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Exercise capacity and VO2 in heart failure

Author
Ileana L Piña, MD, MPH
Section Editor
Stephen S Gottlieb, MD
Deputy Editor
Susan B Yeon, MD, JD, FACC

INTRODUCTION

Limitation of exercise capacity is one of the cardinal manifestations of heart failure (HF), varying directly with the severity of the disease. Thus, decreased maximal exercise capacity is associated with decreased patient survival. Exercise training may have a variety of benefits, including an improvement in quality of life, reduced hospitalization, and improved survival. (See "Cardiac rehabilitation in patients with heart failure".)

The methods used to measure exercise capacity, the factors that limit exercise capacity in HF, and the use of measurement of peak exercise capacity (also called functional exercise testing) to predict prognosis will be reviewed here. This discussion is generally consistent with the 2000 recommendations published by the European Society of Cardiology [1] and the 2010 clinician’s guide to cardiopulmonary testing published by the American Heart Association [2]. Cardiopulmonary exercise testing and the effects of exercise training in patients with HF are discussed separately. (See "Functional exercise testing: Ventilatory gas analysis" and "Cardiac rehabilitation in patients with heart failure".)

MEASUREMENT OF EXERCISE CAPACITY

Peak exercise capacity is defined as "the maximum ability of the cardiovascular system to deliver oxygen to exercising skeletal muscle and of the exercising muscle to extract oxygen from the blood" [3]. As a result, exercise tolerance is determined by three factors: pulmonary gas exchange; cardiovascular performance, including the peripheral vascular tree; and skeletal muscle metabolism. (See "Exercise physiology".)

Peak VO2 — Exercise capacity can be quantitated clinically by measurement of oxygen uptake (Vo2), carbon dioxide production (Vco2), and minute ventilation [4]. These parameters are measured during exercise with rapidly responding gas analyzers capable of breath-by-breath determination of O2 and CO2 concentrations in inspired and expired air, respectively. The maximal oxygen uptake (Vo2max) eventually reaches a plateau despite increasing workload (figure 1). Not surprisingly, Vo2max has a strong linear correlation with both cardiac output and skeletal muscle blood flow (figure 2) [5]. (See "Functional exercise testing: Ventilatory gas analysis".) The peak VO2 divided by the heart rate (peakVo2/HR) is called the oxygen pulse and is an indirect measure of stroke volume.

The relationship between cardiac output and O2 uptake (or oxygen consumption) also forms the basis for the Fick equation used to measure cardiac output:

                   

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Literature review current through: Nov 2016. | This topic last updated: Tue Aug 04 00:00:00 GMT+00:00 2015.
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