Pulmonary versus systemic hemodynamics in determining exercise capacity of patients with chronic left ventricular failure

Franciosa, Joseph A.; Baker, Bonnie J.; Love, Seth

doi:10.1016/0002-8703(85)90461-2

Cited by 132 publications

(41 citation statements)

References 30 publications

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“…Weak correlations have been shown between exercise capacity and pulmonary artery wedge pressure3 and mean pulmonary arterial pressure. 3 Baker et al,6 using a first-pass radionuclide technique, showed a close correlation between peak Vo2 and RVEF in a study of 25 patients with chronic heart failure. It is attractive to propose that a limiting feature in chronic heart failure may be the inability of the right ventricle to eject blood into the pulmonary circulation during exercise sufficiently to perfuse all areas, and thus there will be areas of lung ventilated but underperfused-increased dead space ventilation.…”

Section: Discussionmentioning

confidence: 93%

The role of right and left ventricular function in the ventilatory response to exercise in chronic heart failure.

Clark¹,

Swan²,

Laney³

et al. 1994

Circulation

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BACKGROUND Right ventricular function may be an important determinant of exercise capacity, peak oxygen consumption (VO2), and the ventilatory response to carbon dioxide production (VE/VCO2 relation) in patients with chronic heart failure (CHF). METHODS AND RESULTS We studied the role of right ventricular function in CHF and also investigated the effects of absent right ventricular reserve in patients previously operated on with Fontan's procedure by measuring metabolic gas exchange during exercise in five groups of patients: (1) 10 patients who had previously undergone Fontan's procedure for congenital heart disease in whom the right ventricle is not functional; (2) 11 age-matched control subjects with dilated cardiomyopathy (DCM); (3) 15 age-matched normal subjects; (4) 42 patients with CHF; and (5) 16 age-matched control subjects. Left and right ventricular ejection fractions (LVEF and RVEF) were measured by radionuclide ventriculography in group 4. In the young subjects, the VE/VCO2 slope was lower in the control subjects than in the other two groups, being 24.4 +/- 4.3 against 33.3 +/- 6.6 in group 1 (P < .001) and 29.6 +/- 8.1 in group 2 (P < .05). The correlation between peak VO2 and VE/VCO2 was -0.80 (P = .005) in group 1 and -0.76 (P = .007) in group 2. In the older age groups, the VE/VCO2 slope was significantly greater (38.0 +/- 14.9 versus 25.4 +/- 3.7; P < .001) in the heart failure group (group 4). In neither control group was there a significant relation between peak VO2 and VE/VCO2 slope. In group 4, the relation between peak VO2 and VE/VCO2 was similar to that seen for groups 1 and 2. LVEF was 24.3 +/- 14.1%, and RVEF was 32.5 +/- 13.1%. There was no correlation between either RVEF or LVEF and peak VO2 or VE/VCO2 slope in the heart failure group. CONCLUSIONS The relation between excessive ventilation and reduction in peak oxygen consumption is present in patients with no functioning right ventricle. RVEF is not a determining feature of either exercise capacity or the excessive ventilatory response in CHF.

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Section: Discussionmentioning

confidence: 93%

The role of right and left ventricular function in the ventilatory response to exercise in chronic heart failure.

Clark¹,

Swan²,

Laney³

et al. 1994

Circulation

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“…13) A strong relationship between peak VO2 and peak exercise cardiac output has been found in patients with heart failure. 14,15) ∆VO2/∆WR reflects the rate of increase in cardiac output during incremental exercise. ∆VO2/∆WR in healthy subjects is approximately 10 mL/minute/W, while that in heart disease patients falls to progressively lower levels as the disease worsens.…”

Section: Discussionmentioning

confidence: 99%

Prognostic Value of Cardiopulmonary Exercise Testing in Cardiac Patients With Atrial Fibrillation

et al. 2012

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SummaryParameters obtained from cardiopulmonary exercise testing (CPX) are recognized for their high prognostic value in predicting future cardiac events in cardiac patients. Our group compared the prognostic value of CPX parameters between patients with sinus rhythm (SR) and patients with atrial fibrillation (AF).Peak O2 uptake (VO2), the ratio of the increase in VO2 to the increase in work rate ( ∆VO2/ ∆WR), and the slope of the increase in ventilation to the increase in CO2 output (VE-VCO2 slope) were obtained from CPX in 72 AF patients and 478 SR patients. The prognostic values of these indices were compared between the two groups.Six cardiac deaths and 25 cardiac events were observed in the AF group and 9 cardiac deaths and 96 cardiac events were observed in the SR group, over a prospective follow-up period of 1,192 days. The percentages of cardiac deaths and cardiac events were higher in the AF group than in the SR group. In a multivariate Cox proportional hazards analysis, peak VO2 was identified as a sole significant predictor of cardiac death and cardiac events in SR patients and VE-VCO2 slope was identified as a sole significant predictor of cardiac death and cardiac events in AF patients.Our results suggest that the VE-VCO2 slope is strongly predictive of future cardiac events in patients with AF and that peak VO2 is strongly predictive of future cardiac events in SR patients. (Int Heart J 2012; 53: 102-107)

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“…9,16,17 A strong relationship between peak V O2 and peak exercise cardiac output has been found in patients with heart failure. 18 The V E-V CO2 slope, which ranges from approximately 24 to 34 in healthy subjects, becomes steeper in cardiac patients according to the severity of the heart failure. 19,20 A steep V E-V CO2 slope during exercise is assumed to relate mainly to a ventilation-perfusion mismatch, such as an increased ratio of pulmonary dead space to tidal volume.…”

Section: Parameters Obtained From Cpxmentioning

confidence: 99%

Relation Between Oscillatory Breathing and Cardiopulmonary Function During Exercise in Cardiac Patients

Kato

Koike

Hoshimoto-Iwamoto

et al. 2013

Circ J

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Cardiopulmonary exercise testing (CPX) is a useful clinical tool for evaluating the severity of disease and the limitations of activities of daily life in cardiac patients. 9 As described by the Fick's equation, O2 uptake (V O2) is the product of cardiac output and the arteriovenous O2 difference. Among the parameters obtained from CPX, the peak V O2 is traditionally considered as the gold standard for identifying patients with a poor prognosis and selecting candidates for cardiac transplantation. 10 The slope of the increase in ventilation (V E) to the increase in CO2 output (V CO2) (V E-V CO2 slope) is also an established index reflecting cardiopulmonary dysfunction during exercise. 9 scillatory breathing, alternating between hyperpnea and hypopnea during sleep and commonly referred to as central sleep apnea or Cheyne-Stokes respiration, has long been recognized in cardiac patients. An instability of the ventilatory control system, 1 long circulation time, 2-4 high sensitivity of ventilation to changes in CO2, 5 a decrease in the PaCO2 regulatory set point, 5,6 or fluctuations in the pulmonary blood flow 7,8 have been proposed as possible mechanisms underlying this abnormal breathing. A similar breathing pattern has also been recognized during waking hours in cardiac patients, especially those with heart failure. The mechanisms underlying oscillatory breathing while awake are assumed to overlap, at least in part, with those of central sleep apnea. However, reports on the mechanisms of oscillatory breathing while awake are limited. The relation between the magnitude of oscillatory breathing while awake and the severity of heart failure has not Relation Between Oscillatory Breathing and Cardiopulmonary Function During Exercise in Cardiac PatientsJo Kato, MD; Akira Koike, MD; Masayo Hoshimoto-Iwamoto, PhD; Osamu Nagayama, BSc; Koji Sakurada; Akira Sato, MD; Takeshi Yamashita, MD; Karlman Wasserman, MD, PhD; Kazutaka Aonuma, MD Background: Oscillatory breathing, alternating between hyperpnea and hypopnea, has been recognized in cardiac patients, especially in those with heart failure. We evaluated whether the cycle length and amplitude of oscillatory breathing correlate with impaired cardiopulmonary function during exercise.

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Pulmonary versus systemic hemodynamics in determining exercise capacity of patients with chronic left ventricular failure

Cited by 132 publications

References 30 publications

The role of right and left ventricular function in the ventilatory response to exercise in chronic heart failure.

The role of right and left ventricular function in the ventilatory response to exercise in chronic heart failure.

Prognostic Value of Cardiopulmonary Exercise Testing in Cardiac Patients With Atrial Fibrillation

Relation Between Oscillatory Breathing and Cardiopulmonary Function During Exercise in Cardiac Patients

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