Performance of Heart Failure Patients with Severely Reduced Ejection Fraction during Cardiopulmonary Exercise Testing on Treadmill and Cycle Ergometer; Similarities and Differences

Abstract

Background: Peak oxygen consumption (VO2) measured by cardiopulmonary exercise testing (CPET) is a significant predictor of mortality and future transplantation in heart failure patients with severely reduced ejection fraction (HFrEF). The present study evaluated the differences in peak VO2 and other prognostic variables between treadmill and cycle CPETs in these patients. Methods: In this cross-over study design, thirty males with severe HFrEF underwent CPET on both a treadmill and a cycle ergometer within 2–5 days apart, and important CPET parameters between two exercise test modalities were compared. Results: Peak VO2 was 23.12% higher on the treadmill than on cycle (20.55 ± 3.3 vs. 16.69 ± 3.01, p < 0.001, respectively). Minute ventilation to carbon dioxide production (VE/VCO2) slope was not different between the two CPET modes (p = 0.32). There was a strong positive correlation between the VE/VCO2 slopes during treadmill and cycle testing (r = 0.79; p < 0.001). VE/VCO2 slope was not related to peak respiratory exchange ratio (RER) in either modality (treadmill, r = 0.13, p = 0.48; cycle, r = 0.25, p = 0.17). The RER level was significantly higher on the cycle ergometer (p < 0.001). Conclusion: Peak VO2 is higher on treadmill than on cycle ergometer in severe HFrEF patients. In addition, VE/VCO2 slope is not a modality dependent parameter and is not related to the patients’ effort during CPET.

Estimating VO2peak in 18–90 Year-Old Adults: Development and Validation of the FitMáx©-Questionnaire

“… 36 , 37 According to previous studies, cycle ergometer CPET is likely to underestimate VO 2peak compared to treadmill CPET. 38 , 39 However, for safety concerns, to prevent measurement errors and because of the clinical infrastructure in the Máxima MC, we used cycle ergometer CPET as gold standard. All CPETs were supervised by sports physicians or a human movement scientist, and conducted according to international standards.…”

Heart Failure with Reduced Ejection Fraction and Prognostic Scales: The Impact of Exercise Modality in Cardiopulmonary Exercise Tests

“…This phenomenon, together with the increase in catecholamines during the treadmill exercise and changes in blood flow distribution in HFrEF [ 20 ], may explain the higher HR on the treadmill and higher diastolic BP on the cycle ergometer. Regarding HRR-1, previous studies [ 22 , 23 , 24 ] reported disparate results. In our study, HRR-1 was better on the treadmill.…”

“…Regarding the ventilatory response, VE, RR, and BR reflected the higher ventilatory demand of the treadmill, although with a better ventilatory efficiency when analyzing PetCO 2 and EqO 2 /EqCO 2 . Of these parameters, only PetCO 2 had been studied in HFrEF by Mazaheri et al [ 24 ], although in a small sample of exclusively male patients ( n = 30) with significantly lower effort on the treadmill. These results highlight the importance of the exercise modality in ventilatory demand because the ventilatory response varies with the type of ergometer.…”

“…A few studies compared the two ergometers in the 1990s [ 18 , 19 , 20 ], with a small sample size of select patients, as in Witte et al [ 21 ] ( n = 11), Maeder et al [ 22 ] ( n = 21), Beckers et al [ 23 ] ( n = 55) and Mazaheri et al [ 24 ] ( n = 30). VO 2 differences ranged from 10% to 23% [ 18 , 19 , 20 , 21 , 22 , 23 , 24 ] and with considerable variability in VE/VCO 2 slope [ 21 , 22 , 23 , 24 ].…”

“…To date, few studies involving a small sample size of select patients have compared the results from both exercise modalities using the parameters peak VO 2 and VE/VCO 2 slope [ 18 , 19 , 20 , 21 , 22 , 23 , 24 ].…”