Skip to main content
PMC home page
British Heart Journal logoLink to British Heart Journal
. 1995 Jul;74(1):27–33. doi: 10.1136/hrt.74.1.27

Perfusion/ventilation mismatch during exercise in chronic heart failure: an investigation of circulatory determinants.

A P Banning 1, N P Lewis 1, D B Northridge 1, J S Elborn 1, A H Hendersen 1
PMCID: PMC483942  PMID: 7662449

Abstract

BACKGROUND--The ventilatory cost of carbon dioxide (CO2) elimination on exercise (VE/VCO2) is increased in chronic heart failure (CHF). This reflects increased physiological dead space ventilation secondary to mismatching between perfusion and ventilation during exercise. The objectives of this study were to investigate the relation of this increased VE/VCO2 slope to the syndrome of CHF or to limitation of the exercise related increase of pulmonary blood flow, or both. PATIENTS AND METHODS--Maximal treadmill exercise tests with respiratory gas analysis were performed in 45 patients with CHF (defined as resting left ventricular ejection fraction < 40% on radionuclide scan); 15 normal controls; 23 patients with coronary artery disease and normal resting left ventricular function; and 13 pacemaker dependent patients (six with and seven without CHF) directly comparing exercise responses in rate responsive and fixed rate mode. RESULTS--Patients with CHF had a steeper VE/VCO2 slope than normal controls: this was related inversely to peak VO2 below 20 mol/min/kg. In patients with coronary artery disease in whom peak VO2 (at respiratory exchange ratio > 1) was as limited as in the patients with CHF but resting left ventricular function was normal, the VE/VCO2 slope was normal. In pacemaker dependent patients fixed rate pacing resulted in lower exercise capacity and peak VO2 than rate responsive pacing; the VE/VCO2 slope was normal in patients without CHF but steeper than normal in patients with CHF; the VE/VCO2 slope was steeper during fixed rate than during rate responsive pacing in these patients with CHF. CONCLUSIONS--These findings suggest that the perfusion/ventilation mismatch during exercise in CHF is related to the chronic consequences of the syndrome and not directly to limitation of exercise related pulmonary flow. Only when the syndrome of CHF is present can matching between perfusion and ventilation be acutely influenced by changes in pulmonary flow.

Full text

PDF
27

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Buller N. P., Poole-Wilson P. A. Mechanism of the increased ventilatory response to exercise in patients with chronic heart failure. Br Heart J. 1990 May;63(5):281–283. doi: 10.1136/hrt.63.5.281. [DOI] [PMC free article] [PubMed] [Google Scholar]
  2. Davies N. J., Denison D. M. The measurement of metabolic gas exchange and minute volume by mass spectrometry alone. Respir Physiol. 1979 Feb;36(2):261–267. doi: 10.1016/0034-5687(79)90029-x. [DOI] [PubMed] [Google Scholar]
  3. Davies S. W., Emery T. M., Watling M. I., Wannamethee G., Lipkin D. P. A critical threshold of exercise capacity in the ventilatory response to exercise in heart failure. Br Heart J. 1991 Apr;65(4):179–183. doi: 10.1136/hrt.65.4.179. [DOI] [PMC free article] [PubMed] [Google Scholar]
  4. Drexler H., Hayoz D., Münzel T., Just H., Zelis R., Brunner H. R. Endothelial function in congestive heart failure. Am Heart J. 1993 Sep;126(3 Pt 2):761–764. doi: 10.1016/0002-8703(93)90926-z. [DOI] [PubMed] [Google Scholar]
  5. Drexler H. Skeletal muscle failure in heart failure. Circulation. 1992 Apr;85(4):1621–1623. doi: 10.1161/01.cir.85.4.1621. [DOI] [PubMed] [Google Scholar]
  6. Fink L. I., Wilson J. R., Ferraro N. Exercise ventilation and pulmonary artery wedge pressure in chronic stable congestive heart failure. Am J Cardiol. 1986 Feb 1;57(4):249–253. doi: 10.1016/0002-9149(86)90900-8. [DOI] [PubMed] [Google Scholar]
  7. Franciosa J. A., Leddy C. L., Wilen M., Schwartz D. E. Relation between hemodynamic and ventilatory responses in determining exercise capacity in severe congestive heart failure. Am J Cardiol. 1984 Jan 1;53(1):127–134. doi: 10.1016/0002-9149(84)90696-9. [DOI] [PubMed] [Google Scholar]
  8. Griffith T. M., Edwards D. H., Davies R. L., Harrison T. J., Evans K. T. EDRF coordinates the behaviour of vascular resistance vessels. Nature. 1987 Oct 1;329(6138):442–445. doi: 10.1038/329442a0. [DOI] [PubMed] [Google Scholar]
  9. Katz S. D., Biasucci L., Sabba C., Strom J. A., Jondeau G., Galvao M., Solomon S., Nikolic S. D., Forman R., LeJemtel T. H. Impaired endothelium-mediated vasodilation in the peripheral vasculature of patients with congestive heart failure. J Am Coll Cardiol. 1992 Apr;19(5):918–925. doi: 10.1016/0735-1097(92)90271-n. [DOI] [PubMed] [Google Scholar]
  10. Katz S. D., Schwarz M., Yuen J., LeJemtel T. H. Impaired acetylcholine-mediated vasodilation in patients with congestive heart failure. Role of endothelium-derived vasodilating and vasoconstricting factors. Circulation. 1993 Jul;88(1):55–61. doi: 10.1161/01.cir.88.1.55. [DOI] [PubMed] [Google Scholar]
  11. Kubo S. H., Rector T. S., Bank A. J., Williams R. E., Heifetz S. M. Endothelium-dependent vasodilation is attenuated in patients with heart failure. Circulation. 1991 Oct;84(4):1589–1596. doi: 10.1161/01.cir.84.4.1589. [DOI] [PubMed] [Google Scholar]
  12. Lewis N. P., Macdougall I. C., Willis N., Henderson A. H. The ventilatory cost of exercise compared in chronic heart failure and chronic renal anaemia. Q J Med. 1992 Jul;83(303):523–531. [PubMed] [Google Scholar]
  13. Ontkean M., Gay R., Greenberg B. Diminished endothelium-derived relaxing factor activity in an experimental model of chronic heart failure. Circ Res. 1991 Oct;69(4):1088–1096. doi: 10.1161/01.res.69.4.1088. [DOI] [PubMed] [Google Scholar]
  14. Reibel D. K., O'Rourke B., Foster K. A., Hutchinson H., Uboh C. E., Kent R. L. Altered phospholipid metabolism in pressure-overload hypertrophied hearts. Am J Physiol. 1986 Jan;250(1 Pt 2):H1–H6. doi: 10.1152/ajpheart.1986.250.1.H1. [DOI] [PubMed] [Google Scholar]
  15. Rubin S. A., Brown H. V., Swan H. J. Arterial oxygenation and arterial oxygen transport in chronic myocardial failure at rest, during exercise and after hydralazine treatment. Circulation. 1982 Jul;66(1):143–148. doi: 10.1161/01.cir.66.1.143. [DOI] [PubMed] [Google Scholar]
  16. Schwarz M., Katz S. D., Demopoulos L., Hirsch H., Yuen J. L., Jondeau G., LeJemtel T. H. Enhancement of endothelium-dependent vasodilation by low-dose nitroglycerin in patients with congestive heart failure. Circulation. 1994 Apr;89(4):1609–1614. doi: 10.1161/01.cir.89.4.1609. [DOI] [PubMed] [Google Scholar]
  17. Sullivan M. J., Higginbotham M. B., Cobb F. R. Increased exercise ventilation in patients with chronic heart failure: intact ventilatory control despite hemodynamic and pulmonary abnormalities. Circulation. 1988 Mar;77(3):552–559. doi: 10.1161/01.cir.77.3.552. [DOI] [PubMed] [Google Scholar]
  18. Tani M., Fujiki A., Asanoi H., Yoshida S., Tsuji H., Mizumaki K., Sasayama S. Effects of chronotropic responsive cardiac pacing on ventilatory response to exercise in patients with complete AV block. Pacing Clin Electrophysiol. 1992 Oct;15(10 Pt 1):1482–1491. doi: 10.1111/j.1540-8159.1992.tb02922.x. [DOI] [PubMed] [Google Scholar]
  19. Weber K. T., Janicki J. S. Lactate production during maximal and submaximal exercise in patients with chronic heart failure. J Am Coll Cardiol. 1985 Oct;6(4):717–724. doi: 10.1016/s0735-1097(85)80472-1. [DOI] [PubMed] [Google Scholar]
  20. Weber K. T., Kinasewitz G. T., Janicki J. S., Fishman A. P. Oxygen utilization and ventilation during exercise in patients with chronic cardiac failure. Circulation. 1982 Jun;65(6):1213–1223. doi: 10.1161/01.cir.65.6.1213. [DOI] [PubMed] [Google Scholar]
  21. Weber K. T., Kinasewitz G. T., West J. S., Janicki J. S., Reichek N., Fishman A. P. Long-term vasodilator therapy with trimazosin in chronic cardiac failure. N Engl J Med. 1980 Jul 31;303(5):242–250. doi: 10.1056/NEJM198007313030502. [DOI] [PubMed] [Google Scholar]
  22. Wilson J. R., Mancini D. M., Ferraro N., Egler J. Effect of dichloroacetate on the exercise performance of patients with heart failure. J Am Coll Cardiol. 1988 Dec;12(6):1464–1469. doi: 10.1016/s0735-1097(88)80010-x. [DOI] [PubMed] [Google Scholar]
  23. Wilson J. R., Martin J. L., Ferraro N., Weber K. T. Effect of hydralazine on perfusion and metabolism in the leg during upright bicycle exercise in patients with heart failure. Circulation. 1983 Aug;68(2):425–432. doi: 10.1161/01.cir.68.2.425. [DOI] [PubMed] [Google Scholar]
  24. Wilson J. R., Martin J. L., Schwartz D., Ferraro N. Exercise intolerance in patients with chronic heart failure: role of impaired nutritive flow to skeletal muscle. Circulation. 1984 Jun;69(6):1079–1087. doi: 10.1161/01.cir.69.6.1079. [DOI] [PubMed] [Google Scholar]

Articles from British Heart Journal are provided here courtesy of BMJ Publishing Group

RESOURCES