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Physiology of the abnormal response of heart failure patients to exercise

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Abstract

Chronic heart failure is associated with reduced exercise capacity. Altered diastolic function and reduced chronotropic response play an important role. However, there is no clear correlation between any hemodynamic parameter and exercise capacity. Peripheral factors, long overlooked, seem to play a major role. Altered peripheral vasodilatation, involving endothelial abnormalities, alters the optimal distribution of blood flow. Muscular abnormalities are constant: aside from muscle atrophy, altered muscle metabolism results in an altered utilization of oxygen. A comprehensive understanding of all these determinants of exercise response is important to optimize the care of the patient. Sole improvement of cardiac function may be insufficient to correct their exercise intolerance; regular training may well have beneficial effects on exercise capacity, functional impairment, and quality of life.

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References and Recommended Reading

  1. Franciosa J, Ziesche S, Wilen H: Functional capacity of patients with chronic left ventricular failure: relationship of bicycle exercise performance to clinical and hemodynamic characterisation. Am J Med 1979, 67:460–466.

    Article  PubMed  CAS  Google Scholar 

  2. Weber K, Kinasewitz G, Janicki J, Fishman A: Oxygen utilisation and ventilation during exercise in patients with chronic cardiac failure. Circulation 1982, 65:1213–1223. A key study having shown the characteristics of the cardiac and ventilatory response to exercise in CHF patients.

    PubMed  CAS  Google Scholar 

  3. Mancini D, Eisen H, Kussmaul W, et al.: Value of peak exercise oxygen consumption for optimal timing of cardiac transplantation in ambulatory patients. Circulation 1991, 83:778–786. First study having shown the prognostic value of peak VO2.

    PubMed  CAS  Google Scholar 

  4. Franciosa J, Park M, Levine T: Lack of correlation between exercise capacity and indexes of resting left ventricular performance in heart failure. Am J Cardiol 1981, 47:33–39.

    Article  PubMed  CAS  Google Scholar 

  5. Sullivan MJ, Cobb FR: Central hemodynamic response to exercise in patients with chronic heart failure. Chest 1992, 101:340S-346S. A comprehensive description of the hemodynamic response during exercise in CHF patients.

    PubMed  CAS  Google Scholar 

  6. De Groote P, Millaire A, Foucher-Hossein C, et al.: Right ventricular ejection fraction is an independent predictor of survival in patients with moderate heart failure. J Am Coll Cardiol 1998, 32:948–954.

    Article  PubMed  CAS  Google Scholar 

  7. Colucci W, Ribeiro J, Rocco M, et al.: Impaired chronotropic response to exercise in patients with congestive heart failure. Circulation 1989, 80:314–323. Nice study explaining the determinants of the chronotropic incompetence during exercise in CHF.

    PubMed  CAS  Google Scholar 

  8. Bristow M, Ginsburg R, Ulmans V, et al.: b1 and b2 adrenergicreceptor subpopulations in nonfailing and failing human ventricular myocardium: coupling of both receptor subtypes to muscle contraction and selective b1-receptor down-regulation in heart failure. Circ Res 1986, 59:297–309.

    PubMed  CAS  Google Scholar 

  9. Feldman M, Alderman J, Aroesty J, et al.: Depression of systolic and diastolic myocardial reserve during atrial pacing tachycardia in patients with dilated cardiomyopathy. J Clin Invest 1988, 82:1661–1669.

    Article  PubMed  CAS  Google Scholar 

  10. Schmidt U, Schwinger R, Böhm M, Erdmann E: Alterations of the force-frequency relation depending on stages of heart failure in humans. Am J Cardiol 1994, 74:1066–1068.

    Article  PubMed  CAS  Google Scholar 

  11. Hajjar RJ, Di Salvo TG, Schmidt U, et al.: Clinical correlates of the myocardial force-frequency relationship in patients with endstage heart failure. J Heart Lung Transplant 1997, 16:1157–1167.

    PubMed  CAS  Google Scholar 

  12. Osada N, Chaitman BR, Miller LW, et al.: Cardiopulmonary exercise testing identifies low risk patients with heart failure and severely impaired exercise capacity considered for heart transplantation. J Am Coll Cardiol 1998, 31:577–582.

    Article  PubMed  CAS  Google Scholar 

  13. Williams SG, Cooke GA, Wright DJ, et al.: Peak exercise cardiac power output; a direct indicator of cardiac function strongly predictive of prognosis in chronic heart failure. Eur Heart J 2001, 22:1496–1503.

    Article  PubMed  CAS  Google Scholar 

  14. Cohen-Solal A, Tabet J, Logeart D, Bourgoin P, et al.: A noninvasively determined surrogate of cardiac power (“circulatory power”) at peak exercise is a powerful prognostic factor in chronic heart failure. Eur Heart J 2002, 23:806–814.

    Article  PubMed  CAS  Google Scholar 

  15. Schalcher C, Rickli H, Brehm M, 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, 124:580–586.

    Article  PubMed  Google Scholar 

  16. Cohen-Solal A, Laperche T, Morvan D, et al.: Prolonged kinetics of recovery of oxygen consumption and ventilatory variables after maximal graded exercise in patients with chronic heart failure. Analysis with gas exchange and NMR spectroscopy study. Circulation 1995, 91:2924–2932.

    PubMed  CAS  Google Scholar 

  17. Cohen-Solal A, Chabernaud J, Gourgon R: Comparison of oxygen uptake during bicycle exercise in patients with chronic heart failure and in normal subjects. J Am Coll Cardiol 1990, 16:80–85.

    Article  Google Scholar 

  18. Keren G, Katz S, Gage J, et al.: Effect of isometric exercise on cardiac performance and mitral regurgitation in patients with severe congestive heart failure. Am Heart J 1989, 118:973–979.

    Article  PubMed  CAS  Google Scholar 

  19. Lapu-Bula R, Robert A, Van Craeynest D, et al.: Contribution of exercise-induced mitral regurgitation to exercise stroke volume and exercise capacity in patients with left ventricular systolic dysfunction. Circulation 2002, 106:1342–1348. A recent Doppler echographic study showing how mitral regurgitation can increase during exercise in CHF patients.

    Article  PubMed  Google Scholar 

  20. Lebrun F, Lancellotti P, Pierard LA. Quantitation of functional mitral regurgitation during bicycle exercise in patients with heart failure. J Am Coll Cardiol 2001, 38:1685–1692. Another recent Doppler echographic study showing how mitral regurgitation can increase during exercise in CHF patients.

    Article  PubMed  CAS  Google Scholar 

  21. Maskin C, Foreman R, Sonnenblick E, et al.: Failure of dobutamine to increase exercise capacity despite hemodynamic improvement in severe heart failure. Am J Cardiol 1983, 51:177–183.

    Article  PubMed  CAS  Google Scholar 

  22. Drexler H, Hayoz D, Münzel T, et al.: Endothelial function in chronic congestive heart failure. Am J Cardiol 1992, 69:1596–601.

    Article  PubMed  CAS  Google Scholar 

  23. Katz S, Biasucci L, Sabba C, et al.: Impaired endothelium-mediated vasodilation in the peripheral vasculature of patients with congestive heart failure. J Am Coll Cardiol 1992, 19:918–925.

    Article  PubMed  CAS  Google Scholar 

  24. Ennezat PV, Malendowicz SL, Testa M, et al.: Physical training in patients with chronic heart failure enhances the expression of genes encoding antioxidative enzymes. J Am Coll Cardiol 2001, 38:194–198.

    Article  PubMed  CAS  Google Scholar 

  25. Katz SD, Krum H, Khan T, Knecht M: Exercise-induced vasodilation in forearm circulation of normal subjects and patients with congestive heart failure: role of endothelium-derived nitric oxide. J Am Coll Cardiol 1996, 28:585–590.

    Article  PubMed  CAS  Google Scholar 

  26. Katz SD, Maskin C, Jondeau G, et al.: Near-maximal fractional oxygen extraction by active skeletal muscle in patients with chronic heart failure. J Appl Physiol 2000, 88:2138–2142.

    Article  PubMed  CAS  Google Scholar 

  27. Levine B, Kalman J, Mayer L, et al.: Elevated circulating levels of tumor necrosis factor in severe chronic heart failure. N Engl J Med 1990, 323:236–241.

    Article  PubMed  CAS  Google Scholar 

  28. Harrington D, Anker SD, Chua TP, et al.: Skeletal muscle function and its relation to exercise tolerance in chronic heart failure. J Am Coll Cardiol 1997, 30:1758–1764.

    Article  PubMed  CAS  Google Scholar 

  29. Mancini D, Walter G, Reichek N, et al.: Contribution of skeletal muscle atrophy to exercise intolerance and altered muscle metabolism in heart failure. Circulation 1992, 85:1364–1373.

    PubMed  CAS  Google Scholar 

  30. Sullivan M, Green H, Cobb F: Skeletal muscle biochemistry and histology in ambulatory patients with long-term heart failure. Circulation 1990, 81:518–527.

    PubMed  CAS  Google Scholar 

  31. Drexler H, Riede U, Münzel T, et al.: Alterations of skeletal muscle in chronic heart failure. Circulation 1992, 85:1751–1759. Pioneering study about the muscular abnormalities in CHF.

    PubMed  CAS  Google Scholar 

  32. Vescovo G, Serafini F, Dalla Libera L, et al.: Skeletal muscle myosin heavy chains in heart failure: correlation between magnitude of the isozyme shift, exercise capacity, and gas exchange measurements. Am Heart J 1998, 135:130–137.

    Article  PubMed  CAS  Google Scholar 

  33. Bekedam MA, Van Beek-Harmsen BJ, Boonstra A, et al.: Maximum rate of oxygen consumption related to succinate dehydrogenase activity in skeletal muscle fibres of chronic heart failure patients and controls. Clin Physiol Funct Imaging 2003, 23:337–343.

    Article  PubMed  CAS  Google Scholar 

  34. Mettauer B, Zoll J, Sanchez H, et al.: Oxidative capacity of skeletal muscle in heart failure patients versus sedentary or active control subjects. J Am Coll Cardiol 2001, 38:947–954.

    Article  PubMed  CAS  Google Scholar 

  35. Massie B, Conway M, Yonge R, et al.: 31P nuclear magnetic resonance evidence of abnormal skeletal muscle metabolism in patients with congestive heart failure. Am J Cardiol 1987, 60:309–315. One of the first studies to use nuclear magnetic resonance spectroscopy.

    Article  PubMed  CAS  Google Scholar 

  36. Adams V, Spate U, Krankel N, et al.: Nuclear factor-kappa B activation in skeletal muscle of patients with chronic heart failure: correlation with the expression of inducible nitric oxide synthase. Eur J Cardiovasc Prev Rehabil 2003, 10:273–277.

    Article  PubMed  Google Scholar 

  37. Duscha BD, Annex BH, Keteyian SJ, et al.: Differences in skeletal muscle between men and women with chronic heart failure. J Appl Physiol 2001, 90:280–286.

    PubMed  CAS  Google Scholar 

  38. Nusz DJ, White DC, Dai Q, et al.: Vascular rarefaction in peripheral skeletal muscle after experimental heart failure. Am J Physiol Heart Circ Physiol 2003, 285:H1554-H1562.

    PubMed  CAS  Google Scholar 

  39. Mancini D, Schwartz M, Ferraro N, et al.: Effect of dobutamine on skeletal muscle metabolism in patients with congestive heart failure. Am J Cardiol 1990, 65:1121–1126. A key study showing that increasing cardiac output with dobutamine during exercise does not necessarily improve muscle metabolism in CHF.

    Article  PubMed  CAS  Google Scholar 

  40. Mancini D, Wilson J, Bolinger L, et al.: In vivo magnetic resonance spectroscopy measurement of deowymyoglobin during exercise in patients with heart failure. Demonstration of abnormal muscle metabolism despite adequate oxygenation. Circulation 1994, 90:500–508.

    PubMed  CAS  Google Scholar 

  41. Hambrecht R, Niebauer J, Fiehn E, et al.: Physical training in patients with stable chronic heart failure: effect on cardiorespiratory fitness and ultrastructural abnormalities of leg muscle. J Am Coll Cardiol 1995, 25:1239–1249. A reference study about the effects of exercise training in CHF patients.

    Article  PubMed  CAS  Google Scholar 

  42. Gielen S, Adams V, Mobius-Winkler S, et al.: Anti-inflammatory effects of exercise training in the skeletal muscle of patients with chronic heart failure. J Am Coll Cardiol 2003, 42:861–868.

    Article  PubMed  CAS  Google Scholar 

  43. Witte KK, Thackray SD, Nikitin NP, et al.: Pattern of ventilation during exercise in chronic heart failure. Heart 2003, 89:610–614.

    Article  PubMed  CAS  Google Scholar 

  44. Piepoli M, Ponikowski P, Clark AL, et al.: A neural link to explain the “muscle hypothesis” of exercise intolerance in chronic heart failure. Am Heart J 1999, 137:1050–1056. One of the studies about the muscle hypothesis of exertional dyspnea.

    Article  PubMed  CAS  Google Scholar 

  45. Gitt A, Wasserman K, Kilkowski C, et al.: Exercise anaerobic threshold and ventilatory efficiency identify heart failure patients for high risk of early death. Circulation 2002, 106:3079–3084.

    Article  PubMed  Google Scholar 

  46. Tabet JY, Beauvais F, Thabut G, et al.: A critical appraisal of the prognostic value of the VE/VCO2 slope in chronic heart failure. Eur J Cardiovasc Prev Rehabil 2003, 10:267–272.

    Article  PubMed  Google Scholar 

  47. Corra U, Giordano A, Bosimini E, et al.: Oscillatory ventilation during exercise in patients with chronic heart failure: clinical correlates and prognostic implications. Chest 2002, 121:1572–1580.

    Article  PubMed  Google Scholar 

  48. Leite JJ, Mansur AJ, de Freitas HF, et al.: Periodic breathing during incremental exercise predicts mortality in patients with chronic heart failure evaluated for cardiac transplantation. J Am Coll Cardiol 2003, 41:2175–2181.

    Article  PubMed  Google Scholar 

  49. Mancini DM, Katz SD, Lang CC, et al.: Effect of erythropoietin on exercise capacity in patients with moderate to severe chronic heart failure. Circulation 2003, 107:294–299. A nice study demonstrating that erythropoietin can increase exercise capacity in anemic CHF patients.

    Article  PubMed  CAS  Google Scholar 

  50. Cohen-Solal A: Cardiopulmonary exercise testing in chronic heart failure. In Exercise Gas Exchange in Heart Disease. Edited by Wasserman K. New York: Futura; 1996:17–38.

    Google Scholar 

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  1. Cardiology Department, Hospital Beaujon, 100 Boulevard du Général Leclerc, 92110, Clichy, France

    Alain Cohen-Solal MD, PhD

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  1. Alain Cohen-Solal MD, PhD
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  2. Florence Beauvais MD
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  3. Jean Yves Tabet MD
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Cohen-Solal, A., Beauvais, F. & Tabet, J.Y. Physiology of the abnormal response of heart failure patients to exercise. Curr Cardiol Rep 6, 176–181 (2004). https://doi.org/10.1007/s11886-004-0020-0

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