Circulation, Vol 65, 1213-1223, Copyright © 1982 by American Heart Association
KT Weber, GT Kinasewitz, JS Janicki and AP Fishman
Muscular work requires the integration of cardiopulmonary mechanisms for
gas exchange and O2 delivery. In patients with chronic cardiac failure, the
response of these mechanisms may be impaired, and the pattern of O2
utilization (VO2) and gas exchange during exercise would thus provide an
objective assessment of the severity of heart failure. Accordingly, rates
of air flow, O2 uptake, CO2 elimination and minute ventilation were
determined during progressive treadmill exercise in 62 patients with stable
heart failure. Exercise cardiac output, systemic O2 extraction and lactate
production were measured directly in 40 patients with heart failure of
varying severity. As the severity of heart failure increased from class A
to D, there was a progressive decrease in exercise capacity (from 1157 +/-
154 to 373 +/- 157 seconds) and maximum VO2 (23 +/- 3.2 to 8.4 +/- 1.5
ml/min/kg). These decreases corresponded with the reduced maximum cardiac
output and stroke volume during exercise. The appearance of anaerobic
metabolism (580 +/- 17 to 157 +/- 7 seconds of exercise) and the
corresponding anaerobic threshold (17 +/- 0.34 to 7.1 +/- 1.5 ml/min/kg),
determined noninvasively, were reproducible and correlated with the rise in
mixed venous lactate concentration. No apparent untoward effects were
experienced during or after the progressive exercise test. We conclude that
the measurement of respiratory gas exchange and air flow during exercise is
an objective, reproducible and safe noninvasive method for characterizing
cardiac reserve and functional status in patients with chronic cardiac
failure.
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Oxygen utilization and ventilation during exercise in patients with chronic cardiac failure
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