Gas exchange and metabolic transients in heart transplant recipients

In human heart transplant recipients (HTR) an impairment of the cardiac function was expected to reduce peak oxygen consumption and the kinetics of the adjustment of respiratory gas exchange at the onset of rectangular work loads. In nine patients (males, 23-59 yr) 1 to 8 months after cardiac transplantation average peak VO2 (VO2p) was 1.1 L.min-1 +/- 0.3 (SD), i.e. 45% of that of the controls, the corresponding VCO2p value being 1.4 L.min-1 +/- 0.3 (SD). Mean VEp was 62.9 L.min-1 +/- 20.3 (SD), mean HRp was 136 beats.min-1 +/- 11 (SD), i.e. 45 beats.min-1 higher than preexercise values. Mean [Lab]p was 7.7 mM +/- 1.7 (SD), indicating that at the heaviest load the HTR were performing work at or above their maximum aerobic power. During the initial 60-90 sec of the transition from rest to graded rectangular exercise HR did not change from the resting value, increasing thereafter almost linearly with time. The half time (t1/2) of the VE on-response was 112 sec +/- 30 (SD) (controls values: 59 sec +/- 16), that of the VCO2 on- was 95 sec +/- 18 (SD) (58 sec +/- 11), and that of the VO2 on- was 78 sec +/- 24 (SD) (38 sec +/- 6). In spite of the slow kinetics of the VO2 on- response, no massive accumulation of lactate was found in the early phase of exercise. The limitation of the peak exercise in HTR appears to be imposed by a reduced maximal cardiac performance. The slow readjustment of the latter, as expected from the sluggish heart rate response, however, does not impair substantially the work load transients nor reduce the anaerobic threshold.