Circulation, Vol 86, 1351-1356, Copyright © 1992 by American Heart Association
G Jondeau, SD Katz, L Zohman, M Goldberger, M McCarthy, JP Bourdarias and TH LeJemtel
BACKGROUND. In addition to depressed cardiac reserve, peripheral factors
may contribute to limit maximal exercise capacity in patients with
congestive heart failure (CHF). To investigate the role of reduced active
skeletal muscle mass, peak oxygen uptake (VO2, milligrams per kilogram per
minute) was determined during maximal symptom-limited exercise involving
the lower limbs (LL) alone and the lower limbs and upper limbs (LL+UL)
combined in patients with CHF and in normal subjects of similar age and
sex. METHODS AND RESULTS. LL bicycle exercise was performed upright with a
ramp protocol and continuous expired gas analysis. When respiratory
exchange ratio (RER) reached 1.0, UL exercise was initiated at constant
load with the use of a cranking device positioned at shoulder level. LL
exercise alone and combined LL+UL exercise were performed on separate days
in randomized order by 24 patients with CHF and seven normal subjects. In
patients with CHF, peak VO2 was greater during combined LL+UL exercise than
during LL exercise alone, i.e., 15.8 +/- 0.8 versus 14.2 +/- 0.9 ml.kg-
1.min-1 (p < 0.001), whereas in normal subjects, maximal VO2 was similar
during the two tests, i.e., 26.7 versus 26.2 ml.kg-1.min-1 (NS). The
increase in peak VO2 during combined LL+UL exercise relative to LL exercise
alone was almost exclusively observed in patients with peak VO2 < 15
ml.kg-1.min-1 (mean increase, 21.7 +/- 4.1%). Peak VO2 during combined LL
and UL exercise did not increase relative to LL exercise alone in patients
with peak VO2 > 15 ml.kg-1.min-1 and in normal subjects of similar age
and sex, i.e., 0.1 +/- 4.0% and 2.0 +/- 2.3% respectively. CONCLUSIONS. In
contrast to normal subjects and patients with moderate CHF, patients with
severe CHF do not exhaust their cardiopulmonary reserve during
symptom-limited maximal LL exercise on a bicycle.
ARTICLES
Active skeletal muscle mass and cardiopulmonary reserve. Failure to attain peak aerobic capacity during maximal bicycle exercise in patients with severe congestive heart failure
Department of Medicine, Albert Einstein College of Medicine, Bronx, N.Y. 10461.
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