Clinical correlates and prognostic significance of the ventilatory response to exercise in chronic heart failure

Royal Brompton Hospital and National Heart and Lung Institute, Imperial College School of Medicine, London, England, United Kingdom.

OBJECTIVES: This study sought to investigate the clinical characteristics of patients with chronic heart failure and an increased ventilatory response to exercise and to examine the prognostic usefulness of this response. BACKGROUND: The ventilatory response to exercise is increased in many patients with chronic heart failure and may be characterized by the regression slope relating minute ventilation to carbon dioxide output (VE-VCO2 slope) during exercise. METHODS: One hundred seventy-three consecutive patients (155 men; mean [+/-SD] age 59.8 +/- 11.5 years; radionuclide left ventricular ejection fraction [LVEF] 28.4 +/- 14.6%) underwent cardiopulmonary exercise testing (peak oxygen consumption 18.5 +/- 7.3 ml/kg per min; VE-CO2 slope 34.8 +/- 10.6) over a 2-year period. Using 1.96 standard deviations above the mean VE-VCO2 slope of 68 healthy age-matched subjects (mean slope 26.3 +/- 4.1), we defined a high ventilatory response to exercise as a slope >34. RESULTS: Eighty-three patients (48%) had an increased VE-VCO2 slope (mean 43.1 +/- 8.9). There was a difference in age (62.2 vs. 57.3 years, p = 0.005), New York Heart Association functional class (2.9 vs. 2.1, p < 0.001), LVEF (24.7 vs. 31.9%, p = 0.0016), peak oxygen consumption (14.9 vs. 21.7 ml/kg per min, p < 0.0001) and radiographic cardiothoracic ratio (0.58 vs. 0.55, p = 0.002) between these patients and those with a normal slope. In the univariate Cox proportional hazards model, the E-VCO2 slope was an important prognostic factor (p < 0.0001). In the multivariate Cox analyses using several variables (age, peak oxygen consumption, VE-VCO2 slope and LVEF), the VE-VCO2 slope gave additional prognostic information (p = 0.018) beyond peak oxygen consumption (p = 0.022). Kaplan-Meier survival curves at 18 months demonstrated a survival rate of 95% in patients with a normal VE-VCO2 slope compared with 69% in those with a high slope (p < 0.0001). CONCLUSIONS: A high VE-VCO2 slope selects patients with more severe heart failure and is an independent prognostic marker. The VE-VCO2 slope may be used as a supplementary index in the assessment of patients with chronic heart failure.

This article has been cited by other articles:

				M. Guazzi, K. Dickstein, M. Vicenzi, and R. Arena Six-Minute Walk Test and Cardiopulmonary Exercise Testing in Patients With Chronic Heart Failure: A Comparative Analysis on Clinical and Prognostic Insights Circ Heart Fail, November 1, 2009; 2(6): 549 - 555. [Abstract] [Full Text] [PDF]

				R. Naeije and P. van de Borne Clinical relevance of autonomic nervous system disturbances in pulmonary arterial hypertension Eur. Respir. J., October 1, 2009; 34(4): 792 - 794. [Full Text] [PDF]

				G. Caminiti, M. Volterrani, F. Iellamo, G. Marazzi, R. Massaro, M. Miceli, C. Mammi, M. Piepoli, M. Fini, and G. M.C. Rosano Effect of long-acting testosterone treatment on functional exercise capacity, skeletal muscle performance, insulin resistance, and baroreflex sensitivity in elderly patients with chronic heart failure a double-blind, placebo-controlled, randomized study. J. Am. Coll. Cardiol., September 1, 2009; 54(10): 919 - 927. [Abstract] [Full Text] [PDF]

				P. Laveneziana, D. E. O'Donnell, D. Ofir, P. Agostoni, L. Padeletti, G. Ricciardi, P. Palange, R. Duranti, and G. Scano Effect of biventricular pacing on ventilatory and perceptual responses to exercise in patients with stable chronic heart failure J Appl Physiol, May 1, 2009; 106(5): 1574 - 1583. [Abstract] [Full Text] [PDF]

				D. Magri, M. Brioschi, C. Banfi, J. P. Schmid, P. Palermo, M. Contini, A. Apostolo, M. Bussotti, E. Tremoli, S. Sciomer, et al. Circulating Plasma Surfactant Protein Type B as Biological Marker of Alveolar-Capillary Barrier Damage in Chronic Heart Failure Circ Heart Fail, May 1, 2009; 2(3): 175 - 180. [Abstract] [Full Text] [PDF]

				U. Corra, A. Mezzani, A. Giordano, E. Bosimini, and P. Giannuzzi Exercise haemodynamic variables rather than ventilatory efficiency indexes contribute to risk assessment in chronic heart failure patients treated with carvedilol Eur. Heart J., April 30, 2009; (2009) ehp138v1. [Abstract] [Full Text] [PDF]

				R. Arena, J. Myers, J. Abella, S. Pinkstaff, P. Brubaker, B. Moore, D. Kitzman, M. A. Peberdy, D. Bensimhon, P. Chase, et al. Determining the Preferred Percent-Predicted Equation for Peak Oxygen Consumption in Patients With Heart Failure Circ Heart Fail, March 1, 2009; 2(2): 113 - 120. [Abstract] [Full Text] [PDF]

				M. A. Castel, F. Mendez, D. Tamborero, L. Mont, S. Magnani, J. M. Tolosana, A. Berruezo, M. Godoy, M. Sitges, B. Vidal, et al. Six-minute walking test predicts long-term cardiac death in patients who received cardiac resynchronization therapy Europace, March 1, 2009; 11(3): 338 - 342. [Abstract] [Full Text] [PDF]

				M. Guazzi, J. Myers, M. A. Peberdy, D. Bensimhon, P. Chase, and R. Arena Exercise oscillatory breathing in diastolic heart failure: prevalence and prognostic insights Eur. Heart J., November 2, 2008; 29(22): 2751 - 2759. [Abstract] [Full Text] [PDF]

				G. D. Lewis, R. V. Shah, P. P. Pappagianopolas, D. M. Systrom, and M. J. Semigran Determinants of Ventilatory Efficiency in Heart Failure: The Role of Right Ventricular Performance and Pulmonary Vascular Tone Circ Heart Fail, November 1, 2008; 1(4): 227 - 233. [Abstract] [Full Text] [PDF]

				H. Ukkonen, I. G. Burwash, W. Dafoe, R. A. de Kemp, H. Haddad, K. Yoshinaga, R. A. Davies, E. K. Gannon, J. N. DaSilva, and R. S.B. Beanlands Is ventilatory efficiency (VE/VCO2 slope) associated with right ventricular oxidative metabolism in patients with congestive heart failure? Eur J Heart Fail, November 1, 2008; 10(11): 1117 - 1122. [Abstract] [Full Text] [PDF]

				J. Meadows, P. Lang, G. Marx, and J. Rhodes Fontan Fenestration Closure Has No Acute Effect on Exercise Capacity but Improves Ventilatory Response to Exercise J. Am. Coll. Cardiol., July 8, 2008; 52(2): 108 - 113. [Abstract] [Full Text] [PDF]

				G. V. Guimaraes, V. M. d'Avila, P. R. Camargo, L. F. P. Moreira, J. R. L. Luces, and E. A. Bocchi Prognostic value of cardiopulmonary exercise testing in children with heart failure secondary to idiopathic dilated cardiomyopathy in a non-{beta}-blocker therapy setting Eur J Heart Fail, June 1, 2008; 10(6): 560 - 565. [Abstract] [Full Text] [PDF]

				T V Salukhe, K Dimopoulos, R Sutton, P Poole-Wilson, M Y Henein, M Morgan, J R Clague, and D P Francis Instantaneous effects of resynchronisation therapy on exercise performance in heart failure patients: the mechanistic role and predictive power of total isovolumic time Heart, January 1, 2008; 94(1): 59 - 64. [Abstract] [Full Text] [PDF]

				K. Albouaini, M. Egred, A. Alahmar, and D. J. Wright Cardiopulmonary exercise testing and its application Postgrad. Med. J., November 1, 2007; 83(985): 675 - 682. [Abstract] [Full Text] [PDF]

				K Albouaini, M Egred, A Alahmar, and D J Wright Cardiopulmonary exercise testing and its application Heart, October 1, 2007; 93(10): 1285 - 1292. [Abstract] [Full Text] [PDF]

				E. A. Jankowska, T. Witkowski, B. Ponikowska, K. Reczuch, L. Borodulin-Nadzieja, S. D. Anker, M. F. Piepoli, W. Banasiak, and P. Ponikowski Excessive ventilation during early phase of exercise: A new predictor of poor long-term outcome in patients with chronic heart failure Eur J Heart Fail, October 1, 2007; 9(10): 1024 - 1031. [Abstract] [Full Text] [PDF]

				M. Guazzi, R. Raimondo, M. Vicenzi, R. Arena, C. Proserpio, S. Sarzi Braga, and R. Pedretti Exercise oscillatory ventilation may predict sudden cardiac death in heart failure patients. J. Am. Coll. Cardiol., July 24, 2007; 50(4): 299 - 308. [Abstract] [Full Text] [PDF]

				R. Arena, J. Myers, M. A. Williams, M. Gulati, P. Kligfield, G. J. Balady, E. Collins, and G. Fletcher Assessment of Functional Capacity in Clinical and Research Settings: A Scientific 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, July 17, 2007; 116(3): 329 - 343. [Full Text] [PDF]

				M. Metra, P. Ponikowski, K. Dickstein, J. J.V. McMurray, A. Gavazzi, C.-H. Bergh, A. G. Fraser, T. Jaarsma, A. Pitsis, P. Mohacsi, et al. Advanced chronic heart failure: A position statement from the Study Group on Advanced Heart Failure of the Heart Failure Association of the European Society of Cardiology Eur J Heart Fail, June 1, 2007; 9(6-7): 684 - 694. [Abstract] [Full Text] [PDF]

				D. Mancini and T. H. LeJemtel Is Ventilatory Classification Preferable to Peak Oxygen Consumption for Risk Stratification in Heart Failure? Circulation, May 8, 2007; 115(18): 2376 - 2378. [Full Text] [PDF]

				R. Arena, J. Myers, J. Abella, M. A. Peberdy, D. Bensimhon, P. Chase, and M. Guazzi Development of a Ventilatory Classification System in Patients With Heart Failure Circulation, May 8, 2007; 115(18): 2410 - 2417. [Abstract] [Full Text] [PDF]

				L. A. Smith, M. Vennelle, R. S. Gardner, T. A. McDonagh, M. A. Denvir, N. J. Douglas, and D. E. Newby Auto-titrating continuous positive airway pressure therapy in patients with chronic heart failure and obstructive sleep apnoea: a randomized placebo-controlled trial Eur. Heart J., May 2, 2007; 28(10): 1221 - 1227. [Abstract] [Full Text] [PDF]

				M. M. Hoeper, M. W. Pletz, H. Golpon, and T. Welte Prognostic value of blood gas analyses in patients with idiopathic pulmonary arterial hypertension Eur. Respir. J., May 1, 2007; 29(5): 944 - 950. [Abstract] [Full Text] [PDF]

				G. Tumminello, M. Guazzi, P. Lancellotti, and L. A. Pierard Exercise ventilation inefficiency in heart failure: pathophysiological and clinical significance Eur. Heart J., March 2, 2007; 28(6): 673 - 678. [Abstract] [Full Text] [PDF]

				L. Ingle, A. S. Rigby, S. Carroll, R. Butterly, R. F. King, C. B. Cooke, J. G.J.F. Cleland, and A. L. Clark Prognostic value of the 6 min walk test and self-perceived symptom severity in older patients with chronic heart failure Eur. Heart J., March 1, 2007; 28(5): 560 - 568. [Abstract] [Full Text] [PDF]

				D. Habedank, R. Ewert, M. Hummel, R. Wensel, R. Hetzer, and S. D. Anker Changes in exercise capacity, ventilation, and body weight following heart transplantation Eur J Heart Fail, March 1, 2007; 9(3): 310 - 316. [Abstract] [Full Text] [PDF]

				P. Palange, S. A. Ward, K-H. Carlsen, R. Casaburi, C. G. Gallagher, R. Gosselink, D. E. O'Donnell, L. Puente-Maestu, A. M. Schols, S. Singh, et al. Recommendations on the use of exercise testing in clinical practice Eur. Respir. J., January 1, 2007; 29(1): 185 - 209. [Abstract] [Full Text] [PDF]

				A. Tamura, Y. Kawano, S. Naono, M. Kotoku, and J.-i. Kadota Relationship Between {beta}-Blocker Treatment and the Severity of Central Sleep Apnea in Chronic Heart Failure Chest, January 1, 2007; 131(1): 130 - 135. [Abstract] [Full Text] [PDF]

				R. V. Milani, C. J. Lavie, M. R. Mehra, and H. O. Ventura Understanding the Basics of Cardiopulmonary Exercise Testing Mayo Clin. Proc., December 1, 2006; 81(12): 1603 - 1611. [Abstract] [Full Text] [PDF]

				P. Agostoni, M. Contini, A. Magini, A. Apostolo, G. Cattadori, M. Bussotti, F. Veglia, D. Andreini, and P. Palermo Carvedilol reduces exercise-induced hyperventilation: A benefit in normoxia and a problem with hypoxia Eur J Heart Fail, November 1, 2006; 8(7): 729 - 735. [Abstract] [Full Text] [PDF]

				J. Rhodes, T. J. Curran, L. Camil, N. Rabideau, D. R. Fulton, N. S. Gauthier, K. Gauvreau, and K. J. Jenkins Sustained Effects of Cardiac Rehabilitation in Children With Serious Congenital Heart Disease Pediatrics, September 1, 2006; 118(3): e586 - e593. [Abstract] [Full Text] [PDF]

				D. Schlosshan, D. Barker, C. Pepper, G. Williams, C. Morley, and L.-B. Tan CRT improves the exercise capacity and functional reserve of the failing heart through enhancing the cardiac flow- and pressure-generating capacity Eur J Heart Fail, August 1, 2006; 8(5): 515 - 521. [Abstract] [Full Text] [PDF]

				M. F. Piepoli, A. Kaczmarek, D. P. Francis, L. C. Davies, M. Rauchhaus, E. A. Jankowska, S. D. Anker, A. Capucci, W. Banasiak, and P. Ponikowski Reduced Peripheral Skeletal Muscle Mass and Abnormal Reflex Physiology in Chronic Heart Failure Circulation, July 11, 2006; 114(2): 126 - 134. [Abstract] [Full Text] [PDF]

				D. Messika-Zeitoun, B. D. Johnson, V. Nkomo, J.-F. Avierinos, T. G. Allison, C. Scott, A. J. Tajik, and M. Enriquez-Sarano Cardiopulmonary Exercise Testing Determination of Functional Capacity in Mitral Regurgitation: Physiologic and Outcome Implications J. Am. Coll. Cardiol., June 20, 2006; 47(12): 2521 - 2527. [Abstract] [Full Text] [PDF]

				S. N. Nanas, J. N. Nanas, D. Ch. Sakellariou, S. K. Dimopoulos, S. G. Drakos, S. G. Kapsimalakou, C. A. Mpatziou, O. G. Papazachou, A. S. Dalianis, M. I. Anastasiou-Nana, et al. VE/VCO2 slope is associated with abnormal resting haemodynamics and is a predictor of long-term survival in chronic heart failure Eur J Heart Fail, June 1, 2006; 8(4): 420 - 427. [Abstract] [Full Text] [PDF]

				L. C. Davies, R. Wensel, P. Georgiadou, M. Cicoira, A. J.S. Coats, M. F. Piepoli, and D. P. Francis Enhanced prognostic value from cardiopulmonary exercise testing in chronic heart failure by non-linear analysis: oxygen uptake efficiency slope Eur. Heart J., March 2, 2006; 27(6): 684 - 690. [Abstract] [Full Text] [PDF]

				C. Passino, R. Poletti, F. Bramanti, C. Prontera, A. Clerico, and M. Emdin Neuro-hormonal activation predicts ventilatory response to exercise and functional capacity in patients with heart failure Eur J Heart Fail, January 1, 2006; 8(1): 46 - 53. [Abstract] [Full Text] [PDF]

				S. M. Caples, R. Wolk, and V. K. Somers Influence of cardiac function and failure on sleep-disordered breathing: evidence for a causative role J Appl Physiol, December 1, 2005; 99(6): 2433 - 2439. [Abstract] [Full Text] [PDF]

				J. Rhodes, T. J. Curran, L. Camil, N. Rabideau, D. R. Fulton, N. S. Gauthier, K. Gauvreau, and K. J. Jenkins Impact of Cardiac Rehabilitation on the Exercise Function of Children With Serious Congenital Heart Disease Pediatrics, December 1, 2005; 116(6): 1339 - 1345. [Abstract] [Full Text] [PDF]

				R. L. Bard, M. S. Lauer, J. O. O'Neill, C. E. Pothier, and J. B. Young Letter Regarding Article by O'Neill et al, "Peak Oxygen Consumption as a Predictor of Death in Patients With Heart Failure Receiving {beta}-Blockers" * Response Circulation, October 18, 2005; 112(16): e271 - e271. [Full Text] [PDF]

				R. Arena, J. Myers, J. Abella, and M. A. Peberdy Influence of Heart Failure Etiology on the Prognostic Value of Peak Oxygen Consumption and Minute Ventilation/Carbon Dioxide Production Slope Chest, October 1, 2005; 128(4): 2812 - 2817. [Abstract] [Full Text] [PDF]

				E. A. Jankowska, S. von Haehling, A. Czarny, E. Zaczynska, A. Kus, S. D. Anker, W. Banasiak, and P. Ponikowski Activation of the NF-{kappa}B system in peripheral blood leukocytes from patients with chronic heart failure Eur J Heart Fail, October 1, 2005; 7(6): 984 - 990. [Abstract] [Full Text] [PDF]

				M. Guazzi, G. Reina, G. Tumminello, and M. D. Guazzi Alveolar-capillary membrane conductance is the best pulmonary function correlate of exercise ventilation efficiency in heart failure patients Eur J Heart Fail, October 1, 2005; 7(6): 1017 - 1022. [Abstract] [Full Text] [PDF]

				P. Agostoni, M. Bianchi, A. Moraschi, P. Palermo, G. Cattadori, R. La Gioia, M. Bussotti, and K. Wasserman Work-rate affects cardiopulmonary exercise test results in heart failure Eur J Heart Fail, June 1, 2005; 7(4): 498 - 504. [Abstract] [Full Text] [PDF]

				M. Arzt, M. Schulz, R. Wensel, S. Montalvan, F. C. Blumberg, G. A. J. Riegger, and M. Pfeifer Nocturnal Continuous Positive Airway Pressure Improves Ventilatory Efficiency During Exercise in Patients With Chronic Heart Failure Chest, March 1, 2005; 127(3): 794 - 802. [Abstract] [Full Text] [PDF]

				M. Guazzi, G. Reina, G. Tumminello, and M. D. Guazzi Exercise ventilation inefficiency and cardiovascular mortality in heart failure: the critical independent prognostic value of the arterial CO2 partial pressure Eur. Heart J., March 1, 2005; 26(5): 472 - 480. [Abstract] [Full Text] [PDF]

				A. J.S. Coats Why ventilatory inefficiency matters in chronic heart failure Eur. Heart J., March 1, 2005; 26(5): 426 - 427. [Full Text] [PDF]

				S. D. Katz, K. Hryniewicz, I. Hriljac, K. Balidemaj, C. Dimayuga, A. Hudaihed, and A. Yasskiy Vascular Endothelial Dysfunction and Mortality Risk in Patients With Chronic Heart Failure Circulation, January 25, 2005; 111(3): 310 - 314. [Abstract] [Full Text] [PDF]

				R. L. Bard Cardiopulmonary exercise testing in patients with heart failure J. Am. Coll. Cardiol., January 4, 2005; 45(1): 163 - 163. [Full Text] [PDF]

				P. d. Groote, J. Dagorn, B. Soudan, N. Lamblin, E. Mc Fadden, and C. Bauters Reply J. Am. Coll. Cardiol., January 4, 2005; 45(1): 163 - 164. [Full Text] [PDF]

				R. Naeije Breathing more with weaker respiratory muscles in pulmonary arterial hypertension Eur. Respir. J., January 1, 2005; 25(1): 6 - 8. [Full Text] [PDF]

				M. Guazzi, S. Belletti, G. Tumminello, C. Fiorentini, and M. D. Guazzi Exercise hyperventilation, dyspnea sensation, and ergoreflex activation in lone atrial fibrillation Am J Physiol Heart Circ Physiol, December 1, 2004; 287(6): H2899 - H2905. [Abstract] [Full Text] [PDF]

				W. T. Abraham, J. B. Young, A. R. Leon, S. Adler, A. J. Bank, S. A. Hall, R. Lieberman, L. B. Liem, J. B. O'Connell, J. S. Schroeder, et al. Effects of Cardiac Resynchronization on Disease Progression in Patients With Left Ventricular Systolic Dysfunction, an Indication for an Implantable Cardioverter-Defibrillator, and Mildly Symptomatic Chronic Heart Failure Circulation, November 2, 2004; 110(18): 2864 - 2868. [Abstract] [Full Text] [PDF]

				U. Corra, A. Mezzani, E. Bosimini, and P. Giannuzzi Cardiopulmonary Exercise Testing and Prognosis in Chronic Heart Failure*: A Prognosticating Algorithm for the Individual Patient Chest, September 1, 2004; 126(3): 942 - 950. [Abstract] [Full Text] [PDF]

				H. T. Robertson, R. Pellegrino, D. Pini, J. Oreglia, S. DeVita, V. Brusasco, and P. Agostoni Exercise response after rapid intravenous infusion of saline in healthy humans J Appl Physiol, August 1, 2004; 97(2): 697 - 703. [Abstract] [Full Text] [PDF]

				B. Lamp, J. Vogt, H. Schmidt, and D. Horstkotte Impact of cardiopulmonary exercise testing on patient selection for cardiac resynchronisation therapy Eur. Heart J. Suppl., August 1, 2004; 6(suppl_D): D5 - D9. [Abstract] [Full Text] [PDF]

				S. D. Rosen, K. Murphy, A. P. Leff, V. Cunningham, R. J.S. Wise, L. Adams, A. J.S. Coats, and P. G. Camici Is central nervous system processing altered in patients with heart failure? Eur. Heart J., June 1, 2004; 25(11): 952 - 962. [Abstract] [Full Text] [PDF]

				A. M. Duncan, D. P. Francis, D. G. Gibson, and M. Y. Henein Limitation of exercise tolerance in chronic heart failure: distinct effects of left Bundle-Branch block and coronary artery disease J. Am. Coll. Cardiol., May 5, 2004; 43(9): 1524 - 1531. [Abstract] [Full Text] [PDF]

				G. Deboeck, G. Niset, M. Lamotte, J-L. Vachiery, and R. Naeije Exercise testing in pulmonary arterial hypertension and in chronic heart failure Eur. Respir. J., May 1, 2004; 23(5): 747 - 751. [Abstract] [Full Text] [PDF]

				A. Koike, H. Itoh, R. Oohara, M. Hoshimoto, A. Tajima, T. Aizawa, and L. T. Fu Cerebral Oxygenation During Exercise in Cardiac Patients Chest, January 1, 2004; 125(1): 182 - 190. [Abstract] [Full Text] [PDF]

				M. Rauchhaus, A. L. Clark, W. Doehner, C. Davos, A. Bolger, R. Sharma, A. J. S. Coats, and S. D. Anker The relationship between cholesterol and survival in patients with chronic heart failure J. Am. Coll. Cardiol., December 3, 2003; 42(11): 1933 - 1940. [Abstract] [Full Text] [PDF]

				P. Agostoni, G. Cattadori, M. Bianchi, and K. Wasserman Exercise-Induced Pulmonary Edema in Heart Failure Circulation, November 25, 2003; 108(21): 2666 - 2671. [Abstract] [Full Text] [PDF]

				R. Wolk, B. D. Johnson, and V. K. Somers Leptin and the ventilatory response to exercise in heart failure J. Am. Coll. Cardiol., November 5, 2003; 42(9): 1644 - 1649. [Abstract] [Full Text] [PDF]

				C. Schalcher, H. Rickli, M. Brehm, D. Weilenmann, E. Oechslin, W. Kiowski, and H. P. Brunner-La Rocca Prolonged Oxygen Uptake Kinetics During Low-Intensity Exercise Are Related to Poor Prognosis in Patients With Mild-to-Moderate Congestive Heart Failure Chest, August 1, 2003; 124(2): 580 - 586. [Abstract] [Full Text] [PDF]

				R. Arena, J. Myers, S. S. Aslam, E. B. Varughese, and M. A. Peberdy Technical Considerations Related to the Minute Ventilation/Carbon Dioxide Output Slope in Patients With Heart Failure Chest, August 1, 2003; 124(2): 720 - 727. [Abstract] [Full Text] [PDF]

				A S Androne, K Hryniewicz, R Goldsmith, A Arwady, and S D Katz Acetylcholinesterase inhibition with pyridostigmine improves heart rate recovery after maximal exercise in patients with chronic heart failure Heart, August 1, 2003; 89(8): 854 - 858. [Abstract] [Full Text] [PDF]

				M. Guazzi, R. Brambilla, G. Reina, G. Tumminello, and M. D. Guazzi Aspirin-Angiotensin-Converting Enzyme Inhibitor Coadministration and Mortality in Patients With Heart Failure: A Dose-Related Adverse Effect of Aspirin Arch Intern Med, July 14, 2003; 163(13): 1574 - 1579. [Abstract] [Full Text] [PDF]

				H. Rickli, W. Kiowski, M. Brehm, D. Weilenmann, C. Schalcher, A. Bernheim, E. Oechslin, and H. P. Brunner-La Rocca Combining low-intensity and maximal exercise test results improves prognostic prediction in chronic heart failure J. Am. Coll. Cardiol., July 2, 2003; 42(1): 116 - 122. [Abstract] [Full Text] [PDF]

				J. J. Leite, A. J. Mansur, H. F. G. de Freitas, P. R. Chizola, E. A. Bocchi, M. Terra-Filho, J. A. Neder, and G. Lorenzi-Filho Periodic breathing during incremental exercise predicts mortality in patients with chronic heart failure evaluated for cardiac transplantation J. Am. Coll. Cardiol., June 18, 2003; 41(12): 2175 - 2181. [Abstract] [Full Text] [PDF]

				S Sakurai, H Adachi, A Hasegawa, H Hoshizaki, S Oshima, K Taniguchi, and M Kurabayashi Brain natriuretic peptide facilitates severity classification of stable chronic heart failure with left ventricular dysfunction Heart, June 1, 2003; 89(6): 661 - 662. [Full Text] [PDF]

				A. P Bolger, A. J.S Coats, and M. A Gatzoulis Congenital heart disease: the original heart failure syndrome Eur. Heart J., May 2, 2003; 24(10): 970 - 976. [Abstract] [Full Text] [PDF]

				T Tomita, H Takaki, Y Hara, F Sakamaki, T Satoh, S Takagi, Y Yasumura, N Aihara, Y Goto, and K Sunagawa Attenuation of hypercapnic carbon dioxide chemosensitivity after postinfarction exercise training: possible contribution to the improvement in exercise hyperventilation Heart, April 1, 2003; 89(4): 404 - 410. [Abstract] [Full Text] [PDF]

				C. Varma, S. Sharma, S. Firoozi, W. J. McKenna, J.-C. Daubert, and Multisite Stimulation in Cardiomyopathy (MUSTIC) S Atriobiventricular pacing improves exercise capacity in patients with heart failure and intraventricular conduction delay J. Am. Coll. Cardiol., February 19, 2003; 41(4): 582 - 588. [Abstract] [Full Text] [PDF]

				A. Koike, N. Shimizu, A. Tajima, T. Aizawa, L. T. Fu, H. Watanabe, and H. Itoh Relation Between Oscillatory Ventilation at Rest Before Cardiopulmonary Exercise Testing and Prognosis in Patients With Left Ventricular Dysfunction Chest, February 1, 2003; 123(2): 372 - 379. [Abstract] [Full Text] [PDF]

				ATS/ACCP Statement on Cardiopulmonary Exercise Testing Am. J. Respir. Crit. Care Med., January 15, 2003; 167(2): 211 - 277. [Full Text] [PDF]

				A. K. Gitt, K. Wasserman, C. Kilkowski, T. Kleemann, A. Kilkowski, M. Bangert, S. Schneider, A. Schwarz, and J. Senges Exercise Anaerobic Threshold and Ventilatory Efficiency Identify Heart Failure Patients for High Risk of Early Death Circulation, December 10, 2002; 106(24): 3079 - 3084. [Abstract] [Full Text] [PDF]

				P. Agostoni, M. Guazzi, M. Bussotti, S. De Vita, and P. Palermo Carvedilol Reduces the Inappropriate Increase of Ventilation During Exercise in Heart Failure Patients Chest, December 1, 2002; 122(6): 2062 - 2067. [Abstract] [Full Text] [PDF]

				J. G Lainchbury and A M. Richards EXERCISE TESTING IN THE ASSESSMENT OF CHRONIC CONGESTIVE HEART FAILURE Heart, December 1, 2002; 88(5): 538 - 543. [Full Text] [PDF]

				R. Wensel, C. F. Opitz, S. D. Anker, J. Winkler, G. Hoffken, F. X. Kleber, R. Sharma, M. Hummel, R. Hetzer, and R. Ewert Assessment of Survival in Patients With Primary Pulmonary Hypertension: Importance of Cardiopulmonary Exercise Testing Circulation, July 16, 2002; 106(3): 319 - 324. [Abstract] [Full Text] [PDF]

				T Kohnlein, T Welte, L B Tan, and M W Elliott Central sleep apnoea syndrome in patients with chronic heart disease: a critical review of the current literature Thorax, June 1, 2002; 57(6): 547 - 554. [Abstract] [Full Text] [PDF]

				A. Cohen-Solal, J.Y. Tabet, D. Logeart, P. Bourgoin, M. Tokmakova, and M. Dahan A non-invasively determined surrogate of cardiac power ('circulatory power') at peak exercise is a powerful prognostic factor in chronic heart failure Eur. Heart J., May 2, 2002; 23(10): 806 - 814. [Abstract] [Full Text] [PDF]

				U. Corra, A. Giordano, E. Bosimini, A. Mezzani, M. Piepoli, A. J. S. Coats, and P. Giannuzzi Oscillatory Ventilation During Exercise in Patients With Chronic Heart Failure* : Clinical Correlates and Prognostic Implications Chest, May 1, 2002; 121(5): 1572 - 1580. [Abstract] [Full Text] [PDF]

				A. Koike, H. Itoh, M. Kato, H. Sawada, T. Aizawa, L. T. Fu, and H. Watanabe Prognostic Power of Ventilatory Responses During Submaximal Exercise in Patients With Chronic Heart Disease* Chest, May 1, 2002; 121(5): 1581 - 1588. [Abstract] [Full Text] [PDF]

				M Guazzi, G Pontone, R Brambilla, P Agostoni, and G Reina Alveolar-capillary membrane gas conductance: a novel prognostic indicator in chronic heart failure Eur. Heart J., March 2, 2002; 23(6): 467 - 476. [Abstract] [Full Text] [PDF]

				S. Nanas, J. Nanas, C. Kassiotis, C. Nikolaou, E. Tsagalou, D. Sakellariou, I. Terovitis, O. Papazachou, S. Drakos, A. Papamichalopoulos, et al. Early recovery of oxygen kinetics after submaximal exercise test predicts functional capacity in patients with chronic heart failure Eur J Heart Fail, December 1, 2001; 3(6): 685 - 692. [Abstract] [Full Text] [PDF]

				A. J S Coats HEART FAILURE: What causes the symptoms of heart failure? Heart, November 1, 2001; 86(5): 574 - 578. [Full Text] [PDF]

				T Iwase, N Nagaya, M Ando, T Satoh, F Sakamaki, S Kyotani, H Takaki, Y Goto, Y Ohkita, M Uematsu, et al. Acute and chronic effects of surgical thromboendarterectomy on exercise capacity and ventilatory efficiency in patients with chronic thromboembolic pulmonary hypertension Heart, August 1, 2001; 86(2): 188 - 192. [Abstract] [Full Text] [PDF]

				R. Wensel and S. D. Anker Lean tissue adjusted peak oxygen consumption in congestive heart failure J. Am. Coll. Cardiol., July 1, 2001; 38(1): 287 - 288. [Full Text] [PDF]

				D P Francis, L C Davies, and A J S Coats Diagnostic exercise physiology in chronic heart failure Heart, July 1, 2001; 86(1): 17 - 20. [Full Text] [PDF]

				M. Cicoira, L. Zanolla, L. Franceschini, A. Rossi, G. Golia, M. Zamboni, P. Tosoni, and P. Zardini Skeletal muscle mass independently predicts peak oxygen consumption and ventilatory response during exercise in noncachectic patients with chronic heart failure J. Am. Coll. Cardiol., June 15, 2001; 37(8): 2080 - 2085. [Abstract] [Full Text] [PDF]

				N. de Jonge, H. Kirkels, J. R. Lahpor, C. Klopping, E. J. Hulzebos, A. Brutel de la Riviere, and E. O. Robles de Medina Exercise performance in patients with end-stage heart failure after implantation of a left ventricular assist device and after heart transplantation: An outlook for permanent assisting? J. Am. Coll. Cardiol., June 1, 2001; 37(7): 1794 - 1799. [Abstract] [Full Text] [PDF]

				A. L. Clark, F. X. Kleber, G. Vietzke, K.-D. Wernecke, U. Bauer, C. Opitz, R. Wensel, A. Sperfeld, and S. Glaser Impairment of Ventilatory Efficiency in Heart Failure Response Circulation, May 8, 2001; 103 (18): e97 - e97. [Full Text] [PDF]

				R. L. Johnson Jr Gas Exchange Efficiency in Congestive Heart Failure II Circulation, February 20, 2001; 103(7): 916 - 918. [Full Text] [PDF]

				P. Ponikowski, D. P. Francis, M. F. Piepoli, L. C. Davies, T. P. Chua, C. H. Davos, V. Florea, W. Banasiak, P. A. Poole-Wilson, A. J. S. Coats, 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, February 20, 2001; 103(7): 967 - 972. [Abstract] [Full Text] [PDF]