Central and Peripheral Hemodynamic Adaptations During Cardiopulmonary Exercise Test in Heart Failure Patients With Exercise Periodic Breathing

Abstract

Some heart failure (HF) patients develop ventilatory oscillation which is composed of exercise periodic breathing (EPB) and sleep apnea. The ventilatory oscillation is associated with exercise intolerance. This study employed an integrated monitoring system to elucidate the way of central and peripheral hemodynamic adaption responding to exercise. This study recruited 157 HF patients to perform exercise testing using a bicycle ergometer. A noninvasive bio-reactance device was adopted to measure cardiac hemodynamics, whereas a near-infrared spectroscopy (NIRS) was used to assess perfusion and O2 extraction in the frontal cerebral lobe (FC) and vastus lateralis muscle (VL) during exercise respectively. Furthermore, quality of life (QoL) was measured with the Short Form-36 (SF-36) and the Minnesota Living with Heart Failure questionnaires (MLHFQ). The patients were divided into an EPB group (n = 65) and a non-EPB group (n = 92) according to their ventilation patterns during testing. Compared to their non-EPB counterparts, the patients with EPB exhibited 1) impaired aerobic capacity with a smaller peak oxygen consumption (VO2peak) and oxygen uptake efficiency slopes; 2) impaired circulatory and ventilatory efficiency with relatively high cardiac output and ventilation per unit workload; 3) impaired ventilatory/hemodynamic adaptation in response to exercise with elevated deoxyhemoglobin levels in the FC region; and 4) impaired QoL with lower physical component scores on the SF-36 and higher scores on the MLHFQ. In conclusion, EPB may reduce circulatory-ventilatory-hemodynamic efficiency during exercise, thereby impairing functional capacity in patients with HF.

Non-invasively measured central and peripheral factors of oxygen uptake differ between patients with chronic heart failure and healthy controls

“…Values for cardiac power output for patient and healthy controls were 3.8 ± 0.3 and 4.0 ± 0.3 (− 5.0%), respectively. In contrast, previous studies showed lower values of up to 31.0% in cardiac output [10,11,20,21] and up to 45.8% in cardiac power output [10,11,22] for patients with chronic heart failure compared to separately measured healthy participants. One possible explanation for these inconsistencies may be the different research designs and the high intra-and interindividual variabilities of the patients with chronic heart failure ( Figs.…”

“…In this context, previous studies investigating patients with chronic heart failure have focused on stroke volume [20], cardiac output [10,11,20], and cardiac power output [10,11]. Other studies examined healthy participants on stroke volume, cardiac output [21], and cardiac power output [22].…”

Influence of Cognitive Behavioral Therapy on Mood and Quality of Life After Stent Implantation in Young and Middle-Aged Patients With Coronary Heart Disease

“…1) The relationship between CHD and a change toward a negative mental status has attracted more and more attention, particularly the clinical studies of therapeutic intervention with regards to psychological and social factors of CHD. [2][3][4] Authors agree that many patients with CHD have persistent symptoms of depression and anxiety, 5,6) which significantly influence their quality of life (QOL) and prognosis, often leading to a vicious cycle. 7) However, whether the presence of depressive symptoms is due to depression after CHD or originates from the CHD itself is controversial.…”

Physical Exercise in the Management of Erectile Dysfunction in Patients with Heart Failure

“…The presence of peripheral hypoperfusion in HF patients with impaired LVEF 3,5,48,52 contributes to aggravate ED, 4,10,11 worsening functional status and exercise tolerance. 5,[53][54][55] The symptoms of HF (dyspnea, fatigue, and exercise intolerance) are among the main factors responsible for impairing sexual function. 5,13 The results of this review demonstrated that physical exercise in different intensities was able to promote significant improvement in functional capacity and tolerance to exercise in patients with HF and ED when evaluated by cardiopulmonary test.…”