resting cardiac index (CI) tended to be lower in ischemic heart failure rats (P = 0.07). Resting heart rate (HR) and stroke volume index (SVI) did not differ significantly between ischemic heart failure rats and normal control rats. Peak VO 2 was lower in ischemic heart failure rats (73.72 ± 7.37 vs 109.02 ± 27.87 mL min -1 kg -1 , P = 0.005). The VO 2 and CI responses during exercise were significantly lower in ischemic heart failure rats than in normal control rats. The temporal response of SVI, but not of HR, was significantly lower in ischemic heart failure rats than in normal control rats. Peak CI, HR, and SVI were lower in ischemic heart failure rats. The reduction in VO 2 response during incremental exercise in an ischemic model of heart failure is due to the decreased cardiac output response, largely caused by depressed stroke volume kinetics. Correspondence

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“…Furthermore, we observed that the ∆VO 2 /∆WR significantly deteriorated during the postoperative exercise test. A reduced contractile reserve and transient ischemia after surgery limits the stroke volume increase as shown by decreased peak systolic blood pressure; and a complete β-receptor blockade reduces the HR reserve, both leading to a diminished cardiac output (CO) response (31). Our results showed that the deteriorated resting right and left ventricular function after surgery and the insufficient increase in CO during the exercise test both had a strong role to play in exercise intolerance after surgery.…”

Section: Discussionmentioning

confidence: 74%

Changes in Exercise Capacity and Psychosocial Factors in Hospitalized Cardiac Surgery Patients

Ogawa¹,

Izawa²,

Kitamura³

et al. 2017

Res Cardiovasc Med

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Background: After cardiac valve surgery, postoperative exercise capacity and psychosocial parameters of patients change significantly, both of which can affect prognosis. This study aimed to analyze and clarify the relationship between changes in perioperative exercise capacity and psychosocial factors in the early phase after valvular surgery. Methods: We enrolled 48 consecutive patients who underwent valvular surgery and studied their exercise capacity, health-related quality of life (HRQOL), anxiety disorders, depression symptoms, blood samples, and echocardiograms preoperatively and 14 days postoperatively.

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Hemodynamic basis of the reduced oxygen uptake relative to work rate during incremental exercise in patients with chronic heart failure

Cited by 35 publications

References 18 publications

Clinician’s Guide to Cardiopulmonary Exercise Testing in Adults

Clinician’s Guide to Cardiopulmonary Exercise Testing in Adults

<a name="home"></a>The decreased oxygen uptake during progressive exercise in ischemia-induced heart failure is due to reduced cardiac output rate

Changes in Exercise Capacity and Psychosocial Factors in Hospitalized Cardiac Surgery Patients

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