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Oxygen uptake kinetics in chronic heart failure: clinical and physiological aspects

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Abstract

One of the hallmark symptoms of patients with chronic heart failure (CHF) is exercise intolerance. Therefore, exercise testing has become an important tool for the evaluation and monitoring of heart failure. Whereas the maximal aerobic capacity (peak VO2) is a reliable indicator of the severity and prognosis of heart failure, submaximal exercise parameters may be more closely related to the ability to perform daily activities. As such, oxygen (O2) uptake kinetics, describing the rate change of O2 uptake during onset or recovery of submaximal constant-load exercise (O2 onset and recovery kinetics, respectively), have been shown to be useful parameters for objectively evaluating the functional capacity of CHF patients. However, their evaluation in this population is not a routine part of daily clinical practice. Possible reasons for this include a lack of standardisation of the assessment methodology and a limited number of studies evaluating the clinical use of O2 uptake kinetics in CHF patients. In addition, the pathophysiological mechanisms underlying the delay in O2 uptake kinetics in these patients are not completely understood. This review discusses the current literature on the clinical potency and physiological determinants of O2 uptake kinetics in CHF patients and provides directions for future research. (Neth Heart J 2009;17:238–44.)

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References

  1. Sullivan MJ, Knight JD, Higginbotham MB, Cobb FR. Relation between central and peripheral hemodynamics during exercise in patients with chronic heart failure. Muscle blood flow is reduced with maintenance of arterial perfusion pressure. Circulation 1989;80:769–81.

    Google Scholar 

  2. Kato M, Kinugawa T, Omodani H, Osaki S, Ahmmed GU, Ogino K, et al. Responses of plasma norepinephrine and reninangiotensin-aldosterone system to dynamic exercise in patients with congestive heart failure. J Card Fail 1996;2:103–10.

    Google Scholar 

  3. Katz SD, Biasucci L, Sabba C, Strom JA, Jondeau G, Galvao M, et al. Impaired endothelium-mediated vasodilation in the peripheral vasculature of patients with congestive heart failure. J Am Coll Cardiol 1992;19:918–25.

    Google Scholar 

  4. Wiener DH, Fink LI, Maris J, Jones RA, Chance B, Wilson JR. Abnormal skeletal muscle bioenergetics during exercise in patients with heart failure: role of reduced muscle blood flow. Circulation 1986;73:1127–36.

    Google Scholar 

  5. Ponikowski P, Francis DP, Piepoli MF, Davies LC, Chua TP, Davos CH, et al. Enhanced ventilatory response to exercise in patients with chronic heart failure and preserved exercise tolerance: marker of abnormal cardiorespiratory reflex control and predictor of poor prognosis. Circulation 2001;103:967–72.

    Google Scholar 

  6. Meredith IT, Eisenhofer G, Lambert GW, Dewar EM, Jennings GL, Esler MD. Cardiac sympathetic nervous activity in congestive heart failure. Evidence for increased neuronal norepinephrine release and preserved neuronal uptake. Circulation 1993;88:136–45.

    Google Scholar 

  7. Faggiano P, D’Aloia A, Gualeni A, Giordano A. Relative contribution of resting haemodynamic profile and lung function to exercise tolerance in male patients with chronic heart failure. Heart 2001;85:179–84.

    Google Scholar 

  8. Wilson JR, Rayos G, Yeoh TK, Gothard P, Bak K. Dissociation between exertional symptoms and circulatory function in patients with heart failure. Circulation 1995;92:47–53.

    Google Scholar 

  9. Weber KT, Kinasewitz GT, Janicki JS, Fishman AP. Oxygen utilization and ventilation during exercise in patients with chronic cardiac failure. Circulation 1982;65:1213–23.

    Google Scholar 

  10. Mancini DM, Eisen H, Kussmaul W, Mull R, Edmunds LH Jr, Wilson JR. Value of peak exercise oxygen consumption for optimal timing of cardiac transplantation in ambulatory patients with heart failure. Circulation 1991;83:778–86.

    Google Scholar 

  11. Larsen AI, Aarsland T, Kristiansen M, Haugland A, Dickstein K. Assessing the effect of exercise training in men with heart failure; comparison of maximal, submaximal and endurance exercise protocols. Eur Heart J 2001;22:684–92.

    Google Scholar 

  12. Metra M, Nodari S, Raccagni D, Garbellini M, Boldi E, Bontempi L, et al. Maximal and submaximal exercise testing in heart failure. J Cardiovasc Pharmacol 1998;32(Suppl 1):S36–S45.

    Google Scholar 

  13. Meyer K, Hajric R, Westbrook S, Samek L, Lehmann M, Schwaibold M, et al. Ventilatory and lactate threshold determinations in healthy normals and cardiac patients: methodological problems. Eur J Appl Physiol Occup Physiol 1996;72:387–93.

    Google Scholar 

  14. Meyer K, Stengele E, Westbrook S, Beneke R, Schwaibold M, Gornandt L, et al. Influence of different exercise protocols on functional capacity and symptoms in patients with chronic heart failure. Med Sci Sports Exerc 1996;28:1081–6.

    Google Scholar 

  15. Wu G, Sanderson B, Bittner V. The 6-minute walk test: how important is the learning effect? Am Heart J 2003;146:129–33.

    Google Scholar 

  16. European Heart Failure Training Group. Experience from controlled trials of physical training in chronic heart failure. Protocol and patient factors in effectiveness in the improvement in exercise tolerance. Eur Heart J 1998;19:466–75.

    Google Scholar 

  17. Gademan MG, Swenne CA, Verwey HF, van de Vooren H, Haest JC, van Exel HJ, et al. Exercise training increases oxygen uptake efficiency slope in chronic heart failure. Eur J Cardiovasc Prev Rehabil 2008;15:140–4.

    Google Scholar 

  18. Wasserman K, Hansen JE, Sue D, et al. Physiology of exercise. In: Weinberg R, editor. Principles of exercise testing and interpretation. Baltimore: Lippincott Williams & Wilkins, 1999: 10–61.

  19. Ozyener F, Rossiter HB, Ward SA, Whipp BJ. Influence of exercise intensity on the on- and off-transient kinetics of pulmonary oxygen uptake in humans. J Physiol 2001;533:891–902.

    Google Scholar 

  20. Lamarra N, Whipp BJ, Ward SA, Wasserman K. Effect of interbreath fluctuations on characterizing exercise gas exchange kinetics. J Appl Physiol 1987;62:2003–12.

    Google Scholar 

  21. Francis DP, Davies LC, Willson K, Wensel R, Ponikowski P, Coats AJ, et al. Impact of periodic breathing on measurement of oxygen uptake and respiratory exchange ratio during cardiopulmonary exercise testing. Clin Sci (Lond) 2002;103:543–52.

    Google Scholar 

  22. Sietsema KE, Ben Dov I, Zhang YY, Sullivan C, Wasserman K. Dynamics of oxygen uptake for submaximal exercise and recovery in patients with chronic heart failure. Chest 1994;105:1693–700.

    Google Scholar 

  23. Belardinelli R, Zhang YY, Wasserman K, Purcaro A, Agostoni PG. A four-minute submaximal constant work rate exercise test to assess cardiovascular functional class in chronic heart failure. Am J Cardiol 1998;81:1210–4.

    Google Scholar 

  24. Kemps HM, de Vries WR, Hoogeveen AR, Zonderland ML, Thijssen EJ, Schep G. Reproducibility of onset and recovery oxygen uptake kinetics in moderately impaired patients with chronic heart failure. Eur J Appl Physiol 2007;100:45–52.

    Google Scholar 

  25. Koike A, Yajima T, Adachi H, Shimizu N, Kano H, Sugimoto K, et al. Evaluation of exercise capacity using submaximal exercise at a constant work rate in patients with cardiovascular disease. Circulation 1995;91:1719–24.

    Google Scholar 

  26. Picozzi NM, Clark AL, Lindsay KA, McCann GP, Hillis WS. Responses to constant work exercise in patients with chronic heart failure. Heart 1999;82:482–5.

    Google Scholar 

  27. Kremser CB, O’Toole MF, Leff AR. Oscillatory hyperventilation in severe congestive heart failure secondary to idiopathic dilated cardiomyopathy or to ischemic cardiomyopathy. Am J Cardiol 1987;59:900–5.

    Google Scholar 

  28. Meakins J, Long CN. Oxygen consumption, oxygen debt and lactic acid in circulatory failure. J Clin Invest 1927;4:273–93.

    Google Scholar 

  29. Chelimsky-Fallick C, Stevenson LW, Lem V, Whipp BJ. Excessive oxygen deficit during low-level exercise in heart failure. Am J Cardiol 1995;76:799–802.

    Google Scholar 

  30. Belardinelli R, Barstow TJ, Nguyen P, Wasserman K. Skeletal muscle oxygenation and oxygen uptake kinetics following constant work rate exercise in chronic congestive heart failure. Am J Cardiol 1997;80:1319–24.

    Google Scholar 

  31. Taniguchi Y, Ueshima K, Chiba I, Segawa I, Kobayashi N, Saito M, et al. A new method using pulmonary gas-exchange kinetics to evaluate efficacy of beta-blocking agents in patients with dilated cardiomyopathy. Chest. 2003;124:954–61.

    Google Scholar 

  32. Roditis P, Dimopoulos S, Sakellariou D, Sarafoglou S, Kaldara E, Venetsanakos J, et al. The effects of exercise training on the kinetics of oxygen uptake in patients with chronic heart failure. Eur J Cardiovasc Prev Rehabil 2007;14:304–11.

    Google Scholar 

  33. Borrelli E, Pogliaghi S, Molinello A, Diciolla F, Maccherini M, Grassi B. Serial assessment of peak VO2 and VO2 kinetics early after heart transplantation. Med Sci Sports Exerc 2003;35:1798–804.

    Google Scholar 

  34. Brunner-La Rocca HP, Weilenmann D, Schalcher C, Schlumpf M, Follath F, Candinas R, et al. Prognostic significance of oxygen uptake kinetics during low level exercise in patients with heart failure. Am J Cardiol 1999;84:741–4, A9.

  35. Schalcher C, Rickli H, Brehm M, Weilenmann D, Oechslin E, Kiowski W, et al. Prolonged Oxygen Uptake Kinetics During Low-Intensity Exercise Are Related to Poor Prognosis in Patients With Mild-to-Moderate Congestive Heart Failure. Chest 2003;124: 580–6.

    Google Scholar 

  36. Wilson JR, Groves J, Rayos G. Circulatory status and response to cardiac rehabilitation in patients with heart failure. Circulation 1996;94:1567–72.

    Google Scholar 

  37. Lafitte S, Bordachar P, Lafitte M, Garrigue S, Reuter S, Reant P, et al. Dynamic ventricular dyssynchrony: an exercise-echocardiography study. J Am Coll Cardiol 2006;47:2253–9.

    Google Scholar 

  38. Chomsky DB, Lang CC, Rayos GH, Shyr Y, Yeoh TK, Pierson RN III, et al. Hemodynamic exercise testing. A valuable tool in the selection of cardiac transplantation candidates. Circulation 1996;94:3176–83.

    Google Scholar 

  39. Francis GS, Goldsmith SR, Ziesche SM, Cohn JN. Response of plasma norepinephrine and epinephrine to dynamic exercise in patients with congestive heart failure. Am J Cardiol 1982;49:1152–6.

    Google Scholar 

  40. Chiba Y, Maehara K, Yaoita H, Yoshihisa A, Izumida J, Maruyama Y. Vasoconstrictive response in the vascular beds of the non-exercising forearm during leg exercise in patients with mild chronic heart failure. Circ J 2007;71:922–8.

    Google Scholar 

  41. Drexler H, Riede U, Munzel T, Konig H, Funke E, Just H. Alterations of skeletal muscle in chronic heart failure. Circulation 1992;85:1751–9.

    Google Scholar 

  42. Richardson TE, Kindig CA, Musch TI, Poole DC. Effects of chronic heart failure on skeletal muscle capillary hemodynamics at rest and during contractions. J Appl Physiol 2003;95:1055–62.

    Google Scholar 

  43. Diederich ER, Behnke BJ, McDonough P, Kindig CA, Barstow TJ, Poole DC, et al. Dynamics of microvascular oxygen partial pressure in contracting skeletal muscle of rats with chronic heart failure. Cardiovasc Res 2002;56:479–86.

    Google Scholar 

  44. Koike A, Hiroe M, Adachi H, Yajima T, Yamauchi Y, Nogami A, et al. Oxygen uptake kinetics are determined by cardiac function at onset of exercise rather than peak exercise in patients with prior myocardial infarction. Circulation 1994;90:2324–32.

    Google Scholar 

  45. Matsumoto A, Itoh H, Yokoyama I, Aoyagi T, Sugiura S, Hirata Y, et al. Kinetics of oxygen uptake at onset of exercise related to cardiac output, but not to arteriovenous oxygen difference in patients with chronic heart failure. Am J Cardiol 1999;83:1573–6, A8.

    Google Scholar 

  46. Mancini DM, Wilson JR, Bolinger L, Li H, Kendrick K, Chance B, et al. In vivo magnetic resonance spectroscopy measurement of deoxymyoglobin during exercise in patients with heart failure. Demonstration of abnormal muscle metabolism despite adequate oxygenation. Circulation 1994;90:500–8.

    Google Scholar 

  47. McDonough P, Behnke BJ, Musch TI, Poole DC. Effects of chronic heart failure in rats on the recovery of microvascular PO2 after contractions in muscles of opposing fibre type. Exp Physiol 2004;89:473–85.

    Google Scholar 

  48. Ferreira LF, Hageman KS, Hahn SA, Williams J, Padilla DJ, Poole DC, et al. Muscle microvascular oxygenation in chronic heart failure: role of nitric oxide availability. Acta Physiol (Oxf) 2006; 188:3–13.

    Google Scholar 

  49. Toussaint JF, Koelling TM, Schmidt CJ, Kwong KK, LaRaia PJ, Kantor HL. Local relation between oxidative metabolism and perfusion in leg muscles of patients with heart failure studied by magnetic resonance imaging and spectroscopy. J Heart Lung Transplant 1998;17:892–900.

    Google Scholar 

  50. Hanada A, Okita K, Yonezawa K, Ohtsubo M, Kohya T, Murakami T, et al. Dissociation between muscle metabolism and oxygen kinetics during recovery from exercise in patients with chronic heart failure. Heart 2000;83:161–6.

    Google Scholar 

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Correspondence to H. M. C. Kemps.

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Department of Cardiology, Máxima Medical Centre, Veldhoven, the Netherlands

Department of Sports Medicine, Máxima Medical Centre, Veldhoven, the Netherlands

Department of Cardiology, Máxima Medical Centre, Veldhoven, the Netherlands

Department of Cardiology, Máxima Medical Centre, Veldhoven, the Netherlands

Rudolf Magnus Institute of Neuroscience, Section Rehabilitation and Sports Medicine, University Medical Center Utrecht, Utrecht, the Netherlands

University Medical Center Utrecht, Department of Medical Physiology, Division Heart & Lungs, Utrecht, the Netherlands

Department of Cardiology, University Medical Center Utrecht, Utrecht, the Netherlands

H.M.C. Kemps Department of Cardiology, Máxima Medical Centre, PO Box 7777, 5500 MB, Veldhoven, the Netherlands

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Kemps, H.M.C., Schep, G., Hoogsteen, J. et al. Oxygen uptake kinetics in chronic heart failure: clinical and physiological aspects. NHJL 17, 238–244 (2009). https://doi.org/10.1007/BF03086254

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