Document Detail


Abnormal haemodynamic response to exercise in heart failure with preserved ejection fraction.
MedLine Citation:
PMID:  21979991     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
AIMS: Peak oxygen uptake (VO(2)) is diminished in patients with heart failure with preserved ejection fraction (HFpEF) suggesting impaired cardiac reserve. To test this hypothesis, we assessed the haemodynamic response to exercise in HFpEF patients.
METHODS AND RESULTS: Eleven HFpEF patients (73 ± 7 years, 7 females/4 males) and 13 healthy controls (70 ± 4 years, 6 females/7 males) were studied during submaximal and maximal exercise. The cardiac output (Q(c), acetylene rebreathing) response to exercise was determined from linear regression of Q(c) and VO(2) (Douglas bags) at rest, ∼30% and ∼60% of peak VO(2), and maximal exercise. Peak VO(2) was lower in HFpEF patients than in controls (13.7 ± 3.4 vs. 21.6 ± 3.6 mL/kg/min; P < 0.001), while indices of cardiac reserve were not statistically different: peak cardiac power output [CPO = Q(c) × mean arterial pressure (MAP); HFpEF 1790 ± 509 vs. controls 2119 ± 581 L/mmHg/min; P = 0.20]; peak stroke work [SW = stroke volume (SV) × MAP; HFpEF 13 429 ± 2269 vs. controls 13 200 ± 3610 mL/mmHg; P = 0.80]. The ΔQ(c)/ΔVO(2) slope was abnormally elevated in HFpEF patients vs. controls (11.2 ±3.6 vs. 8.3 ± 1.5; P = 0.015).
CONCLUSION: Contrary to our hypothesis, cardiac reserve is not significantly impaired in well-compensated outpatients with HFpEF. The abnormal haemodynamic response to exercise (decreased peak VO(2), increased ΔQ(c)/ΔVO(2) slope) is similar to that observed in patients with mitochondrial myopathies, suggesting an element of impaired skeletal muscle oxidative metabolism. This impairment may limit functional capacity by two mechanisms: (i) premature skeletal muscle fatigue and (ii) metabolic signals to increase the cardiac output response to exercise which may be poorly tolerated by a left ventricle with impaired diastolic function.
Authors:
Paul S Bhella; Anand Prasad; Katja Heinicke; Jeff L Hastings; Armin Arbab-Zadeh; Beverley Adams-Huet; Eric L Pacini; Shigeki Shibata; M Dean Palmer; Bradley R Newcomer; Benjamin D Levine
Publication Detail:
Type:  Comparative Study; Journal Article; Research Support, N.I.H., Extramural     Date:  2011-10-05
Journal Detail:
Title:  European journal of heart failure     Volume:  13     ISSN:  1879-0844     ISO Abbreviation:  Eur. J. Heart Fail.     Publication Date:  2011 Dec 
Date Detail:
Created Date:  2011-11-21     Completed Date:  2012-03-27     Revised Date:  2013-06-27    
Medline Journal Info:
Nlm Unique ID:  100887595     Medline TA:  Eur J Heart Fail     Country:  Netherlands    
Other Details:
Languages:  eng     Pagination:  1296-304     Citation Subset:  IM    
Affiliation:
The Institute for Exercise and Environmental Medicine, 7232 Greenville Avenue, Dallas, TX 75231, USA.
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MeSH Terms
Descriptor/Qualifier:
Aged
Disease Progression
Echocardiography
Electrocardiography
Exercise Test
Exercise Tolerance / physiology*
Female
Follow-Up Studies
Heart Failure / diagnosis,  metabolism,  physiopathology*
Hemodynamics / physiology*
Humans
Magnetic Resonance Spectroscopy
Male
Myocardium / metabolism
Oxygen Consumption
Stroke Volume / physiology
Ventricular Function, Left
Grant Support
ID/Acronym/Agency:
R01 AG17479/AG/NIA NIH HHS; UL1 RR024982/RR/NCRR NIH HHS
Comments/Corrections

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