Maximal Exercise Tolerance in Chronic Congestive Heart Failure

Carell, Edgar S.; Murali, Srinivas; Schulman, Douglas S.; Estrada-Quintero, Tulio; Uretsky, Barry F.

doi:10.1378/chest.106.6.1746

Cited by 38 publications

(26 citation statements)

References 29 publications

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“…Numerous studies have demonstrated that, in patients with heart failure of various aetiologies, baseline left ventricular function is poorly correlated to peak exercise capacity [20][21][22][23][24][25][26]. In particular, left ventricular ejection fraction (LVEF) [20,21,[23][24][25][26], E and A wave velocities [24] and right ventricular ejection fraction [21] have been shown to be poorly related to exercise capacity, although other markers of diastolic function may perform slightly better [22].…”

Section: Is Dyspnoea Related To Left and Right Ventricular Haemodynammentioning

confidence: 99%

“…In particular, left ventricular ejection fraction (LVEF) [20,21,[23][24][25][26], E and A wave velocities [24] and right ventricular ejection fraction [21] have been shown to be poorly related to exercise capacity, although other markers of diastolic function may perform slightly better [22]. In addition, resting baseline left ventricular function is poorly associated with baseline dyspnoea and functional class [20,24]. Although these studies have not directly quantified the relationship between exertional dyspnoea and markers of ventricular function, it seems unlikely that these indices would provide a satisfactory estimation of the dyspnoea burden of heart failure patients given that exertional dyspnoea, even in this population, increases relatively linearly with exercise capacity [3].…”

Section: Is Dyspnoea Related To Left and Right Ventricular Haemodynammentioning

confidence: 99%

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Exertional dyspnoea in chronic heart failure: the role of the lung and respiratory mechanical factors

2016

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Exertional dyspnoea is among the dominant symptoms in patients with chronic heart failure and progresses relentlessly as the disease advances, leading to reduced ability to function and engage in activities of daily living. Effective management of this disabling symptom awaits a better understanding of its underlying physiology.Cardiovascular factors are believed to play a major role in dyspnoea in heart failure patients. However, despite pharmacological interventions, such as vasodilators or inotropes that improve central haemodynamics, patients with heart failure still complain of exertional dyspnoea. Clearly, dyspnoea is not determined by cardiac factors alone, but likely depends on complex, integrated cardio-pulmonary interactions.A growing body of evidence suggests that excessively increased ventilatory demand and abnormal "restrictive" constraints on tidal volume expansion with development of critical mechanical limitation of ventilation, contribute to exertional dyspnoea in heart failure. This article will offer new insights into the pathophysiological mechanisms of exertional dyspnoea in patients with chronic heart failure by exploring the potential role of the various constituents of the physiological response to exercise and particularly the role of abnormal ventilatory and respiratory mechanics responses to exercise in the perception of dyspnoea in patients with heart failure. @ERSpublications In heart failure, respiratory and peripheral factors play a significant role in exertional dyspnoea development

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Section: Is Dyspnoea Related To Left and Right Ventricular Haemodynammentioning

confidence: 99%

Section: Is Dyspnoea Related To Left and Right Ventricular Haemodynammentioning

confidence: 99%

Exertional dyspnoea in chronic heart failure: the role of the lung and respiratory mechanical factors

2016

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“…However, EF at times fails to document the LV dysfunction responsible for heart failure symptoms [2]. Further, previous work has shown that EF does not correlate with quantitative measures of functional capacity [3,4]. In patients with heart failure and preserved EF, researchers have suggested that abnormal Doppler echocardiographic measures of LV diastolic filling and myocardial relaxation velocities are able to quantify the abnormal myocardial compliance responsible for symptoms.…”

Section: Introductionmentioning

confidence: 99%

Speckle tracking echocardiography-determined measures of global and regional left ventricular function correlate with functional capacity in patients with and without preserved ejection fraction

Petersen

Nazir

Lee

et al. 2013

Cardiovasc Ultrasound

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BackgroundStandard measures of left ventricular systolic and diastolic function often fail to identify left ventricular dysfunction in patients with heart failure and do not correlate with measures of functional capacity.AimTo determine if speckle tracking echocardiography (STE)–determined measures of global and regional myocardial contractility have a linear association with functional capacity in patients with and without preserved ejection fraction.MethodsIn 68 adult patients, functional status was estimated with the Duke Activity Status Index (DASI), left ventricular ejection fraction was determined with Simpson’s biplane method, and QLAB advanced quantification software (Philips, The Netherlands) was used to determine peak measures of strain.ResultsGlobal and regional measures of longitudinal, circumferential, and radial strain had a strong linear association with the DASI score. Longitudinal strain in the inferolateral segments had the strongest correlation with DASI (r = −0.72, P < 0.001). In patients with an ejection fraction ≥45%, ejection fraction and E/e’ had no correlation with DASI, whereas longitudinal strain in the inferolateral segments had significant correlation with DASI (r = −0.53, P = 0.03, n = 16).ConclusionsSTE–determined measures of global and regional left ventricular function have a strong linear association with estimates of functional capacity in patients with and without preserved ejection fraction. STE–determined measures of strain, especially longitudinal strain, are likely to be important targets for therapy and should be considered in future studies aimed at improving our diagnosis of left ventricular inadequacy in patients with heart failure, especially those with preserved ejection fraction.

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“…In particular, exercise tolerance does not correlate with ejection fraction at rest, [2] or central haemodynamics at rest or on exercise [3], though some echocardiographic measures of left ventricular function fare better [4]. Models incorporating adaptations to organs other than the heart have been more successful [5] and there is growing interest in exercise and rehabilitation as therapy for heart failure patients [6].…”

Section: Introductionmentioning

confidence: 99%

Central and peripheral quadriceps fatigue in congestive heart failure

Hopkinson¹,

Dayer²,

Antoine‐Jonville³

et al. 2013

International Journal of Cardiology

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AimsThe clinical syndrome of heart failure includes exercise limitation that is not directly linked to measures of cardiac function. Quadriceps fatigability may be an important component of this and this may arise from peripheral or central factors.Methods and resultsWe studied 10 men with CHF and 10 healthy age-matched controls. Compared with a rest condition, 10 min after incremental maximal cycle exercise, twitch quadriceps force in response to supramaximal magnetic femoral nerve stimulation fell in both groups (CHF 14.1% ± 18.1%, p = 0.037; Control: 20.8 ± 11.0%, p < 0.001; no significant difference between groups). There was no significant change in quadriceps maximum voluntary contraction voluntary force. The difference in the motor evoked potential (MEP) response to transcranial magnetic stimulation of the motor cortex between rest and exercise conditions at 10 min, normalised to the peripheral action potential, also fell significantly in both groups (CHF: 27.3 ± 38.7%, p = 0.037; Control: 41.1 ± 47.7%, p = 0.024). However, the fall in MEP was sustained for a longer period in controls than in patients (p = 0.048).ConclusionsThe quadriceps is more susceptible to fatigue, with a similar fall in TwQ occurring in CHF patients at lower levels of exercise. This is associated with no change in voluntary activation but a lesser degree of depression of quadriceps motor evoked potential.

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Maximal Exercise Tolerance in Chronic Congestive Heart Failure

Cited by 38 publications

References 29 publications

Exertional dyspnoea in chronic heart failure: the role of the lung and respiratory mechanical factors

Exertional dyspnoea in chronic heart failure: the role of the lung and respiratory mechanical factors

Speckle tracking echocardiography-determined measures of global and regional left ventricular function correlate with functional capacity in patients with and without preserved ejection fraction

Central and peripheral quadriceps fatigue in congestive heart failure

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