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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.

Keywords:

COPD cardiopulmonary exercise test cycle ergometer heart failure treadmill

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Published on: February 20, 2017

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.