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Published on: October 1, 2019
Characterization of exercise limitations by evaluating individual cardiac output patterns: a prospective cohort study
Ruud F Spee1, Victor M Niemeijer2, Bart Wessels3
1Department of Cardiology, Máxima Medical Centre, De Run 4600, P.O. Box 7777, Veldhoven, 5500 MB, The Netherlands. r.spee@mmc.nl.
Insights
Chronic heart failure patients show varied exercise intolerance. One-third experience central hemodynamic limitations, impacting cardiac output and stroke volume, highlighting the need for personalized treatment strategies.
Area of Science:
- Cardiology
- Exercise Physiology
Background:
- Chronic heart failure (CHF) patients exhibit exercise intolerance.
- Central hemodynamic impairment and peripheral skeletal muscle alterations contribute to reduced exercise capacity.
- The precise balance between central and peripheral factors remains debated.
Purpose of the Study:
- Investigate heterogeneity in exercise intolerance by analyzing cardiac output (Q) patterns.
- Determine if patient and disease characteristics correlate with central hemodynamic exercise limitation.
Main Methods:
- Sixty-four stable CHF patients underwent symptom-limited incremental exercise tests.
- Cardiac output (Q) was assessed using radial artery pulse contour analysis.
- Central hemodynamic exercise limitation was defined as a plateau or decline in Q during peak exercise.
Main Results:
- A central hemodynamic limitation was identified in 34% of patients.
- These patients showed higher rates of plateau/decrease in oxygen uptake (VO2) and stroke volume (SV).
- Chronotropic incompetence was more prevalent, while left bundle branch block (LBBB) was less common.
Conclusions:
- Significant heterogeneity exists in exercise limitations among CHF patients.
- A central hemodynamic limitation, indicated by reduced Q, affects approximately one-third of patients.
- This limitation is linked to impaired augmentation of stroke volume and heart rate.
Background:
Patients with chronic heart failure (CHF) suffer from exercise intolerance due to impaired central hemodynamics and subsequent alterations in peripheral skeletal muscle function and structure. The relative contribution of central versus peripheral factors in the reduced exercise capacity is still subject of debate. The main purpose was to investigate heterogeneity in the nature of exercise intolerance by evaluating individual cardiac output (Q) patterns. The secondary purpose was to evaluate whether patient and disease characteristics were associated with a central hemodynamic exercise limitation.
Methods:
Sixty-four stable CHF patients performed a symptom limited incremental exercise test with respiratory gas analysis and simultaneous assessment of Q, using a radial artery pulse contour analysis method. A central hemodynamic exercise limitation was defined as a plateau or decline in Q from 90 to 100 % of exercise duration.
Results:
Data from 61 patients were analyzed. A central hemodynamic exercise limitation was observed in 21 patients (34 %). In these patients, a higher occurrence of a plateau/decrease in oxygen uptake (VO2) (52 % vs 23 %, p = 0.02), stroke volume (SV) (100 % vs. 75 %, p = 0.01) and chronotropic incompetence (31 % vs. 2.5 %, p = 0.01) was observed, while presence of a left bundle branch block (LBBB) occurred significantly less (19 % vs 48 %, p = 0.03) There was no difference in disease characteristics such as etiology, duration, NYHA class, mitral regurgitation or ischemia.
Conclusions:
The study revealed considerable heterogeneity in the nature of exercise limitations between moderately impaired CHF patients. In one third of the study population a plateau or decrease in Q towards peak exercise was demonstrated, which is indicative of a central hemodynamic exercise limitation. A central hemodynamic exercise limitation was associated with an impairment to augment stroke volume and heart rate.
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