Determination of the V.E/V.CO2 slope from a constant work-rate exercise test in cardiac patients

Incremental exercise testing to a symptom-limited maximum has been used to measure the ratio of the increase in ventilation (V.E) to the increase in CO(2) output (V.CO(2)) during exercise (V.E/V.CO(2) slope), a valuable index reflecting the severity of the ventilation-perfusion mismatch in heart failure. Here we studied whether this same value for the slope of V.E/V.CO(2) could be determined from a short constant work-rate exercise test of moderate intensity. Twenty-three patients with a previous myocardial infarction underwent moderate-intensity (69+/-15 W) constant work-rate exercise for 6 min and an incremental work-rate exercise test to the max. The V.E/V.CO(2) slope was calculated from the incremental exercise test from the start of increasing the work-rate to the ventilatory compensation point. The V.E/V.CO(2) slope was similarly calculated from the start of constant work-rate exercise until the 4th minute, when V.E and V.CO(2) changed minimally. The V.E/V.CO(2) slope determined from incremental exercise was 33.8+/-5.9, ranging from 20.9 to 42.8. The slope obtained from constant work-rate exercise was 32.9+/-5.7. The V.E/V.CO(2) slopes obtained from the two exercise tests did not differ significantly. The slope obtained from constant work-rate exercise was significantly positively correlated with the slope obtained from the incremental exercise (r=0.84, p<0.0001). The V.E/V.CO(2) slope can be determined from constant work-rate exercise at a moderate intensity. This indicates that the relationship between ventilation and CO(2) output is consistent and independent of the mode of exercise testing.