Related Experiment Video
Updated: Oct 5, 2025
07:49
Author Spotlight: Investigating HR-Dependent Cardiac Function in Mouse Models Through a Novel Atrial-Pacing Approach
Published on: July 21, 2023
1.6K
The double anaerobic threshold in heart failure
Sara Rovai1, Mauro Contini1, Susanna Sciomer2
1Centro Cardiologico Monzino, IRCCS, Milano, Italy.
International Journal of Cardiology
|January 29, 2022
Summary
Double anaerobic threshold (AT) is common in heart failure patients and occurs more frequently with carvedilol than bisoprolol treatment. This finding may be linked to greater sympathetic inhibition and prolonged circulatory time.
Area of Science:
- Cardiology
- Exercise Physiology
Background:
- Cardiopulmonary exercise testing (CPET) is crucial for heart failure (HF) assessment.
- The anaerobic threshold (AT) is a key CPET parameter, typically determined by multiple methods.
- A lack of concordance between AT methods, termed double AT (DT), occurs in ~10% of healthy individuals.
Purpose of the Study:
- To investigate the frequency of double AT (DT) in heart failure (HF) patients.
- To compare the incidence of DT between bisoprolol and carvedilol treatments.
- To explore the potential link between DT and chemoreflex response in HF.
Main Methods:
- Reanalysis of CPET data from two cross-over studies involving stable HF patients.
- Comparison of CPET parameters during treatment with bisoprolol versus carvedilol.
- Assessment of chemoreflex response differences between the two beta-blockers.
Main Results:
- Double AT (DT) was identified in a high percentage of HF patients (46% with bisoprolol, 66% with carvedilol).
- Carvedilol treatment was associated with a significantly higher incidence of DT compared to bisoprolol (p < 0.01).
- Carvedilol use correlated with reduced peak oxygen uptake and oxygen pulse, suggesting lower peak cardiac output.
Conclusions:
- Double AT (DT) is a frequent finding in heart failure (HF) patients.
- DT occurs more often with carvedilol than bisoprolol, potentially due to greater sympathetic inhibition.
- These results suggest DT may indicate prolonged circulatory time and warrants further research.
Related Concept Videos
01:30Heart Failure V: Medical Management
40
Medical Management of Acute Decompensated Heart Failure (ADHF)The primary goals of therapy for patients hospitalized with acute decompensated heart failure (ADHF) include:Relieving symptomsOptimizing volume statusSupporting oxygenation and ventilationMaintaining cardiac output (CO) and end-organ perfusionIdentifying and addressing the cause of ADHFPreventing complicationsProviding patient education on factors precipitating HF exacerbationPlanning for dischargeOngoing monitoring and assessment...
40
01:17Pathophysiology of Heart Failure
1.9K
Heart failure (HF) is a progressive syndrome involving ventricles that leads to inadequate cardiac output. It can be classified based on location and output or ejection fraction. Ejection fraction (EF) is an essential measurement in the diagnosis and surveillance of HF. Reduced EF corresponds to systolic heart failure (HFrEF). However, HF with preserved ejection fraction (HFpEF) is becoming increasingly prevalent. Also known as diastolic HF, this form of HF is related to aging. The...
1.9K
01:29Heart Failure II: Pathophysiology
92
Systolic Heart Failure and Compensatory MechanismsSystolic heart failure (also termed HFrEF, Heart Failure with Reduced Ejection Fraction) is the most prevalent type of heart filure. It results in a decreased volume of blood being pumped from the ventricle. The aortic arch and carotid sinuses have baroreceptors that detect reduced blood pressure, triggering the sympathetic nervous system (SNS) to release epinephrine and norepinephrine. Initially, this response aims to boost heart rate and...
92
01:30Heart Failure IV: Classification and Diagnostic Evaluation
65
Heart failure can be classified in various ways, with the most common classifications based on physical activity limitations, disease progression, severity, and treatment strategies.The Functional Classification of Heart Failure divides patients into four categories based on physical activity limitation due to symptom burden.Class I: Patients in this class have cardiac disease but no physical activity limitations. Ordinary activities like walking, climbing stairs, or routine tasks do not cause...
65
01:30Heart Failure VII: Nursing Interventions
164
The first step in nursing management of a patient with heart failure involves thoroughly assessing the patient's medical history.Subjective Data: Obtain the patient's medical history of coronary artery disease, hypertension, myocardial infarction, and symptoms like dyspnea, orthopnea, and paroxysmal nocturnal dyspnea.Objective Data: Conduct a physical examination to identify findings such as jugular vein distention, pulmonary crackles, tachycardia, murmurs, peripheral edema, and vital signs,...
164
01:22Heart Failure VI: Adjunct Therapies
48
Additional therapies for treating patients with heart failure (HF) may include procedural interventions, supplemental oxygen, the management of sleep disorders, and nutritional therapy.Procedural InterventionsImplantable Cardioverter-Defibrillator: For patients at risk of life-threatening arrhythmias due to severe left ventricular dysfunction, an Implantable Cardioverter-Defibrillator (ICD) can detect and terminate these arrhythmias, preventing sudden cardiac death and improving survival rates.
48