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ARTICLE

Prolonged recovery of cardiac output after maximal exercise in patients with chronic heart failure

Yasuhiko Tanabe, MD^*, Minoru Takahashi, MD, Yukio Hosaka, MD^*, Masahiro Ito, MD^*, Eiichi Ito, MD^* and Kaoru Suzuki, MD^*

^* Department of Internal Medicine, Niigata Prefectural Shibata Hospital, Niigata, Japan
First Department of Internal Medicine, Niigata University School of Medicine, Niigata, Japan

Manuscript received March 31, 1999; revised manuscript received October 27, 1999, accepted December 15, 1999.

Reprint requests and correspondence: Dr. Yasuhiko Tanabe, Department of Internal Medicine, Niigata Prefectural Shibata Hospital, Ohte-machi 4-5-48, Shibata City, Niigata 957-8588, Japan

OBJECTIVES

The aim of this study was to characterize the kinetics of cardiac output during recovery from maximal exercise in patients with chronic heart failure (CHF).

BACKGROUND

Recent studies have shown that oxygen uptake kinetics during recovery from exercise are delayed in patients with CHF. However, the kinetics of cardiac output during recovery from maximal exercise in CHF has not been examined.

METHODS

Thirty patients with CHF performed maximal upright ergometer exercise with respiratory gas analysis. Kinetics of oxygen uptake (VO₂) and carbon dioxide output (VCO₂) during recovery were characterized by T1/2, the time to reach 50% of the peak values. Cardiac output was measured at 1-min intervals during exercise and recovery. Kinetics of cardiac output during recovery were characterized by the ratios of cardiac output during the first 4 min of recovery to cardiac output at peak exercise. Overshoot of cardiac output was defined as a further increase in cardiac output at 1 min of recovery above the cardiac output at peak exercise.

RESULTS

Both T1/2 VO₂ and T1/2 VCO₂ increased as CHF worsened. The ratios of cardiac output during recovery to cardiac output at peak exercise were significantly correlated with T1/2 VO₂ (r = 0.47 to 0.62, p < 0.05) and T1/2 VCO₂ (r = 0.40 to 0.70, p < 0.05). There was a negative correlation between cardiac index at peak exercise and both T1/2 VO₂ (r = –0.65, p < 0.001) and T1/2 VCO₂ (r = –0.60, p < 0.001). Overshoot of cardiac output was recognized in 11 of 30 patients. Cardiac index at peak exercise was significantly lower in patients with overshoot (4.5 ± 0.9 L/min/m²) than in those without overshoot (6.1 ± 2.1 L/min/m², p < 0.05). However, because of a continued increase in cardiac output at 1 min of recovery in patients with overshoot, there were no differences in cardiac index after the first minute of recovery. Heart rate at peak exercise and recovery of heart rate did not differ between these groups. Overshoot of cardiac output was caused by a rebound increase in stroke volume which was due to a reduction in systemic vascular resistance.

CONCLUSIONS

Prolonged kinetics of VO₂ or VCO₂ during recovery from maximal exercise represent impairment of circulatory response to exercise and delayed recovery of cardiac output after exercise. Overshoot of cardiac output at 1 min of recovery was characteristic of severe CHF with poor cardiac output response to exercise.

Abbreviations and Acronyms   CHF = chronic heart failure   VCO2 = carbon dioxide output   VO2 = oxygen uptake   NYHA = New York Heart Association

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