© 2005 European Society of Cardiology
Work-rate affects cardiopulmonary exercise test results in heart failure
a Centro Cardiologico Monzino IRCCS, Institute of Cardiology, University of Milan 20138 Milan, Italy
b Fondazione Salvatore Maugeri IRCCS, Divisione di Cardiologia, Centro Medico di Cassano Murge Bari, Italy
c Division of Respiratory and Critical Care Medicine, Department of Medicine, Harbor-University of California Los Angeles Medical Center, University of California Los Angeles School of Medicine Torrance, CA 90509, USA
* Corresponding author. Tel.: +39 2 58002299; Fax: +39 2 58011039. E-mail address: Piergiuseppe.Agostoni{at}ccfm.it
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Abstract |
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Aims: Cardiopulmonary exercise test (CPET) is used to evaluate patients with chronic heart failure (HF) usually by means of a personalized ramp exercise protocol. Our aim was to evaluate if exercise duration or ramp rate influences the results.
Methods and results: Ninety HF patients were studied (peak VO2: >20 ml/min/kg, n=28, 15>20 ml/min/kg, n=39 and <15 ml/min/kg, n=23). Each patient did four CPET studies. The initial study was used to separate the subjects into three groups, according to their exercise capacity. In the remaining studies, work-rate was increased at three different rates designed to have the subjects reach peak exercise in 5, 10 and 15 min from the start of the ramp increase in work-rate, respectively. The order was randomized. The work-rate applied for the total population averaged 22.7±8.0, 11.6±3.7, 7.5±2.9 W/min with effective loaded exercise duration of 5 min and 16 s±29 s, 9 min and 43 s±49 s and 14 min and 32 s±1 min and 12 s for the 5-, 10- and 15-min tests, respectively. Peak VO2 averaged 16.9±4.3*, 18.0±4.4 and 18.0±5.4 ml/min/kg for the 5-, 10- and 15-min tests, (*=p<0.001 vs. 10 min). The shortest test had the lowest peak heart rate and ventilation and highest peak work-rate. Peak VO2 and heart rate were lowest in 5-min tests regardless of HF severity. The 
VO2/work-rate was lowest in 5-min tests and highest in 15-min tests. At all ramp rates, VO2/work-rate was lower for the subjects with the lower peak VO2. The VE/VCO2 slope and VO2 at anaerobic threshold were not affected by the protocol for any grade of HF.
Conclusions: In chronic HF, exercise protocol has a small effect on peak VO2 and VO2/work but does not affect VO2 at anaerobic threshold and VE/VCO2 slope.
Key Words: Exercise • Oxygen consumption • Heart failure
Received December 17, 2003; Revised April 30, 2004; Accepted June 10, 2004
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