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Ventilatory Response to Exercise in HFrEF-COPD: Importance of Exercise Modality
Marta Íscar Urrutia1, Julia Herrero Huertas2, Marina Acebo Castro1
1Department of Pneumology, Asturias Central University Hospital, 33011 Oviedo, Spain.
Journal of Clinical Medicine
|April 26, 2025
Summary
Cardiopulmonary exercise testing (CPET) on a treadmill yields higher oxygen consumption and ventilation compared to a cycle ergometer in heart failure with reduced ejection fraction and COPD patients. Breathing reserve differs by modality, aiding in diagnosing ventilatory limitation.
Area of Science:
- Cardiopulmonary physiology
- Exercise testing
- Respiratory and cardiovascular medicine
Background:
- Heart failure with reduced ejection fraction (HFrEF) and chronic obstructive pulmonary disease (COPD) often coexist, sharing symptoms like exertional dyspnea.
- Cardiopulmonary exercise testing (CPET) is crucial for diagnosing dyspnea but the influence of exercise modality (treadmill vs. cycle ergometer) on key parameters is not well understood in HFrEF patients, particularly those with comorbid COPD.
Purpose of the Study:
- To compare oxygen consumption (V·O2) and breathing reserve (BR) values derived from treadmill CPET versus cycle ergometer CPET.
- To investigate these differences in patients with coexisting HFrEF and COPD compared to those with HFrEF alone.
Main Methods:
- A prospective observational study involving 65 patients with HFrEF (left ventricular ejection fraction ≤ 40%), including 18 with comorbid COPD.
- Each patient underwent two CPETs: one on a treadmill and another on a cycle ergometer 48-72 hours later.
Main Results:
- In the HFrEF-COPD group, peak oxygen consumption (VO2/kg) and maximum ventilation (VE) were significantly higher during treadmill CPET compared to cycle ergometer CPET (p < 0.001 for both).
- Breathing reserve (BR%) was significantly lower on the treadmill (16 ± 21%) versus the cycle ergometer (33 ± 20%) in the HFrEF-COPD group (p < 0.001).
- Patients with HFrEF-COPD exhibited a lower BR across both exercise modalities compared to the HFrEF-only group (p = 0.01).
Conclusions:
- Treadmill CPET elicits a greater oxygen consumption and a more pronounced ventilatory response than cycle ergometry in patients with HFrEF and comorbid COPD.
- Breathing reserve emerges as a valuable differential parameter for identifying ventilatory limitation.
- The selection of exercise modality for CPET should be carefully considered based on the patient's specific underlying pathologies and the diagnostic goals of the test.
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