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. 1999 Feb;81(2):121–127. doi: 10.1136/hrt.81.2.121

Oxygen uptake kinetics during low level exercise in patients with heart failure: relation to neurohormones, peak oxygen consumption, and clinical findings

H Rocca 1, D Weilenmann 1, F Follath 1, M Schlumpf 1, H Rickli 1, C Schalcher 1, F Maly 1, R Candinas 1, W Kiowski 1
PMCID: PMC1728933  PMID: 9922345

Abstract

Objective—To investigate whether oxygen uptake (V̇O2) kinetics during low intensity exercise are related to clinical signs, symptoms, and neurohumoral activation independently of peak oxygen consumption in chronic heart failure.
Design—Comparison of V̇O2 kinetics with peak V̇O2, neurohormones, and clinical signs of chronic heart failure.
Setting—Tertiary care centre.
Patients—48 patients with mild to moderate chronic heart failure.
Interventions—Treadmill exercise testing with "breath by breath" gas exchange monitoring. Measurement of atrial natriuretic factor (ANF), brain natriuretic peptide (BNP), and noradrenaline. Assessment of clinical findings by questionnaire.
Main outcome measures—O2 kinetics were defined as O2 deficit (time [rest to steady state] × ΔV̇O2 − ∑V̇O2 [rest to steady state]; normalised to body weight) and mean response time of oxygen consumption (MRT; O2 deficit/ΔV̇O2).
Results—V̇O2 kinetics were weakly to moderately correlated to the peak V̇O2 (O2 deficit, r = −0.37, p < 0.05; MRT, r = −0.49, p < 0.001). Natriuretic peptides were more closely correlated with MRT (ANF, r = 0.58; BNP, r = 0.53, p < 0.001) than with O2 deficit (ANF, r = 0.48, p = 0.001; BNP, r = 0.37, p < 0.01) or peak V̇O2 (ANF, r = −0.40; BNP, r = −0.31, p < 0.05). Noradrenaline was correlated with MRT (r = 0.33, p < 0.05) and O2 deficit (r = 0.39, p < 0.01) but not with peak V̇O2 (r = −0.20, NS). Symptoms of chronic heart failure were correlated with all indices of oxygen consumption (MRT, r = 0.47, p < 0.01; O2 deficit, r = 0.39, p < 0.01; peak V̇O2, r = −0.48, p < 0.01). Multivariate analysis showed that the correlation of V̇O2 kinetics with neurohormones and symptoms of chronic heart failure was independent of peak V̇O2 and other variables.
Conclusions—Oxygen kinetics during low intensity exercise may provide additional information over peak V̇O2 in patients with chronic heart failure, given the better correlation with neurohormones which represent an index of homeostasis of the cardiovascular system.

 Keywords: oxygen consumption; low intensity exercise; heart failure; neurohormones

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Figure 1  .

Figure 1  

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Patient with delayed (upper panel) and normal (lower panel) oxygen uptake (V̇O2 ) kinetics at exercise onset. First vertical line (arrow) indicates onset of exercise and the second vertical line the time to steady state.

Figure 2  .

Figure 2  

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Scatterplot of peak oxygen consumption (V̇O2) (upper panel) and mean response time (MRT) of oxygen consumption at exercise onset to natriuretic peptides. The correlation of MRT to natriuretic peptides was closer (ANF, r = 0.59; BNP, r =0.53; p < 0.001) than the correlation of peak V̇O2 (ANF, r = −0.40, p < 0.01; BNP, r = −0.31, p < 0.05).

Figure 3  .

Figure 3  

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Scatterplot of peak oxygen consumption (V̇O2) (upper panel) and mean response time (MRT) of oxygen consumption at exercise onset to noradrenaline. Only the correlation of MRT with noradrenaline was significant (r = 0.33; p < 0.05; peak V̇O2, r = −0.20, NS).

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