Inspiratory Capacity and Dynamic Hyperinflation During Exercise in Patients With Cardiovascular Disease: A SYSTEMATIC...

Expiratory flow limitation (EFL) and dynamic hyperinflation (DH) may significantly impact exercise capacity in patients with heart disease. Although commonly linked to lung diseases, recent evidence highlights their role in cardiovascular disease (CVD), contributing to exercise intolerance. This systematic review examines studies from the past decade on pulmonary function during exercise, measured using inspiratory capacity (IC) maneuvers, in patients with CVD, emphasizing prevalence and clinical significance.

A systematic literature search in PubMed, Scopus, and Cochrane (January 2014-February 2024) explored pulmonary function during exercise in patients with CVD. Two independent reviewers assessed studies using established Quality Assessment Tools.

Seven studies including 231 patients with CVD (mean age 31-66 yr, predominantly male) used cardiopulmonary exercise testing to evaluate exercise-induced DH or EFL with varying definitions. Study quality was mixed. Patients with myocardial infarction showed EFL at moderate exercise, while patients with stable coronary artery disease exhibited EFL only at high intensities. Up to 50% of patients with pulmonary arterial hypertension have DH during peak exercise (P < .05). In patients with heart failure, 25% experienced DH, while others maintained stable breathing. Patients who are post-Fontan displayed pulmonary inefficiencies without DH. Methodological variability precludes definitive conclusions on DH prevalence in patients with CVD. However, reduced IC during exercise, DH, and EFL occur in a substantial proportion of patients, indicating a lower EFL threshold and earlier ventilatory constraints. Further research into heart-lung integration during exercise is crucial for developing personalized treatments and improving clinical management in those patients.