Contribution of central and peripheral factors at peak exercise in heart failure patients with progressive severity of exercise limitation

Alberico Del Torto, Nicoletta Corrieri, Carlo Vignati, Piero Gentile, Gaia Cattadori, Stefania Paolillo, Piergiuseppe Agostoni

Research output: Contribution to journalArticlepeer-review

Abstract

BACKGROUND: A reduced cardiac output (CO) response during exercise is a major limiting factor in heart failure (HF). Oxygen consumption (VO2) is directly proportional to CO. Peripheral mechanisms via arteriovenous oxygen difference (Δ(a-v)O2) play a pivotal role in chronic HF. We hypothesized a weak correlation between peak VO2and peak CO with a greater Δ(a-v)O2variability in most severe HF.

METHODS: We analyzed 278 HF patients (NYHA II-III) who performed maximal cardiopulmonary exercise test with non-invasive CO measurement by inert gas rebreathing.

RESULTS: Median peakVO2, CO and Δ(a-v)O2were 0.96 (0.78-1.28) L/min, 6.3 (5.1-8.0) L/min and 16.0 (14.2-18.0) mL/100mL respectively, with a linear relationship between VO2and CO: CO=5.3×VO2+1.13 (r2=0.705, p<0.001). Patients were grouped according to exercise limitation. Group 1 (101 patients) peakVO2<50% pred: peakVO20.80 (0.67-0.94) L/min, peakCO 5.6 (4.7-6.5) L/min, peakΔ(a-v)O214.8 (12.9-17.1) mL/100mL. Group 2 (89 patients) peakVO2≥50-<65% pred: peakVO21.02 (0.84-1.29) L/min, peakCO 6.4 (5.1-8.0) L/min, peakΔ(a-v)O216.7 (15.0-18.5) mL/100mL. Group 3 (88 patients) peakVO2≥65% pred: peakVO21.28 (0.93-1.66) L/min, peakCO 8.0 (6.2-9.7) L/min, peakΔ(a-v)O216.8 (14.6-18.3) mL/100mL. A peakVO2and peakCO linear relationship was observed in Group 1 (r2=0.381, p<0.001), Group 2 (r2=0.756, p<0.001) and Group 3 (r2=0.744, p<0.001).

CONCLUSIONS: With worsening HF we observed a progressive reduction of peak CO and peak VO2. However in most compromised patients also peripheral mechanisms play a role as indicated by reduced Δ(a-v)O2.

Original languageEnglish
Pages (from-to)252-256
Number of pages5
JournalInternational Journal of Cardiology
Volume248
DOIs
Publication statusPublished - Dec 1 2017

Keywords

  • Journal Article

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