The clinical importance of cardiopulmonary exercise testing and aerobic training in patients with heart failure

Revista Brasileira de Fisioterapia

Volumn 12, Issue 2, 2008, Pages 75-87

  Arena, Ross ^a   Myers, J ^b   Guazzi, M ^c  

^a VIRGINIA COMMONWEALTH UNIVERSITY   (United States)

^b STANFORD UNIVERSITY   (United States)

^c UNIVERSITY OF MILAN   (Italy)

Author keywords

Cardiac output; Skeletal muscle; Survival; Ventilatory expired gas

Indexed keywords

EID: 48949093198     PISSN: 14133555     EISSN: 18099246     Source Type: Journal    
DOI: 10.1590/S1413-35552008000200002     Document Type: Review

References (93)

1. Armstrong L, Balady G, Berry M et al. Health-Related Physical Testing and Interpretation. In: Whaley MH, Brubaker PH, Otto R, editors. ACSM's Guidelines for exercise testing and prescription. 7th ed. Philadelphia: Lippincott Williams and Wilkins; 2007. p. 55-92.
2. Tanabe Y, Nakagawa I, Ito E, Suzuki K Hemodynamic basis of the reduced oxygen uptake relative to work rate during incremental exercise in patients with chronic heart failure. Int J of Cardiol. 2002;83:57-62.
3. Matsumoto A, Itoh H, Eto Y, Kobayashi T, Kato M, Omata M, et al. End-tidal CO2 pressure decreases during exercise in cardiac patients: association with severity of heart failure and cardiac output reserve. J Am Coll Cardiol. 2000;36:242-9.
4. Metra M, Faggiano P, D'Aloia A, Nodari S, Gualeni A, Raccagni D, et al. Use of cardiopulmonary exercise testing with hemodynamic monitoring in the prognostic assessment of ambulatory patients with chronic heart failure. J Am Coll Cardiol. 1999;33:943-50.
5. Myers J, Gujja P, Neelagaru S, Burkhoff D. Cardiac output and cardiopulmonary responses to exercise in heart failure: Application of a new bio-reactance device. J Card Fail. 2007;13:629-36.
6. Duscha BD, Kraus WE, Keteyian SJ, Sullivan MJ, Green HJ, Schachat FH, et al. Capillary density of skeletal muscle: a contributing mechanism for exercise intolerance in class II-III chronic heart failure independent of other peripheral afterations. J Am Coll Cardiol. 1999;33:1956-63.
7. Pina IL, Apstein CS, Balady GJ, Belardinelli R, Chaitman BR, Duscha BD, et al. Exercise and head failure: A statement from the american heart association committee on exercise, Rehabilitation, and Prevention. Circulation. 2003;107:1210-25.
8. Hambrecht R, Fiehn E, Yu J, Niebauer J, Weigl C, Hilbrich L, et al. Effects of endurance training on mitochondriall ultrastructure and fiber type distribution in skeletal muscle of patients with stable chronic heart failure. J Am Coll Cardiol. 1997;29:1067-73.
9. Bekedam MA, van Beek-Harmsen BJ, Boonstra A, van MW, Visser FC, van der Laarse WJ. 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; 23:337-43.
10. Witte KK, Clark AL. Why does chronic heart failure cause breathlessness and fatigue? Prog Cardiovasc Dis. 2007;49:366-84.
11. Mettauer B, Zoll J, Gamier A, Ventura-Clapier R. Heart failure: a model of cardiac and skeletal muscle energetic failure. Pflugers Archiv. 2006;452:653-66.
12. Sullivan MJ, Knight JD, Higgin botham 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 perlusion pressure. Circulation. 1989;80:769-81.
13. Myers J, Froelicher VF. Hemodynamic determinants of exercise capacity in chronic heart failure. Ann Intern Med. 1991;115:377-86.
14. Myers J. Principles of exercise prescription for patients with chronic heart failure. Heart Fail Rev. 2008;13:61-8.
15. Nanas S, Nanas J, Papazachou O, Kassiotis C, Papamichalopoulos A, Milic-Emili J, et al. Resting lung function and hemodynamic parameters as predictors of exercise capacity in patients with chronic heart failure. Chest. 2003;123:1386-93.
16. Papazachou O, Anastasiou-Nana M, Sakellariou D, Tassiou A, Dimopoulos S, Venetsanakos J, et al. Pulmonary function at peak exercise in patients with chronic heart failure. Int J Cardiol. 2007;118:28-35.
17. Agostoni P, Bussotti M, Cattadori G, Margutti E, Contini M, Muratori M, et al. Gas diffusion and alveolar-capillary unit in chronic head failure. Eur Heart J. 2006;27:2538-43.
18. Meyer K, Westbrook S, Schwaibold M, Hajric R, Peters K, Roskamm H. Short-term reproducibility of cardiopulmonary measurements during exercise testing in patients with severe chronic head failure. Am Head J. 1997;134:20-6.
19. Gibbons RJ, Balady GJ, Beasley JW, Bricker JT, Duvernoy WF, Froelicher VF, et al. ACC/AHA Guidelines for exercise testing. A report of the American College of Cardiology/American Head Association Task Force on Practice Guidelines (Committee on Exercise Testing). J Am Coll Cardiol. 1997; 30:260-311.
20. Gibbons RJ, Balady GJ, Timothy BJ, Chaitman BR, Fletcher GF, Froelicher VF, et al. ACC/AHA 2002 guideline update for exercise testing: summary article. A report of the American College of Cardiology/American Head Association Task Force on Practice Guidelines (Committee to Update the 1997 Exercise Testing Guidelines). J Am Coll Cardiol. 2002; 40:1531-40.
21. Arena R, Myers J, Abella J, Peberdy MA, Bensimhon D, Chase P et al. Development of a ventilatory classification system in patients with heart failure. Circulation. 2007;115:2410-7.
22. Piepoli MF, Corra U, Agostoni PG, Belardinelli R, Cohen-Solal A, Hambrecht R, et al. Statement on cardiopulmonary exercise testing in chronic head failure due to left ventricular dysfunction: recommendations for performance and interpretation. Pad I: definition of cardiopulmonary exercise testing parameters for appropriate use in chronic head failure. Eur J Cardiovasc Prev Rehabil. 2006;13:150-64.
23. Piepoli MF, Corra U, Agostoni PG, Belardinelli R, Cohen-Solal A, Hambrecht R, et al. Statement on cardiopulmonary exercise testing in chronic head failure due to left ventricular dysfunction: recommendations for performance and interpretation Part II: How to perform cardiopulmonary exercise testing in chronic head failure. Eur J Cardiovasc Prev Rehabil. 2006;13:300-11.
24. Piepoli MF, Corra U, Agostoni PG, Belardinelli R, Cohen-Solal A, Hambrecht R, et al. Statement on cardiopulmonary exercise testing in chronic heart failure due to left ventricular dysfunction: recommendations for performance and interpretation Pan III: Interpretation of cardiopulmonary exercise testing in chronic heart failure and future applications. Eur J Cardiovasc Prev Rehabil. 2006;13:485-94.
25. Arena R, Humphrey R, Peberdy MA, Madigan M. Predicting peak oxygen consumption during a conservative ramping protocol: implications for the head failure population. J Cardiopulm Rehabil, 2003; 23:183-9.
26. Fletcher GF, Balady GJ, Amsterdam, EA, Chaitman B, Eckel R, Flog J, et al. Exercise standards for testing and training: a statement for healthcare professionals from the American Head Association. Circulation. 2001;104:1694-740.
27. Guazzi M, Myers J, Arena R. Cardiopulmonary exercise testing in the clinical and prognostic assessment of diastolic head failure. J Am Coll Cardiol. 2005;46:1883-90.
28. Guazzi M, Pontone G, Brambilla R, Agostoni P, Reina G. Alveolar-capillary membrane gas conductance: a novel prognostic indicator in chronic head failure. Eur Head J. 2002;23:467-76.
29. Ponikowski P, Chua TP, Piepoli M, Banasiak W, Anker SD, Szelemej R, et al. Ventilatory response to exercise correlates with impaired heart rate variability in patients with chronic congestive head failure. Am J Cardiol. 1998;82:338-44.
30. Reindl I, Wernecke KD, Opitz C, Wensel R, Konig D, Dengler T, et al. Impaired ventilatory efficiency in chronic heart failure: possible role of pulmonary vasoconstriction. Am Heart J. 1998;136:778-85.
31. Myers J, Dziekan G, Goebbels U, Dubach P. Influence of high-intensity exercise training on the ventilatory response to exercise in patients with reduced ventricular function. Med Sci Sports Exerc.1999; 31:929-37.
32. Kruger S, Graf Ju, Kunz D, Stickel T, Hanrath P, Janssens U. brain natriuretic peptide levels predict functional capacity in patients with chronic heart failure. J Am Coll Cardiol. 2002;40:718-22.
33. Passino C, Poletti R, Bramanti F, Prontera C, Clerico A, Emdin M. Neuro-hormonal activation predicts; ventilatory response to exercise and functional capacity in patients with head failure. Eur J Heart Fail. 2006;8:46-53.
34. Scardovi AB, De MR, Coletta C, Aspromonte N, Perna S, Infusino T, et al. Brain natriuretic peptide is a reliable indicator of ventilatory abnormalities during cardiopulmonary exercise test in head failure patients. Med Sci Monit. 2006;12:CR191-5.
35. Guazzi M, Reina G, Tumminello G, Guazzi MD. Improvement of alveolar-capillary membrane diffusing capacity with exercise training in chronic heart failure. J Appl Physiol. 2004:97:1866-73.
36. Dall'Ago P, Chiappa GR, Guths H, Stein R, Ribeiro JP. Inspiratory muscle training in patients with head failure and inspiratory muscle weakness: a randomized trial. J Am Coll Cardiol. 2006;47:757-63.
37. de Jonge N, Kirkels H, Lahpor JR, Klopping C, Hulzebos EJ, de la Riviere AB, et al. Exercise performance in patients with end-stage heart failure after implantation of a left ventricular assist device and after head transplantation: an outlook for permanent assisting? J Am Coll Cardiol. 2001;37:1794-9.
38. Auricchio A, Stellbrink C, Sack S, Block M, Vogt Ju, Bakker P, et al. Longterm clinical effect of hemodynamically optimized cardiac resynchronization therapy in patients with heart failure and ventricular conduction delay. J Am Coll Cardiol. 2002;39:2026-33.
39. Guazzi M, Marenzi G, Alimento M, Contini M, Agostoni P. Improvement of alveolar-capillary membrane diffusing capacity with enalapril in chronic heart failure and counteracting effect of aspirin. Circulation. 1997; 95:1930-6.
40. Guazzi M, Samaja M, Arena R, Vicenzi M, Guazzi MD. Long-term use of Sildenafil in the therapeutic management of heart failure. J Am Coll Cardiol. 2007;50:2136-44.
41. Agostoni P, Guazzi M, Bussotti M, De Vita S, Palermo P. Carvedilol reduces the inappropriate increase of ventilation during exercise in heart failure patients. Chest. 2002;122:2062-7.
42. Wolk R, Johnson BD, Somers VK, Allison TG, Squires RW, Gau GT, et al. Effects of [beta]-Blocker therapy on ventilatory responses to exercise in patients with heart failure. J Card Fail. 2005;11:333-9.
43. 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 head failure. Circulation. 1991;83:778-86.
44. Myers J, Gullestad L, Vagelos R, Do D, Bellin D, Ross H, et al. Cardiopulmonary exercise testing and prognosis in severe head failure: 14 mL/kg/min revisited. Am Head J. 2000;139:78-84.
45. Arena R, Myers J, Aslam SS, Varughese EB, Peberdy MA. Peak V02 and VENC02 slope in patients with head failure: a prognostic comparison. Am Heart J. 2004;147:354-60.
46. O'Neill JO, Young JB, Pothier CE, Lauer MS. Peak oxygen consumption as a predictor of death in patients with head failure receiving (beta)-blockers. Circulation. 2005;111:2313-8.
47. Mezzani A, Corra U, Bosimini E, Giordano A, Giannuzzi P. Contribution of peak respiratory exchghge ratio to peak V02 prognostic reliability in patients with chronic head failure and severely reduced exercise capacity. Am Head J. 2003;145:1102-7.
48. Wilson JR, Ferraro N, Weber Kr. Respiratory gas analysis during exercise as a noninvasive measure of lactate concentration in chronic congestive heart failure. Am J Cardiol. 1983;51:1639-43.
49. Arena R, Myers J, Williams MA, Gulati M, Kligfield P, Balady GJ, et al. Assessment of functional capacity in clinical and research settings: ascientific statement from the American Heart Association Committee on Exercise, Rehabilitation, and Prevention of the Council on Clinical Cardiology and the Council on Cardiovascular Nursing. Circulation. 2007;116:329-43.
50. Myers J. Information from ventilatory gas exchange data. In: Washburn R, editor. Essentials of cardiopulmonary exercise testing. Champaign: Human Kinetics; 1996. p. 83-108.
51. Gitt AK, Wasserman K, Kilkowski C, Kleemann T, Kilkowski A, Bangert M, et al. Exercise anaerobic threshold and ventilatory efficiency identify head failure patients for high risk of early death. Circulation. 2002;106:3079-84.
52. Uren NG, Davies SW, Agnew JE, Irwin AG, Jordan SL, Hilson AJ, et al. Reduction of mismatch of global ventilation and perfusion on exercise is related to exercise capacity in chronic head failure. Br Heart J. 1993;70:241-6.
53. Wada O, Asanoi H, Miyagi K, Ishizaka S, Kameyama T, Seto H, et al. Importance of abnormal lung perfusion in excessive exercise ventilation in chronic head failure. Am Heart J. 1993;125:790-8.
54. 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.
55. Chua TP, Clark AL, Amadi AA. The relationship between chemosensitivity and the ventilatory response to exercise in chronic head failure. J Am Coll Cardiol. 1996; 27:650-7.
56. Piepoli M, Clark AL, Volterrani M. Contribution of Muscle Affarents to the Hemodynamic, Autonomic, and Ventilatory Responses to Exercise in Patients with Chronic Head Failure. Circulation. 1996; 93:940-52.
57. Sullivan MJ, Higginbotham MB, Cobb FR. Increased exercise ventilation in patients with chronic head failure: intact ventilatory control despite hemodynamic and pulmonary abnormalities. Circulation. 1988; 77:552-9.
58. Guazzi M, Reina G, Tumminello G, Guazzi MD. Alveolar-capillary membrane conductance is the best pulmonary function correlate of exercise ventilation efficiency in head failure patients. Eur J Head Fail. 2005; 7:1017-22.
59. Francis DP, Shamim W, Davies LC, Piepoli MF, Ponikowski P, Anker SD, et al. Cardiopulmonary exercise testing for prognosis in chronic head failure: continuous and independent prognostic value from VE/VCO(2) slope and peak VO(2). Eur Head J. 2000; 21:154-61.
60. Kleber FX, Vietzke G, Wernecke KD, Bauer U, Opitz C, Wensel R, et al. Impairment of ventilatory efficiency in head failure: prognostic impact, Circulation. 2000;101:2803-9.
61. Bard RL, Gillespie BW, Clarke NS, Egan TG, Nicklas JM. Determining the best ventilatory efficiency measure to predict mortality in patients with head failure. Head Lung Transplant. 2006; 25:589-95.
62. Arena R, Myers J, Guazzi M. The clinical and research applications of aerobic capacity and ventilatory efficiency in head failure: an evidence-based review. Heart Fail Rev. In press 2007.
63. Arena R, Myers J, Aslam S, Varughese EB, Peberdy MA. Technical considerations related to the minute ventilation/carbon dioxide output slope in patients with heart failure. Chest. 2003;124:720-7.
64. Ribeiro JP, Knutzen A, Rocco MB, Hartley LH, Colucci WS. Periodic breathing during exercise in severe head failure. Reversal with milrinone or cardiac transplantation. Chest. 1987;92:555-6.
65. Feld H, Priest S. A cyclic breathing pattern in patients with poor left ventricular function and compensaled heart failure: a mild form of Cheyne-Stokes respiration? J Am Coll Cardiol. 1993; 21:971-4.
66. Corra U, Pistono M, Mezzani A, Braghiroli A, Giordano A, Lanfranchi P, et al. Sleep and exertional periodic breathing in chironic heart failure: prognostic importance and interdependence. Circulation. 2006;113:44-50.
67. Corra U, Giordano A, Bosimini E, Mezzani A, Piepoli M, Coats AJ, et al. Oscillatory ventilation during exercise in patients with chronic head failure: clinical correlates and prognostic implications. Chest. 2002; 121:1572-80.
68. Lahiri S, Hsiao C, Zhang R, Molkashi A, Nishinol T. Peripheral chemoreceptors in respiratory oscillations. J Appl Physiol. 1985; 58:1901-8.
69. Yajima T, Koike A, Sugimoto K, Miyahara Y, Marumo F, Hiroe M. Mechanism of periodic breathing in patients with cardiovascular disease. Chest. 1994;106:142-6.
70. Francis DP, Willson K, Davies LC, Coats AJ, Piepoli M. Quantitative general theory for periodic breathing in chronic head failure and its clinical implications. Circulation. 2000;102:2214-21.
71. Guazzi M, Raimondo R, Vicenzi M, Arena R, Proserpio C, Sarzi BS, et al. Exercise oscillatory ventilation may predict sudden cardiac death in heart failure patients. J Am Coll Cardiol. 2007;50:299-308.
72. Guazzi M, Arena R, Ascione A, Piepoli M, Guazzi MD. Exercise oscillatory breathing and increased ventilation to carbon dioxide production slope in head failure: an unfavorable combination with high prognostic value. Am Heart J. 2007;153:859-67.
73. Arena R, Myers J, Hsu L, Peberdy MA, Pinkstaff S, Bensimhon D, et al. The minute ventilation/carbon dioxide production slope is prognostically superior to the oxygen uptake efficiency slope. J Card Fail. 2007;13:462-9.
74. Davies LC, Wensel R, Georgiadou P, Cicoira M, Coats AJ, Piepoli MF, et al. Enhanced prognostic value from cardiopulmonary exercise testing in chronic head failure by non-linear analysis: oxygen uptake efficiency slope. Eur Heart J. 2006;27:684-90.
75. Arena R, Peberdy MA, Myers J, Guazzi M, Tevald M. Prognostic value of resting end-tidal carbon dioxide in patients with head failure. Int J Cardiol. 2006;109:351-8.
76. Arena R, Guazzi M, Myers J. Prognostic value of end-tidal carbon dioxide during exercise testing in head failure. Int J Cardiol. 2007; 117:103-8.
77. Arena R, Guazzi M, Myers J, Peberdy MA. Prognostic value of head rate recovery in patients with heart failure. Am Head J. 2006;151:851.
78. Lipinski MJ, Vetrovec GW, Gorelik D, Froelicher VF. The importance of heart rate recovery in patients with head failure or left ventricular systolic dysfunction. J Card Fail. 2005;11:624-30.
79. Sheppard RJ, Racine N, Roof A, Ducharme A, Blanchet M, White M. Heart rate recovery - a potential marker of clinical outcomes in heart failure patients receiving beta-blocker therapy. Can J Cardiol. 2007; 23:1135-8.
80. Van Laethem C, Van De Veire N, Backer GD, Bihija S, Seghers T, Cambier D. et al. Response of the oxygen uptake efficiency slope to exercise training in patients with chronic heart failure. Eur J Heart Fail. 2007;9:625-9.
81. Myers J, Hadley D, Oswald U, Bruner K, Kottman W, Hsu L, et al. Effects of exercise training on heart rate recovery in patients with chronic heart failure. Am Heart J. 2007;153:1056-63.
82. Froelicher V, Morrow K, Brown M, Atwood E, Morris C. Prediction of atherosclerotic cardiovascular death in men using a prognostic score. Am J Cardiol. 1994; 73:133-8.
83. Morris CK, Morrow K, Froelicher VF, Hideg A, Hunter D, Kawaguchi T, et al. Prediction of cardiovascular death by means of clinical and exercise test variables in patients selected for cardiac catheterization. Am Heart J. 1993;125:1717-26.
84. Dubach P, Froelicher VF, Klein J, Oakes D, Grover-McKay M, Friis R. Exercise-induced hypotension in a male population. Criteria, causes, and prognosis. Circulation. 1988; 78:1380-7.
85. Morrow K, Morris CK, Froelicher VF, Hideg A, Hunter D, Johnson E, et al. Prediction of cardiovascular death in men undergoing noninvasive evaluation for coronary artery disease. Ann Intern Med. 1993;118:689-95.
86. Mezzani A, Corra U, Giannuzzi P. Central adaptations to exercise training in patients with chronic heart failure. Heart Fail Rev. 2008;13:13-20.
87. Haykowsky MJ, Liang Y, Pechter D, Jones LW, McAlister FA, Clark AM. A Meta-Analysis of the effect of exercise training on left ventricular remodeling in heart failure patients: The benefit depends on the type of training performed. J Am Coll Cardiol. 2007;49:2329-36.
88. Whellan DJ, O'Connor CM, Lee KL, Keteyian SJ, Cooper LS, Ellis SJ, et al. Heart failure and a controlled trial investigating outcomes of exercise training (HF-ACTION): Design and rationale. Am Heart J. 2007;153:201-11.
89. Smart N, Haluska B, Jeffriess L, Marwick TH. Exercise training in systolic and diastolic dysfunction: Effects on cardiac function, functional capacity, and quality of life. Am Heart J. 2007;153:530-6.
90. Braith R, Beck D. Resistance exercise: training adaptations and developing a safe exercise prescription. Heart Fail Rev. 2008;13:69-79.
91. Quittan M, Wiesinger GF, Sturm B, Puig S, Mayr W, Sochor A, et al. Improvement of thigh muscles by neuromuscular electrical stimulation in patients with refractory heart failure: a single-blind, randomized, controlled trial. Am J Phys Med Rehabil. 2001; 80:206-14.
92. Nuhr MJ, Pette D, Berger R, Quittan M, Crevenna R, Huelsman M, et al. Beneficial effects of chronic low-frequency stimulation of thigh muscles in patients with advanced chronic heart failure. Eur Heart J. 2004;25:136-43.
93. Deley G, Kervio G, Verges B, Hannequin A, Petitdant MF, Salmi-Belmihoub S, et al. Comparison of low-frequency electrical myostimulation and conventional aerobic exercise training inpatients with chronic heart failure. Eur J Cardiovasc Prev Rehabil. 2005;12:226-33.