| Determinants of exercise intolerance in elderly heart failure patients with preserved ejection fraction. | |
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MedLine Citation:
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PMID: 21737017 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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OBJECTIVES: The purpose of this study was to determine the mechanisms responsible for reduced aerobic capacity (peak Vo(2)) in patients with heart failure with preserved ejection fraction (HFPEF). BACKGROUND: HFPEF is the predominant form of heart failure in older persons. Exercise intolerance is the primary symptom among patients with HFPEF and a major determinant of reduced quality of life. In contrast to patients with heart failure and reduced ejection fraction, the mechanism of exercise intolerance in HFPEF is less well understood. METHODS: Left ventricular volumes (2-dimensional echocardiography), cardiac output, Vo(2), and calculated arterial-venous oxygen content difference (A-Vo(2) Diff) were measured at rest and during incremental, exhaustive upright cycle exercise in 48 HFPEF patients (age 69 ± 6 years) and 25 healthy age-matched controls. RESULTS: In HFPEF patients compared with healthy controls, Vo(2) was reduced at peak exercise (14.3 ± 0.5 ml·kg·min(-1) vs. 20.4 ± 0.6 ml·kg·min(-1); p < 0.0001) and was associated with a reduced peak cardiac output (6.3 ± 0.2 l·min(-1) vs. 7.6 ± 0.2 l·min(-1); p < 0.0001) and A-Vo(2) Diff (17 ± 0.4 ml·dl(-1) vs. 19 ± 0.4 ml·dl(-1), p < 0.0007). The strongest independent predictor of peak Vo(2) was the change in A-Vo(2) Diff from rest to peak exercise (A-Vo(2) Diff reserve) for both HFPEF patients (partial correlate, 0.58; standardized β coefficient, 0.66; p = 0.0002) and healthy controls (partial correlate, 0.61; standardized β coefficient, 0.41; p = 0.005). CONCLUSIONS: Both reduced cardiac output and A-Vo(2) Diff contribute significantly to the severe exercise intolerance in elderly HFPEF patients. The finding that A-Vo(2) Diff reserve is an independent predictor of peak Vo(2) suggests that peripheral, noncardiac factors are important contributors to exercise intolerance in these patients. |
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Authors:
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Mark J Haykowsky; Peter H Brubaker; Jerry M John; Kathryn P Stewart; Timothy M Morgan; Dalane W Kitzman |
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Publication Detail:
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Type: Journal Article; Research Support, N.I.H., Extramural |
Journal Detail:
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Title: Journal of the American College of Cardiology Volume: 58 ISSN: 1558-3597 ISO Abbreviation: J. Am. Coll. Cardiol. Publication Date: 2011 Jul |
Date Detail:
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Created Date: 2011-07-08 Completed Date: 2011-09-13 Revised Date: 2012-05-17 |
Medline Journal Info:
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Nlm Unique ID: 8301365 Medline TA: J Am Coll Cardiol Country: United States |
Other Details:
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Languages: eng Pagination: 265-74 Citation Subset: AIM; IM |
Copyright Information:
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Copyright © 2011 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved. |
Affiliation:
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Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Alberta, Canada. |
Export Citation:
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APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
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Aged Cardiac Output Echocardiography Exercise Test Exercise Tolerance* Female Heart Failure / physiopathology*, ultrasonography Humans Male Oxygen / blood Oxygen Consumption Stroke Volume* Ventricular Function, Left |
| Grant Support | |
ID/Acronym/Agency:
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5T32HL076132-02/HL/NHLBI NIH HHS; MO1RR07122/RR/NCRR NIH HHS; P30 AG021332-08/AG/NIA NIH HHS; P30AG21332/AG/NIA NIH HHS; R01 AG012257-07/AG/NIA NIH HHS; R01AG12257/AG/NIA NIH HHS; R37 AG018915/AG/NIA NIH HHS; R37 AG018915-07/AG/NIA NIH HHS; R37AG18915/AG/NIA NIH HHS |
| Chemical | |
Reg. No./Substance:
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7782-44-7/Oxygen |
| Comments/Corrections | |
Comment In:
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J Am Coll Cardiol. 2011 Jul 12;58(3):275-7
[PMID:
21737018
]
J Am Coll Cardiol. 2011 Dec 6;58(24):2547-8; author reply 2548-9 [PMID: 22133861 ] |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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