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Published on: February 13, 2021
Exercise capacity in chronic heart failure is related to the aetiology of heart disease
A L Clark1, D Harrington, T P Chua
1Department of Cardiology, Western Infirmary, Glasgow, UK.
Insights
The cause of chronic heart failure influences exercise capacity, even with similar cardiac dysfunction. Ischaemic heart disease patients show poorer exercise performance than dilated cardiomyopathy patients.
Area of Science:
- Cardiology
- Exercise Physiology
Background:
- Chronic heart failure (CHF) aetiology impacts patient outcomes.
- Understanding exercise performance variations is crucial for CHF management.
Purpose of the Study:
- To determine if the underlying cause of chronic heart failure predicts exercise performance.
- To compare exercise capacity in patients with ischaemic heart disease versus dilated cardiomyopathy.
Main Methods:
- Retrospective analysis of 212 CHF patients undergoing maximal exercise testing.
- Assessment of metabolic gas exchange, left ventricular function (echocardiography, radionucleide ventriculography), and coronary angiography.
- Categorization into ischaemic heart disease (n=122) and dilated cardiomyopathy (n=90) groups.
Main Results:
- Dilated cardiomyopathy patients were younger but had similar ejection fraction and fractional shortening compared to ischaemic patients.
- Peak oxygen consumption (VO2) was higher in the dilated cardiomyopathy group.
- After age adjustment, peak VO2 remained significantly higher in the dilated cardiomyopathy group (p < 0.002).
Conclusions:
- Heart failure aetiology affects exercise performance independently of cardiac dysfunction severity.
- Separate consideration of ischaemic and dilated cardiomyopathy is warranted for exercise physiology abnormalities.
- Aetiology-driven differences in exercise performance may contribute to worse prognosis in ischaemic heart failure.
Objective:
To assess whether the underlying aetiology of chronic heart failure is a predictor of exercise performance.
Setting:
Tertiary referral centre for cardiology.
Patients And Outcome Measures:
Retrospective study of maximum exercise testing with metabolic gas exchange measurements in 212 patients with chronic heart failure who had undergone coronary angiography. Echocardiography and radionucleide ventriculography were used to determine indices of left ventricular function, and coronary arteriography was used to determine whether the cause of chronic heart failure was ischaemic heart disease (n = 122) or dilated cardiomyopathy (n = 90).
Results:
The cardiomyopathy group was younger (mean (SD) age 58.45 (11.66) years v 61.49 (7.42); p = 0.02) but there was no difference between the groups in ejection fraction or fractional shortening. Peak oxygen consumption (VO2) was higher in the dilated group, while the slope relating carbon dioxide production and ventilation (VE/VCO2 slope) was the same in both groups. Both groups achieved similar respiratory exchange ratios at peak exercise, suggesting that there was near maximum exertion. There was a relation between peak VO2 and age (peak VO2 = 33.9-0.267*age; r = 0.36; p < 0.001). After correcting for age, the peak achieved VO2 was still greater in the cardiomyopathy group than in the ischaemic group (p < 0.002).
Conclusions:
Exercise performance for a given level of cardiac dysfunction appears to vary with the aetiology of heart failure. Thus the two diagnostic categories should be considered separately in relation to abnormalities of exercise physiology. The difference may in part account for the worse prognosis in ischaemic patients.
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