Mechanisms of exercise intolerance in congestive heart failure

Current Opinion in Cardiology

Volumn 12, Issue 3, 1997, Pages 224-232

  Harrington, Derek ^a   Coats, Andrew J S ^a  

^a NATIONAL HEART AND LUNG INSTITUTE   (United Kingdom)

Author keywords

[No Author keywords available]

Indexed keywords

INOTROPIC AGENT; VASODILATOR AGENT;

BREATHING MUSCLE; CONGESTIVE HEART FAILURE; DYSPNEA; EXERCISE TOLERANCE; HEART HEMODYNAMICS; HEART OUTPUT; HEART VENTRICLE FILLING; HUMAN; LUNG DIFFUSION; LUNG VENTILATION; OXYGEN CONSUMPTION; PERIPHERAL CIRCULATION; PRIORITY JOURNAL; QUALITY OF LIFE; REVIEW; SKELETAL MUSCLE; SYMPTOM;

EID: 0030916724     PISSN: 02684705     EISSN: None     Source Type: Journal    
DOI: 10.1097/00001573-199705000-00003     Document Type: Review

References (86)

1. 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. Investigates the relationship between symptoms and circulatory, ventilatory. and metabolic function during exercise.
2. Smith RF, Johnson G, Ziesche S, Bhat G, Blankenship K, Cohn JN: Functional capacity in heart failure. Circulation 1993, 87(suppl VI):VI-88-VI-93.
3. Weber KT, Kinasewitz GT, Janicki JS, Fishman AP: Oxygen utilisation and ventilation during exercise in patients with chronic cardiac failure. Circulation 1982, 65:1213-1223.
4. Sullivan MJ, Higginbotham MB, Cobb FR: Increased exercise ventilation in patients with chronic heart failure: intact ventilatory control despite haemodynamic and pulmonary abnormalities. Circulation 1988, 77:552-559.
5. Franciosa JA, Park M, Levine TB: Lack of correlation between exercise capacity and indices of resting left ventricular performance in heart failure. Am J Cardiol 1981, 47:33-39.
6. Weber KT, Wilson JR, Janicki J, Likoff MJ: Exercise testing in the evaluation of the patient with chronic cardiac failure. Am Rev Resp Diseases 1984, 129(suppl):S60-S62.
7. Fink LI, Wilson JR, Ferraro N: Exercise ventilation and pulmonary artery wedge pressure in chronic stable congestive heart failure. Am J Cardiol 1986, 57:249-253.
8. Metra M, Raddino R, Dei cas L, Visioli O: Assessment of peak oxygen consumption with resting and exercise heamodynamic data in chronic congestive heart failure. Am J Cardiol 1990, 65:1127-1133.
9. Szlachcic J, Massie BM, Kramer BL, Topic N, Tubau J: Correlates and prognostic implication of exercise capacity in chronic congestive heart failure. Am J Cardiol 1985, 55:1037-1363.
10. Maskin CS, Forman R, Sonnenblick EH, Frishman WH, LeJemtel TH: Failure of dobutamine to increase exercise capacity despite haemodynamic improvement in severe chronic heart failure. Am J Cardiol 1983, 51:177-182.
11. Wilson JR, Martin JL, Ferraro N: Impaired skeletal muscle nutritive flow during exercise in patients with congestive heart failure: role of cardiac pump dysfunction as determined by the effect of dobutamine. Am J Cardiol 1984, 53:1308-1315.
12. Massie BM, Kramer B, Haughom F: Acute- and long-term effects of vasodilator therapy on resting and exercise haemodynamics and exercise tolerance. Circulation 1983, 64:1218-1226.
13. Wilson JR, Martin JL, Ferraro N, Weber KT: Effect of hydralazine on perfusion and metabolism in the leg during upright bicycle exercise in patients with heart failure. Circulation 1983, 68:425-432.
14. Marzo KP, Herrmann HC, Mancini DM: Effect of balloon mitral valvuloplasty on exercise capacity, ventilation and skeletal muscle oxygenation. J Am Coll Cardiol 1993, 21:856-865.
15. Savin WM, Haskell WL, Schroeder JS, Stinson EB: Cardiopulmonary responses of cardiac transplant patients to graded, symptom limited exercise. Circulation 1980, 62:55-60.
16. Metra M, Dei Cas L, Panina G, Visioli O: Exercise hyperventilation in chronic congestive heart failure and its relation to functional capacity and hemodynamics. Am J Cardiol 1992, 70:622-628.
17. Wada O, Asonoi H, Miyagi K, Ishizaka S, Kameyama T, Seto H, Sasayama S: Importance of abnormal lung perfusion in excessive exercise ventilation in chronic heart failure. Am Heart J 1993, 125:790-798.
18. Clark AL, Coats AJS: Usefulness of arterial blood gas estimations during exercise in patients with chronic heart failure. Br Heart J 1994, 71:528-530.
19. Rubin SA, Brown HV, Swan HJC: Arterial oxygenation and arterial oxygen transport in chronic myocardial failure at rest, during exercise and after hydralazine treatment. Circulation 1982, 66:143-148.
20. Chua TP, Clark AL, Amadi A, Coats AJS: Relation between chemosensitivity and the ventilatory response to exercise in chronic heart failure. J Am Coll Cardiol 1996, 27:650-657. Demonstrated increased hypoxic and central hypercapnic chemosensitivity in CHF, postulating this as cause of the abnormal ventilation seen in CHF.
21. Chua TP, Harrington D, Ponikowski P, Webb-Peploe K, Poole-Wilson PA, Coats AJS: The effects of dihydrocodeine on chemosensitivity and exercise tolerance in chronic heart failure. J Am Coll Cardiol 1997, 29:147-152.
22. Piepoli M, Clark AL, Volterrani M, Adamopoulous S, Sleight P, Coats AJS: Contribution of muscle afferents to the hemodynamic, autonomic, and ventilatory responses to exercise in patients with chronic heart failure: effects of physical training. Circulation 1996, 93:940-952. Highlights a possible link between abnormal muscle and ventilation in CHF and demonstrates improvements following a training regimen.
23. Chua TP, Coats AJS: The lungs in chronic heart failure. Eur Heart J 1995, 16:882-887.
24. Siegel JL, Miller A, Brown LK, DeLuca A, Tierstein AJ: Pulmonary diffusing capacity in left ventricular failure. Chest 1990, 98:550-553.
25. Ravenscraft SA, Gross CR, Kobo SH, Olivari MT, Shumway SJ, Bolman RE III, Hertz MI: Pulmonary function after successful heart transplantation. Chest 1993, 103:857-861.
26. Puri S, Baker L, Dutka DP, Oakley CM, Hughes JMB, Cleland JGF: Reduced alveolar-capillary membrane diffusing capacity in chronic heart failure. Circulation 1995, 91:2769-2774.
27. Messner-Pellenc P, Brasilero C, Ahmaidi S, Mercier J, Ximenes C, Grolleau R, Prefaut C: Exercise intolerance in patients with chronic heart failure: role of pulmonary diffusion limitation. Eur Heart J 1995, 16:201-209. Demonstrates a failure of pulmonary diffusing capacity to increase normally with exercise but no association between this abnormality and exercise capacity.
28. Kraemer MD, Kobo SH, Rector TS, Brunsvold N, Bank AJ: Pulmonary and peripheral vascular factors are important determinants of peak oxygen uptake in patients with heart failure. J Am Coll Cardiol 1993, 21:641-648.
29. Collins JV, Clark TJH, Brown DJ: Airway function in healthy subjects and patients with left heart disease. Clin Sci Mol Med 1975, 49:217-228.
30. Wright RS, Levine MS, Bellamy PE, Simmons MS, Batra P, Stevenson LW, Walden JA, Laks H, Tashkin DP: Ventilatory and diffusion abnormalities in potential heart transplant recipients. Chest 1990, 98:816-820.
31. Naum C, Sciurba FC, Rogers P: Pulmonary function abnormalities in chronic severe cardiomyopathy preceeding cardiac transplantation. Am Rev Respir Dis 1992, 145:1334-1338.
32. Cabanes LR, Weber SN, Matran R, Regnard J, Richard MO, Degeorges ME, Lockhart A: Bronchial hyperresponsiveness to methacoline in patients with impaired left ventricular function. N Engl J Med 1989, 320:1317-1322.
33. Pison C, Malo JL, Rouleau J, Chalauoi J, Ghezzo H, Malo J: Bronchial hyperresponsiveness to inhaled methacholine in subjects with chronic left heart failure at a time of exacerbation and after increasing therapy. Chest 1989, 96:230-235.
34. Saski F, Ishizaki T, Mifune J, Fijimura M, Nishioka S, Miyabo S: Bronchial hyperresponsiveness in patients with chronic congestive heart failure. Chest 1990, 97:534-538.
35. Chua TP, Lallo U, Wordsell M, Kharitonov S, Chung KF, Coats AJS: Airway and cough responsiveness and exhaled nitric oxide in chronic heart failure. Heart 1996, 76:144-149.
36. Hammond MD, Bauer KA, Sharp JT, Rocha RD: Respiratory muscle strength in congestive heart failure. Chest 1990, 98:1091-1094.
37. McParland C, Krishnan B, Wang Y, Gallagher CG: Inspiratory muscle weakness and dyspnoea in chronic heart failure. Am Rev Respir Dis 1992, 146:467-472.
38. Evans SA, Watson L, Hawkins M, Cowley AJ, Johnston IDA, Kinnear WJM: Respiratory muscle strength in chronic heart failure. Thorax 1995, 50:625-628.
39. Mancini DM, Henson D, LaManca J, Levine S: Respiratory muscle function and dyspnoea in patients with chronic congestive heart failure. Circulation 1992, 86:909-918.
40. Nishimura Y, Maeda H, Tanaka K, Nakamura H, Hashimoto Y, Yokoyama M: Respiratory muscle strength and hemodynamics in chronic heart failure. Chest 1994, 105:355-359.
41. Chua TP, Anker SD, Harrington D, Coats AJS: Inspiratory muscle strength is a determinant of maximum oxygen consumption in chronic heart failure. Br Heart J 1995, 74:381-385.
42. Mancini DM, LaManca J, Donchez L, Henson D, Levine S: The sensation of dyspnoea is not determined by the work of breathing in patients with heart failure. J Am Coll Cardiol 1996, 28:391-395. Heart transplantation improves breathlessness but does not reduce the work of breathing; however, abnormal respiratory muscle perfusion is corrected.
43. Mancini DM, Henson D, LaManca J, Levine S: Evidence of reduced respiratory muscle endurance in patients with heart failure. J Am Coll Cardiol 1994, 24:972-981.
44. Walsh JT, Andrews R, Johnson P, Phillips L, Cowley AJ, Kinnear WJM: Inspiratory muscle endurance in patients with chronic heart failure. Heart 1996, 76:332-336.
45. Zelis R, Longhurst J, Capone RJ, Mason DT: A comparison of regional blood flow and oxygen utilization during dynamic forearm exercise in normal subjects and patients with congestive heart failure. Circulation 1974, 50:137-143.
46. Wilson JR, Martin JL, Schwartz D, Ferraro N: Exercise intolerance in patients with chronic heart failure: role of impaired nutritive flow to skeletal muscle. Circulation 1984, 69:1079-1087.
47. Lejemtel TH, Maskin CS, Lucido D, Chadwick BJ: Failure to augment maximal limb blood flow in response to one leg versus two-leg exercise in patient with severe heart failure. Circulation 1986, 74:245-251.
48. Sullivan MJ, Knight JD, Higginbotham MB, Cobb FR: Relation between central and peripheral hemodynamics during exercise in patients with chronic heart failure. Circulation 1989, 80:769-781.
49. McMurray JJ, Ray SG, Abdullah I, Dargie HJ, Morton JJ: Plasma endothelin in chronic heart failure. Circulation 1982, 85:1374-1379.
50. Drexler H, Banhardt U, Meinertz T, Wollschläger H, Lehmen M, Just H: Contrasting peripheral short-term and long-term of converting enzyme inhibition in patients with congestive heart failure: a doudle blind placebo controlled trial. Circulation 1989, 79:491-502.
51. Zelis R, Mason DT, Braunwald: A comparison of the effects of vasodilator stimuli on peripheral resistance vessels in normal subjects and patients with congestive heart failure. J Clin Invest 1968, 47:960-970.
52. Lindsay DC, Anand IS, Bennett JG, Pepper JR, Yacoub MH, Rothery SM, Severs NJ, Poole-Wilson PA: Ultrastructural analysis of skeletal muscle: microvascular dimensions and basement membrane thickness in chronic heart failure. Eur Heart J 1994, 15:1470-1476.
53. Wroblinski H, Kastrup J, Norgeerd T, Mortensen S-A, Haunso S: Evidence of increased microvascular resistance and arteriolar hyalinosis in skin in congestive heart failure secondary to idiopathic dilated cardiomyopathy. Am J Cardiol 1992, 69:769-774.
54. Kubo SH, Rector TS, Bank AJ, Williams RE, Heifertz SM: Endothelium dependant vasodilation is attenuated in patients with heart failure. Circulation 1991, 84:1589-1596.
55. Hornig B, Volker M, Drexler H: Physical training improves endothelial function in patients with chronic heart failure. Circulation 1996, 93:210-214. A physical training program improves flow-dependent vasodilation, perhaps via an increase in endothelial nitric oxide release.
56. Herrlin B, Sylvén C: Increased arterial oxygen content: an important compensatory mechanism in chronic heart failure. Cardiovasc Res 1991, 84:1589-1596.
57. Schaufelberger M, Andersson G, Eriksson BO, Grimby G, Held P, Swedberg K: Skeletal muscle changes in patients with chronic heart failure before and after treatment with enalapril. Eur Heart J 1996, 17:1678-1685.
58. Krum H, Goldsmith R, Wilshire-Clement, Miller M, Packer M: Role of endothelin in the exercise intolerance of chronic heart failure. Am J Cardiol 1995, 75:1282-1283.
59. Mancini DM, Walter G, Reichnek N, Lenkinski R, McCully KK, Mullen JL, Wilson JR: Contribution of skeletal muscle atrophy to exercise intolerance and altered muscle metabolism in heart failure. Circulation 1992, 85:1364-1373.
60. Minotti JR, Pillay P, Oka R, Wells L, Christoph I, Massie BM: Skeletal muscle size: relationship to muscle function in heart failure. J Appl Physiol 1993, 75:373-381.
61. Buller NP, Jones D, Poole-Wilson PA: Direct measurements of skeletal muscle fatigue in patients with chronic heart failure. Br Heart J 1991, 65:20-24.
62. Minotti JR, Christoph I, Oka R, Weiner MW, Wells L, Massie BM: Impaired skeletal muscle function in patients with congestive heart failure: relationship to systemic exercise performance. J Clin Invest 1991, 88:2077-2082.
63. Lipkin D, Jones D, Round J, Poole-Wilson P: Abnormalities of skeletal muscle in patients with chronic heart failure. Int J Cardiol 1988, 18:187-195.
64. Sullivan MJ, Green HJ, Cobb FR: Skeletal muscle biochemistry and histology in ambulatory patients with long-term heart failure. Circulation 1990, 81:518-527.
65. Vescovo G, Serafini F, Tenderini P, Carraro U, Dalla Libera L, Catani C, Ambrisio GB: Specific changes in skeletal muscle myosin heavy chain composition in cardiac failure: differences compared with disuse atrophy as assessed on microbiopsies by high resolution electrophoresis. Heart 1996, 76:337-343.
66. Simonini A, Long CS, Dudley GA, Yue P, McElhinny J, Massie BM: Heart failure in rats causes changes in skeletal muscle morphology and gene expression that are not explained by reduced activity. Circ Res 1996, 79:128-136. Demonstrates changes in skeletal muscle MRNA expression for oxidative enzymes and myosin phenotypes. The finding that these changes are closely related to the severity of heart failure and unrelated to the activity of the rats suggests that the skeletal muscle abnormalities are primary to heart failure and not caused by disease.
67. Wilson JR, Martin JL, Schwartz D, Ferraro N: Exercise intolerance in patients with chronic heart failure: role of impaired nutritive flow to skeletal muscle. Circulation 1984, 69:1079-1087.
68. Wilson JR, Mancini DM, Dunkman WB: Exertional fatigue due to skeletal muscle dysfunction in patients with heart failure. Circulation 1993, 87:470-475.
69. Wilson JR, Martin JL, Ferraro N, Weber KT: Effect of hydralazine on perfusion and metabolism in the leg during upright bicycle exercise in patients with heart failure. Circulation 1983, 68:425-432.
70. Wilson JR, Martin JL, Ferraro N: Impaired skeletal muscle nutritive flow during exercise in patients with congestive heart failure: role of cardiac pump dysfunction as determined by the effect of dobutamine. Am J Cardiol 1984, 53:1308-1315.
71. Wilson JR, Fink L, Maris J, Ferraro N, Power-Vanart J, Eleff S, Chance B: Evaluation of energy metabolism in skeletal muscle of patients with heart failure with gated phosphorous-31 nuclear magnetic resonance. Circulation 1985, 71:57-62.
72. Massie BM, Conway M, Yonge R, Frostick S, Ledingham J, Sleight P, Radda G, Rajagopalan B: Skeletal muscle metabolism in patients with congestive heart failure: relation to clinical severity and blood flow. Circulation 1987, 76:1009-1019.
73. 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, 73:1127-1136.
74. Massie BM, Conway M, Yonge R, Frostick S, Ledingham J, Sleight P, Radda G, Rajagopalan B: Skeletal muscle metabolism in patients with congestive heart failure: relation to clinical severity and blood flow. Circulation 1987, 76:1009-1019.
75. Jondeau G, Katz SD, Zohman L, Goldberger M, McCarthy M, Bourdarias JP, LeJemtel TH: Active skeletal muscle mass and cardiopulmonary reserve. Failure to attain peak aerobic capacity during maximal bicycle exercise in patients with severe congestive heart failure. Circulation 1992, 86:1351-1356.
76. Volterrani M, Clark AL, Ludman PF, Swan JW, Adamopoulos S, Piepoli M, Coats AJS: Determinants of exercise capacity in chronic heart failure. Eur Heart J 1994, 15:801-809.
77. Massie BM, Simonini A, Sahagal P, Wells I, Dudley GA: Relation of systemic and local muscle exercise capacity to skeletal muscle characteristics in men with congestive heart failure. J Am Coll Cardiol 1996, 27:140-145.
78. Mancini DM, Coyle E, Coggan A, Beltz J, Ferraro N, Montain S, Wilson JR: Contribution of intrinsic skeletal muscle changes to 31P NMR skeletal muscle abnormalities in patients with chronic heart failure. Circulation 1989, 80:1338-1346.
79. Drexler H, Riede U, Munzel T, Knight H, Funke E, Just H: Alterations in skeletal muscle in chronic heart failure. Circulation 1992, 85:1751-1759.
80. Sullivan MJ, Green HJ, Cobb FR: Skeletal muscle biochemistry and histology in ambulatory patients with long-term heart failure. Circulation 1990, 81:518-527.
81. Sullivan HJ, Higginbotham MB, Cobb FR: Exercise training in patients with severe left ventricular dysfunction: hemodynamic and metabolic effects. Circulation 1988, 78:506-516.
82. Coats AJS, Adamopoulos S, Radaelli A, McCance A, Meyer TE, Bernardi L, Solda PL, Davey P, Ormerod O, Forfar C, et al.: Controlled trial of physical training in chronic heart failure: exercise performance, hemodynamics, ventilation, and autonomic function. Circulation 1992, 85:2119-2131.
83. Wilson JR, Groves J, Rayos G: Circulatory status and response to cardiac rehabilitation in patients with heart failure. Circulation 1996, 94:1567-1572 Patients with CHF should be divided into those with normal and those with abnormal hemodynamics. Those with normal hemodynamics should be limited by the periphery and are thus more responsive to training.
84. Hambrecht R, Niebauer J, Fiehn E, Kalberer B, Offner B, Hauer K, Riede U, Schliert G, Kubler W, Schuler G: Physical training in patients with stable chronic heart failure: effects on cardiopulmonary fitness and ultrastructural abnormalities of leg muscles. J Am Coll Cardiol 1995, 25:1239-1249. The improvement following exercise testing correlates closely with an improvement in the oxidative capacity of skeletal muscle.
85. 2 and mitochondrial density.
86. Clark AL, Sparrow JL, Coats AJS: Muscle fatigue and dyspnoea in chronic heart failure: two sides of the same coin? Eur Heart J 1995, 16:49-52.