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document
Cardiopulmonary exercise variables in diastolic versus systolic heart failure . The response to cardiopulmonary exercise ( CPX ) in patients with heart failure ( HF ) with normal left ventricular ( LV ) ejection fractions ( EFs ) is not well characterized . To determine if CPX testing could distinguish between patients with HF with normal EFs ( > 50 % ; i.e. , diastolic HF ) and those with decreased EFs ( > or =50 % ; i.e. , systolic HF ) , CPX responses were compared between 185 patients with systolic HF ( 79 % men , mean age 62.6 +/- 10.9 years ) and 43 with diastolic HF ( 54 % men , mean age 67.4 +/- 9.8 years ) enrolled in a phase II multicenter clinical trial . All patients were evaluated with echocardiography and a standardized CPX test as part of the trial . CPX variables , including oxygen uptake at peak exercise ( peak VO ( 2 ) ) and the slope of the ventilation/carbon dioxide production ratio ( VE/VCO ( 2 ) ) , were determined and analyzed by core laboratory personnel . Echocardiographic measurements included the LV EF , the E/A ratio , filling time , cavity volumes , right ventricular function , and mitral regurgitation . Patients in the diastolic HF group tended to be older ( p < 0.08 ) , with more women ( p < 0.006 ) and with greater body mass indexes ( p < 0.02 ) , than those in the systolic HF group . There was no significant difference in the use of beta blockers or the incidence of coronary artery disease . Patients with diastolic HF had decreased E/A ratios ( 0.9 +/- 0.4 vs 1.4 +/- 1.1 , p < 0.02 , diastolic HF vs systolic HF ) and increased filling times ( 30.4 +/- 3.2 vs 26.5 +/- 4.7 ms , p < 0.01 , diastolic HF vs systolic HF ) . No significant differences in peak VO ( 2 ) ( 14.4 +/- 1.9 vs 15.6 +/- 3.2 ml/kg/min , p = 0.06 , diastolic HF vs systolic HF ) were observed . The VE/VCO ( 2 ) ratios for the 2 groups were abnormal and comparable ( 32 2 +/- 7.5 vs 34.0 +/- 8.3 , p = 0.3 , diastolic HF vs systolic HF ) . In conclusion , the CPX response in patients with diastolic HF and systolic HF is markedly abnormal and indistinguishable with regard to peak VO ( 2 ) and ventilation despite marked differences in the LV EF .
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Intervention_Physical
Cardiopulmonary exercise
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Intervention_Physical
cardiopulmonary exercise ( CPX )
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Intervention_Physical
CPX
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Intervention_Physical
CPX
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Intervention_Physical
echocardiography
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Intervention_Physical
standardized CPX test
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Intervention_Physical
CPX
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Intervention_Physical
CPX
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Outcome_Physical
oxygen uptake at peak exercise ( peak VO ( 2 ) )
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Outcome_Physical
slope of the ventilation/carbon dioxide production ratio ( VE/VCO ( 2 ) )
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Outcome_Physical
LV EF
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Outcome_Physical
the E/A ratio
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Outcome_Physical
filling time
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Outcome_Physical
cavity volumes
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Outcome_Physical
right ventricular function
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Outcome_Physical
mitral regurgitation
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Outcome_Other
use of beta blockers
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Outcome_Physical
incidence of coronary artery disease
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Outcome_Physical
E/A ratios
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Outcome_Physical
filling times
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Outcome_Physical
peak VO ( 2 )
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Outcome_Physical
VE/VCO ( 2 )
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Outcome_Physical
peak VO ( 2 ) and ventilation