Cardiopulmonary exercise response in patients with left ventricular dysfunction or heart failure: A noninvasive study by gas exchange and impedance cardiography monitoring

Massimo Romano, Ida Monteforte, Stefania Cardei, Anna Lerro, Giovanna Celano, Alfredo Mazza, Marianunzia Capaldo, Nella Paglia, Amalia Campopiano, Giuseppe Lembo, Bruno Trimarco, Mario Condorelli

Research output: Contribution to journalArticlepeer-review


We investigated the upright bicycle exercise cardiopulmonary response in 20 patients with left ventricular dysfunction (LVD, secondary to previous myocardial infarction, left ventricular ejection fraction range 18-44%). Ten patients (48 ± 7 years) were asymptomatic (I NYHA class) without drug treatment (LVD group). The others (n = 10) (50 ± 1 years) complained of dyspnea and/or fatigue despite therapy (NYHA II-III). They represented the heart failure (HF) group. Eight sedentary men (40 ± 10 years) served as controls. Controls and patients performed stress testings under drug treatment, when administered. Anaerobic ventilatory threshold (ATge) was considered as an index of submaximal exercise while peak exercise VO2 (PeakVO2) was considered the maximal volitional exercise capacity. The ratio between minute ventilation (VE) to carbon dioxide release (VCO2) (VE/CO2) was assessed to evaluate the ventilatory response during exercise. We coupled gas exchange assessment (2001, MGC) with noninvasive monitoring of stroke volume (SV) by impedance cardiography (NCCOM3, BOMED) and total systemic vascular resistances (TSVR; by auscultatory blood pressure measurement). In controls VO2 increase during exercise was related to higher heart rate (HR) and SV both from resting to ATge and from this point to the peak. TSVR declined during both steps. In patients with HF VO2 rose from resting to ATge (by faster HR and unchanged SV). VO2 increased slightly from this point to PeakVO2. This result was related to flat HR increase and unchanged SV as well as TSVR. In patients with LVD VO2 increased similarly to controls from resting to ATge and less above the threshold. In these patients both HR and SV increased during submaximal exercise. From ATge to PeakVO2 only HR increased. TSVR declined significantly similarly to controls. The VE/CO2 ratio was higher at peak exercise in patients with HF compared to controls. Different determinants were demonstrated in patients with left ventricular dysfunction with mild or symptomatic chronic heart failure (CHF). These findings and the increased ventilatory response in patients with CHF can explain different changes of VO2 in these patients during submaximal and maximal voluntary exercise and contribute to explain exercise-induced exertion in these subjects.

Original languageEnglish
Pages (from-to)147-152
Number of pages6
Issue number2
Publication statusPublished - Jan 1996


  • Anaerobic threshold
  • Cardiopulmonary stress testing
  • Congestive heart failure
  • Exercise stress testing
  • Impedance cardiography
  • Mild heart failure
  • Myocardial function

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine


Dive into the research topics of 'Cardiopulmonary exercise response in patients with left ventricular dysfunction or heart failure: A noninvasive study by gas exchange and impedance cardiography monitoring'. Together they form a unique fingerprint.

Cite this