Mechanism of the increased ventilatory response to exercise in patients with chronic heart failure.

N P Buller, P A Poole-Wilson

National Heart and Lung Institute, National Heart Hospital, London.

Minute ventilation, respiratory rate, and metabolic gas exchange were measured continuously during maximal symptom limited treadmill exercise in 30 patients with stable chronic heart failure. The ventilatory response to exercise was assessed by calculation of the slope of the relation between minute ventilation and rate of carbon dioxide production. There was a close correlation between the severity of heart failure, determined as the maximal rate of oxygen consumption, and the ventilatory response to exercise. Reanalysis of the data after correction for ventilation of anatomical dead space did not significantly weaken the correlation but reduced the slope of the relation by approximately one third. These results show that the increased ventilatory response to exercise in patients with chronic heart failure is largely caused by mechanisms other than increased ventilation of anatomical dead space. This finding supports the concept that a significant pulmonary ventilation/perfusion mismatch develops in patients with chronic heart failure and suggests that the magnitude of this abnormality is directly related to the severity of chronic heart failure.

CiteULike    Complore    Connotea    Del.icio.us    Digg    Reddit    Technorati    What's this?

This article has been cited by other articles:

• Witte, K. K.A., Clark, A. L. (2008). Dyspnoea versus fatigue: Additional prognostic information from symptoms in chronic heart failure?. Eur J Heart Fail 10: 1224-1228 [Abstract] [Full Text]  
• Ingle, L., Witte, K. K., Cleland, J. G.F., Clark, A. L. (2008). Combining the ventilatory response to exercise and peak oxygen consumption is no better than peak oxygen consumption alone in predicting mortality in chronic heart failure. Eur J Heart Fail 10: 85-88 [Abstract] [Full Text]  
• Hoeper, M. M., Pletz, M. W., Golpon, H., Welte, T. (2007). Prognostic value of blood gas analyses in patients with idiopathic pulmonary arterial hypertension. Eur Respir J 29: 944-950 [Abstract] [Full Text]  
• Witte, K K A, Nikitin, N P, Cleland, J G F, Clark, A L (2006). Excessive breathlessness in patients with diastolic heart failure. Heart 92: 1425-1429 [Abstract] [Full Text]  
• Torchio, R., Gulotta, C., Greco-Lucchina, P., Perboni, A., Montagna, L., Guglielmo, M., Milic-Emili, J. (2006). Closing Capacity and Gas Exchange in Chronic Heart Failure. Chest 129: 1330-1336 [Abstract] [Full Text]  
• Clark, A L (2006). Origin of symptoms in chronic heart failure. Heart 92: 12-16 [Abstract] [Full Text]  
• Witte, K. K.A., Thackray, S. D.R., Lindsay, K. A., Cleland, J. G.F., Clark, A. L. (2005). Metabolic gas kinetics depend upon the level of exercise performed. Eur J Heart Fail 7: 991-996 [Abstract] [Full Text]  
• Witte, K. K.A., Thackray, S., Nikitin, N. P., Cleland, J. G.F., Clark, A. L. (2005). The effects of long-term {beta}-blockade on the ventilatory responses to exercise in chronic heart failure. Eur J Heart Fail 7: 612-617 [Abstract] [Full Text]  
• Witte, K K A, Clark, A L (2005). Cycle exercise causes a lower ventilatory response to exercise in chronic heart failure. Heart 91: 225-226 [Full Text]  
• Guazzi, M., Reina, G., Tumminello, G., Guazzi, M. D. (2004). Improvement of alveolar-capillary membrane diffusing capacity with exercise training in chronic heart failure. J. Appl. Physiol. 97: 1866-1873 [Abstract] [Full Text]  
• Witte, K. K.A., Clark, A. L. (2004). The effect of aspirin on the ventilatory response to exercise in chronic heart failure. Eur J Heart Fail 6: 745-748 [Abstract] [Full Text]  
• Rosen, S. D., Murphy, K., Leff, A. P., Cunningham, V., Wise, R. J.S., Adams, L., Coats, A. J.S., Camici, P. G. (2004). Is central nervous system processing altered in patients with heart failure?. Eur Heart J 25: 952-962 [Abstract] [Full Text]  
• Hart, N, Kearney, M T, Pride, N B, Green, M, Lofaso, F, Shah, A M, Moxham, J, Polkey, M I (2004). Inspiratory muscle load and capacity in chronic heart failure. Thorax 59: 477-482 [Abstract] [Full Text]  
• Glaser, S., Opitz, C. F., Bauer, U., Wensel, R., Ewert, R., Lange, P. E., Kleber, F. X. (2004). Assessment of Symptoms and Exercise Capacity in Cyanotic Patients With Congenital Heart Disease. Chest 125: 368-376 [Abstract] [Full Text]  
• Koike, A., Itoh, H., Oohara, R., Hoshimoto, M., Tajima, A., Aizawa, T., Fu, L. T. (2004). Cerebral Oxygenation During Exercise in Cardiac Patients. Chest 125: 182-190 [Abstract] [Full Text]  
• Adachi, H., Oshima, S., Sakurai, S., Toyama, T., Hoshizaki, H., Taniguchi, K., Ito, H. (2003). Nitric oxide exhalation correlates with ventilatory response to exercise in patients with heart disease. Eur J Heart Fail 5: 639-643 [Abstract] [Full Text]  
• Witte, K K A, Thackray, S D R, Nikitin, N P, Cleland, J G F, Clark, A L (2003). The effects of {alpha} and {beta} blockade on ventilatory responses to exercise in chronic heart failure. Heart 89: 1169-1173 [Abstract] [Full Text]  
• Witte, K K A, Thackray, S D R, Nikitin, N P, Cleland, J G F, Clark, A L (2003). Pattern of ventilation during exercise in chronic heart failure. Heart 89: 610-614 [Abstract] [Full Text]  
• Tomita, T, Takaki, H, Hara, Y, Sakamaki, F, Satoh, T, Takagi, S, Yasumura, Y, Aihara, N, Goto, Y, Sunagawa, K (2003). Attenuation of hypercapnic carbon dioxide chemosensitivity after postinfarction exercise training: possible contribution to the improvement in exercise hyperventilation. Heart 89: 404-410 [Abstract] [Full Text]  
• (2003). ATS/ACCP Statement on Cardiopulmonary Exercise Testing. Am. J. Respir. Crit. Care Med. 167: 211-277 [Full Text]  
• Witte, K. K.A., Clark, A. L. (2002). Is the elevated slope relating ventilation to carbon dioxide production in chronic heart failure a consequence of slow metabolic gas kinetics?. Eur J Heart Fail 4: 469-472 [Abstract] [Full Text]  
• Koike, A., Itoh, H., Kato, M., Sawada, H., Aizawa, T., Fu, L. T., Watanabe, H. (2002). Prognostic Power of Ventilatory Responses During Submaximal Exercise in Patients With Chronic Heart Disease*. Chest 121: 1581-1588 [Abstract] [Full Text]  
• Guimaraes, G. V., Bellotti, G., Mocelin, A. O., Camargo, P. R., Bocchi, E. A. (2001). Cardiopulmonary Exercise Testing in Children With Heart Failure Secondary to Idiopathic Dilated Cardiomyopathy. Chest 120: 816-824 [Abstract] [Full Text]  
• Cicoira, M., Zanolla, L., Franceschini, L., Rossi, A., Golia, G., Zamboni, M., Tosoni, P., Zardini, P. (2001). Skeletal muscle mass independently predicts peak oxygen consumption and ventilatory response during exercise in noncachectic patients with chronic heart failure. J Am Coll Cardiol 37: 2080-2085 [Abstract] [Full Text]  
• Tanabe, Y., Hosaka, Y., Ito, M., Ito, E., Suzuki, K. (2001). Significance of End-Tidal PCO2 Response to Exercise and Its Relation to Functional Capacity in Patients With Chronic Heart Failure. Chest 119: 811-817 [Abstract] [Full Text]  
• Caruana, L., Petrie, M. C., McMurray, J. J., MacFarlane, N. G. (2001). Altered diaphragm position and function in patients with chronic heart failure. Eur J Heart Fail 3: 183-187 [Abstract] [Full Text]  
• Scott, A. C, Francis, D. P, Davies, L C., Ponikowski, P., Coats, A. J S, Piepoli, M. F (2000). Contribution of skeletal muscle 'ergoreceptors' in the human leg to respiratory control in chronic heart failure. J. Physiol. 529: 863-870 [Abstract] [Full Text]  
• Matsumoto, A., Itoh, H., Eto, Y., Kobayashi, T., Kato, M., Omata, M., Watanabe, H., Kato, K., Momomura, S.-i. (2000). End-tidal CO2 pressure decreases during exercise in cardiac patients: Association with severity of heart failure and cardiac output reserve. J Am Coll Cardiol 36: 242-249 [Abstract] [Full Text]  
• Johnson, R. L. Jr (2000). Gas Exchange Efficiency in Congestive Heart Failure. Circulation 101: 2774-2776 [Full Text]  
• Kleber, F. X., Vietzke, G., Wernecke, K. D., Bauer, U., Opitz, C., Wensel, R., Sperfeld, A., Glaser, S. (2000). Impairment of Ventilatory Efficiency in Heart Failure : Prognostic Impact. Circulation 101: 2803-2809 [Abstract] [Full Text]  
• MacFarlane, N. G., Darnley, G. M., Smith, G. L. (2000). Cellular basis for contractile dysfunction in the diaphragm from a rabbit infarct model of heart failure. Am. J. Physiol. Cell Physiol. 278: C739-C746 [Abstract] [Full Text]  
• Pardaens, K., Van Cleemput, J., Vanhaecke, J., Fagard, R. H. (2000). Peak Oxygen Uptake Better Predicts Outcome Than Submaximal Respiratory Data in Heart Transplant Candidates. Circulation 101: 1152-1157 [Abstract] [Full Text]  
• Clark, A. L., Davies, L. C., Francis, D. P., Coats, A. J.S. (2000). Ventilatory capacity and exercise tolerance in patients with chronic stable heart failure. Eur J Heart Fail 2: 47-51 [Abstract] [Full Text]  
• Davies, L C, Francis, D P, Piepoli, M, Scott, A C, Ponikowski, P, Coats, A J S (2000). Chronic heart failure in the elderly: value of cardiopulmonary exercise testing in risk stratification. Heart 83: 147-151 [Abstract] [Full Text]  
• Francis, D.P., Shamim, W., Davies, L.C., Piepoli, M.F., Ponikowski, P., Anker, S.D., Coats, A.J.S. (2000). Cardiopulmonary exercise testing for prognosis in chronic heart failure: continuous and independent prognostic value from VE/VCO2slope and peak VO2. Eur Heart J 21: 154-161 [Abstract]  
• O'DONNELL, D. E., D'ARSIGNY, C., RAJ, S., ABDOLLAH, H., WEBB, K. A. (1999). Ventilatory Assistance Improves Exercise Endurance in Stable Congestive Heart Failure. Am. J. Respir. Crit. Care Med. 160: 1804-1811 [Abstract] [Full Text]  
• Leyva, F, Chua, T-P, Godsland, I F, Coats, A J S, Anker, S D (1999). Loss of the normal coupling between the anaerobic threshold and insulin sensitivity in chronic heart failure. Heart 82: 348-351 [Abstract] [Full Text]  
• Niebauer, J., Pflaum, C.-D., Clark, A. L., Strasburger, C. J., Hooper, J., Poole-Wilson, P. A., Coats, A. J. S., Anker, S. D. (1998). Deficient insulin-like growth factor I in chronic heart failure predicts altered body composition, anabolic deficiency, cytokine and neurohormonal activation. J Am Coll Cardiol 32: 393-397 [Abstract] [Full Text]  
• CLARK, A L, MCDONAGH, T (1997). The origin of symptoms in chronic heart failure. Heart 78: 429-430 [Full Text]  
• Piepoli, M., Clark, A. L., Volterrani, M., Adamopoulos, S., Sleight, P., Coats, A. J.S. (1996). Contribution of Muscle Afferents to the Hemodynamic, Autonomic, and Ventilatory Responses to Exercise in Patients With Chronic Heart Failure : Effects of Physical Training. Circulation 93: 940-952 [Abstract] [Full Text]  
• Agostoni, P., Pellegrino, R., Conca, C., Rodarte, J. R., Brusasco, V. (2002). Exercise hyperpnea in chronic heart failure: relationships to lung stiffness and expiratory flow limitation. J. Appl. Physiol. 92: 1409-1416 [Abstract] [Full Text]