DELAYED VO2 KINETICS DURING RAMP EXERCISE - A CRITERION FOR CARDIOPULMONARY EXERCISE CAPACITY IN CHRONIC HEART-FAILURE

Purpose: Kinetics of VO2 at onset of constant work rare exercise was p reviously shown to be slowed in patients with chronic heart failure (C HF) compared with that in healthy normals. Because bicycle ergometry w ith ramp protocol is usually used for exercise testing with CHF patien ts, it would be of practical importance if it can be shown that a dela y in the time interval of linear increase of VO2 (TILIV) to work rate occurs after beginning ramp exercise. Data of central hemodynamics (CH F) and noninvasive cardiopulmonary parameters (CHF, normals) should al so correlate with VO2 delay time if this parameter is related to cardi opulmonary exercise capacity. Methods: Fifteen males with CHF (mean +/ - SEM: age 52 +/- 2 yr; ejection fraction 32 +/- 4%; peak cardiac inde x 3.9 +/- 0.3 L.m(-2).min(-1)) and 28 healthy males (50 +/- 1 yr) were assessed. During ramp bicycle ergometry (3 min unloaded, work rate in crements of 12.5 W.min(-1)), VO2 was measured breath by breath. Result s: After the onset of ramp exercise, there was a difference in the TIL IV between patients and normals (83.7 +/- 3.6 vs 66.8 +/- 2.9 s; P < 0 .001). Significant differences between both groups were also found for VO2 at ventilatory threshold (VT) (10.1 +/- 0.1 vs 15.2 +/- 0.7 mL.kg (-1).min(-1); P < 0.0001), VO2 at VT relative to predicted VT (58 +/- 4 vs 97 +/- 4%; P < 0.0001), peak VO2 (13.2 +/- 1.0 vs 34 +/- 1.4 ml.k g(-1).min(-1), P < 0.001), and increase of systolic blood pressure (36 +/- 7 vs 71 +/- 5 mm Hg; P < 0.0001). In CHF, the TLLIV correlated si gnificantly with peak cardiac index and VO2 at VT (r = -0.71; P < 0.00 5 each), relative value of VO2/kg at VT (r = -0.61; P < 0.03), peak VO 2/kg (r = -0.63; P < 0.01), and increase of systolic blood pressure (r = -0.52; P < 0.02). In the normals only VO2/kg at VT correlated signi ficantly with TILIV (r = -0.41; P < 0.03). In patients, stepwise regre ssion analysis identified three predictors which could explain 79% of the variance of TILIV: VO2/kg at VT (r(2) = 0.51), peak cardiac index (r(2) = 0.20), and peak VO2/kg (r(2) = 0.08). Conclusion: TILTV, deter mined at the onset of ramp exercise, is prolonged in CHF patients comp ared with that in normals and reflects severity of functional impairme nt because of reduced cardiac index and aerobic capacity. TILIV can pr ovide information about changes in cardiopulmonary exercise capacity a nd thus can be used for follow-up and treatment studies in CHF.