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Heart Failure with Reduced Ejection Fraction and Prognostic Scales: The Impact of Exercise Modality in

Julia Herrero Huertas1, Marta García Clemente2, Beatriz Díaz Molina3

  • 1Department of Pneumology, Fundación Jiménez Díaz University Hospital, 28040 Madrid, Spain.

Journal of Clinical Medicine
|June 10, 2022
PubMed

Insights

Cardiopulmonary exercise testing (CPET) reveals significant differences in heart failure with reduced ejection fraction (HFrEF) patients based on exercise modality. Treadmill testing yields higher peak VO2 and altered ventilatory responses compared to cycle-ergometry, impacting patient classification.

Area of Science:

  • Cardiology
  • Exercise Physiology
  • Pulmonology

Background:

  • Cardiopulmonary exercise testing (CPET) is crucial for assessing heart failure with reduced ejection fraction (HFrEF).
  • Current CPET protocols often overlook the influence of exercise modality (e.g., treadmill vs. cycle-ergometer) on results.
  • Understanding these differences is vital for accurate patient stratification and treatment decisions.

Purpose of the Study:

  • To investigate and compare key physiological parameters obtained during CPET using treadmill versus cycle-ergometer exercise in HFrEF patients.
  • To determine if the choice of exercise modality affects patient classification and prognostic assessment.

Main Methods:

  • A prospective study involving 65 HFrEF patients.
  • Each patient underwent both treadmill and cycle-ergometer CPET, separated by 72 hours.
  • Key metrics analyzed included peak oxygen consumption (VO2), VE/VCO2 slope, maximum ventilation, and ventilatory reserve.

Main Results:

  • Peak VO2 was significantly higher (20%) during treadmill exercise compared to cycle-ergometry.
  • The VE/VCO2 slope, indicating ventilatory efficiency, was lower on the treadmill (32 vs. 34).
  • Treadmill testing resulted in greater maximum ventilation and ventilatory reserve, leading to changes in functional and ventilatory class for a significant proportion of patients.

Conclusions:

  • Exercise modality significantly influences CPET results in HFrEF patients.
  • Differences in peak VO2 and ventilatory parameters between treadmill and cycle-ergometer tests can alter patient prognostication and treatment recommendations.
  • CPET results must be interpreted considering the specific exercise modality employed.

Keywords:
VE/VCO2 slopeVO2cardiopulmonary exercise testscycle ergometerheart failure with reduced ejection fractionprognostic scalestreadmill

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