Heart 1999;81:121-127 ( February )

Oxygen uptake kinetics during low level exercise in patients with heart failure: relation to neurohormones, peak oxygen consumption, and clinical findings

H P Brunner-La Rocca,^a D Weilenmann,^a F Follath,^b M Schlumpf,^b H Rickli,^a C Schalcher,^a F E Maly,^c R Candinas,^a W Kiowski^a

^a Department of Internal Medicine, Division of Cardiology, University Hospital, Zurich, Switzerland, ^b Department of Internal Medicine, University Hospital, Zurich, ^c Institute of Clinical Chemistry, University Hospital, Zurich

Correspondence to: Dr H P Brunner-La Rocca, Baker Medical Research Institute, PO Box 6492, Melbourne 8008, Victoria, Australia.

Accepted for publication 10 September 1998

ObjectiveTo investigate whether oxygen uptake (O₂) kinetics during low intensity exercise are related to clinical signs, symptoms, and neurohumoral activation independently of peak oxygen consumption in chronic heart failure.
DesignComparison of O₂ kinetics with peak O₂, neurohormones, and clinical signs of chronic heart failure.
SettingTertiary care centre.
Patients48 patients with mild to moderate chronic heart failure.
InterventionsTreadmill exercise testing with "breath by breath" gas exchange monitoring. Measurement of atrial natriuretic factor (ANF), brain natriuretic peptide (BNP), and noradrenaline. Assessment of clinical findings by questionnaire.
Main outcome measuresO₂ kinetics were defined as O₂ deficit (time [rest to steady state] × O₂  O₂ [rest to steady state]; normalised to body weight) and mean response time of oxygen consumption (MRT; O₂ deficit/O₂).
ResultsO₂ kinetics were weakly to moderately correlated to the peak O₂ (O₂ deficit, r = 0.37, p < 0.05; MRT, r = 0.49, p < 0.001). Natriuretic peptides were more closely correlated with MRT (ANF, r = 0.58; BNP, r = 0.53, p < 0.001) than with O₂ deficit (ANF, r = 0.48, p = 0.001; BNP, r = 0.37, p < 0.01) or peak O₂ (ANF, r = 0.40; BNP, r = 0.31, p < 0.05). Noradrenaline was correlated with MRT (r = 0.33, p < 0.05) and O₂ deficit (r = 0.39, p < 0.01) but not with peak O₂ (r = 0.20, NS). Symptoms of chronic heart failure were correlated with all indices of oxygen consumption (MRT, r = 0.47, p < 0.01; O₂ deficit, r = 0.39, p < 0.01; peak O₂, r = 0.48, p < 0.01). Multivariate analysis showed that the correlation of O₂ kinetics with neurohormones and symptoms of chronic heart failure was independent of peak O₂ and other variables.
ConclusionsOxygen kinetics during low intensity exercise may provide additional information over peak O₂ in patients with chronic heart failure, given the better correlation with neurohormones which represent an index of homeostasis of the cardiovascular system.

Keywords: oxygen consumption; low intensity exercise; heart failure; neurohormones

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© 1999 by Heart
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