Critical capillary oxygen partial pressure and lactate threshold in patients with cardiovascular disease

Kasumigaura Branch Hospital, Tokyo Medical and Dental University, Ibaraki, Japan.

OBJECTIVES. The aim of this study was to determine the relation between femoral vein oxygen partial pressure (PO2) and lactate increase during exercise in patients with cardiovascular disease. BACKGROUND. Considerable controversy surrounds the relation between the increase in lactate during exercise and the oxygen supply to the exercising muscles. We assumed that femoral vein PO2 would be a measure of end-capillary PO2 during leg-cycling exercise and that it would decrease to a "floor" level when the critical capillary PO2 (the PO2 below which the capillary-mitochondrial difference would be too low to allow oxygen consumption) was reached. At the critical capillary PO2, anaerobic metabolism should take place, and lactate should increase in the effluent blood. METHODS. Ten patients with cardiovascular disease performed two 6-min constant work rate tests (moderate and heavy intensity) and an incremental exercise test to the symptom-limited maximum on a cycle ergometer. Femoral vein blood was repeatedly sampled through a percutaneous catheter before and during each exercise test. RESULTS. The PO2 rapidly decreased toward a minimal value with increasing oxygen uptake for all three tests in all patients. After reaching its nadir (18.2 +/- 2.0 mm Hg), the PO2 remained unchanged in five patients but increased in the other five patients despite the further increase in work rate and oxygen uptake. The relation between PO2 and oxygen uptake was characteristic for each patient and independent of the protocol used for the study. Femoral vein lactate did not change appreciably until PO2 reached the minimal (critical) value. Thereafter, it dramatically increased without a further decrease in PO2. The minimal PO2 was positively correlated with the peak oxygen uptake (r = 0.70, p = 0.01). CONCLUSIONS. During leg-cycling exercise, muscle capillary PO2 reaches a minimal value in the midrange of the subjects' work capacity before lactate concentration increases in patients with cardiovascular disease. The lack of further decrease in PO2 at the oxygen uptake at which lactate starts to increase suggests that the minimal capillary PO2 is the "critical" capillary PO2.

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