Metabolic gas kinetics depend upon the level of exercise performed

Effects of gas exchange on acid-base balance

This paper describes the interactions between ventilation and acid-base balance under a variety of conditions including rest, exercise, altitude, pregnancy, and various muscle, respiratory, cardiac, and renal pathologies. We introduce the physicochemical approach to assessing acid-base status and demonstrate how this approach can be used to quantify the origins of acid-base disorders using examples from the literature. The relationships between chemoreceptor and metaboreceptor control of ventilation and acid-base balance summarized here for adults, youth, and in various pathological conditions. There is a dynamic interplay between disturbances in acid-base balance, that is, exercise, that affect ventilation as well as imposed or pathological disturbances of ventilation that affect acid-base balance. Interactions between ventilation and acid-base balance are highlighted for moderate- to high-intensity exercise, altitude, induced acidosis and alkalosis, pregnancy, obesity, and some pathological conditions. In many situations, complete acid-base data are lacking, indicating a need for further research aimed at elucidating mechanistic bases for relationships between alterations in acid-base state and the ventilatory responses.

Cardiac output does not limit submaximal exercise capacity in patients with chronic heart failure

AIMS

Mechanisms of exercise limitation in patients with chronic heart failure (CHF) are incompletely understood. During matched submaximal, fixed-rate exercise, oxygen uptake is similar in patients and healthy controls. However, the importance of cardiac output (CO) remains unresolved. We aimed to determine the effect of submaximal exercise on CO and other haemodynamic variables in patients with CHF using a validated non-invasive inert gas rebreathing system.

METHODS AND RESULTS

Seventy-two subjects with a mean age (+/-SD) of 68.2 (+/-8.1) years, performed fixed-rate exercise for 3 min at 15, 30, 45, and 60 W workloads on a cycle ergometer. Cardiac output/index (CI) and oxygen uptake (VO(2)) were determined at each stage by inert gas rebreathing. Subjects with systolic HF (n = 27) were compared with those without (n = 45). Cardiac index was lower in subjects with CHF at rest and throughout exercise. VO(2) was the same for both groups at rest and during exercise. There was no difference in the relative or absolute increase in CI from rest to 60 W (1.70 +/- 0.69 vs. 1.99 +/- 0.56 L/min/m(2), P = 0.102, respectively). Arterio-venous O(2) saturation difference at peak exercise was 75.4 +/- 10.4 vs. 63.0 +/- 12.1%, P = 0.001, for CHF and non-CHF subjects, respectively.

CONCLUSION

During submaximal exercise, patients with systolic heart failure are able to increase their CO to a similar extent as those without; with equal levels of oxygen consumption, but requiring a much greater degree of tissue oxygen extraction.

Biventricular pacing: impact on exercise-induced increases in mitral insufficiency in patients with chronic heart failure

INTRODUCTION

Mitral regurgitation (MR) in chronic heart failure (CHF) patients frequently worsens with exercise. Cardiac resynchronization therapy (CRT) reduces MR at rest, but its effects on exercise-induced worsening of MR are incompletely explored. The present study examined the influence of CRT on MR during submaximal exercise in CHF patients.

METHODS

Eleven patients with CHF who were treated with CRT underwent echocardiography while performing steady-state exercise during four conduction modes (intrinsic rhythm, right ventricular [RV], biventricular [BiV] and left ventricular [LV] pacing). Measurements of MR were jet area planimetry, effective regurgitant orifice area, peak MR flow rate and regurgitant volume.

RESULTS

At rest and during exercise, there were no differences in dyssynchrony between intrinsic rhythm and RV pacing. BiV and LV pacing reduced dyssynchrony at rest and during exercise compared with intrinsic conduction and RV pacing, and there were no differences in the magnitude of these effects between these two pacing modes. At rest, RV pacing increased MR compared with intrinsic conduction (MR regurgitant volume; P<0.05), whereas BiV and LV pacing reduced MR (reductions in effective regurgitant orifice area and jet area; P<0.02, and MR flow rate; P<0.05 with BiV pacing from intrinsic conduction). MR significantly increased on exercise with intrinsic rhythm and RV pacing, whereas with LV and BiV pacing, there were no significant exercise-induced increases in any MR variable. There were relationships between changes in measures of dyssynchrony and reductions in MR at rest and during exercise.

CONCLUSIONS

CRT reduces MR at rest and during exercise, and prevents exercise-induced MR. Reductions in MR during exercise correlate with improvements in dyssynchrony.

Control of microvascular oxygen pressures during recovery in rat fast-twitch muscle of differing oxidative capacity

Whether the speed of recovery of microvascular O(2) pressures (Pmvo(2) ) differs within muscles composed primarily of type II fibres with contrasting oxidative capacity has not been determined. We tested the hypothesis that, following contractions, the recovery of Pmvo(2) would be slower in the white (WG; low oxidative capacity) versus the mixed gastrocnemius (MG; comparatively high oxidative capacity). Radiolabelled microsphere and phosphorescence quenching techniques were used to measure muscle blood flow ( Q, hence O(2) delivery, Q(O2)) and during contractions (1 Hz twitch) at low (LO, 2.5 V) and high intensities (HI, 4.5 V) in rat (n = 15) MG and WG muscle and during subsequent recovery. Following the LO protocol, end-contraction Pmvo(2) was lower in WG (11.6 +/- 0.5 mmHg) than in MG (16.2 +/- 0.6 mmHg; P < 0.05) while, contrary to our hypothesis, the initial rate of change in during recovery ( d P(O2)/dt; MG 0.11 +/- 0.01 mmHg s(-1) and WG 0.06 +/- 0.03 mmHg s(-1)) and mean response time (MRT; MG 110.3 +/- 5.1 s and WG 113.5 +/- 8.4 s, P > 0.05) were not different. In contrast, end-contraction baseline Pmvo(2) was not different following the HI protocol (MG 10.3 +/- 0.6 mmHg and WG 9.2 +/- 0.6 mmHg; P > 0.05) but, in agreement with our hypothesis, d P(O2)/dt was slower (MG 0.07 +/- 0.01 mmHg s(-1) and WG 0.03 +/- 0.003 mmHg s(-1); P < 0.05) and MRT longer (WG 180.8 +/- 4.5 s and MG 115.4 +/- 6.7 s; P < 0.05) in WG versus MG following the HI protocol. These data suggest that following high-intensity, though submaximal, muscle contractions, Pmvo(2) recovers much faster in the more oxidative mixed gastrocnemius than in the less oxidative white gastrocnemius.

Biomechanical efficiency is impaired in patients with chronic heart failure

INTRODUCTION

Patients with chronic heart failure (CHF) have a lower peak oxygen consumption (pVO2) than normal subjects, and for a given quantity of work, have a lower total oxygen consumption (VO2) than controls. This apparent increase in biomechanical efficiency (BE) might be due to a higher proportion of anaerobic metabolism which, although leading to lower VO2 during steady state exercise, must be compensated for during recovery.

METHODS

13 patients with stable CHF and 12 controls underwent peak cycle exercise testing followed by three separate steady state exercise tests at 15%, 25% and 50% of the peak workload in random order. Oxygen consumption at steady state, deficit (during onset) and debt (during recovery) were calculated. BE was estimated as the total oxygen required to perform a given quantity of work.

RESULTS

Patients had lower pVO2 and peak workload than control subjects. Absolute oxygen deficit and debt as a percentage of total oxygen consumed during the steady state tests was the same in both groups. However, once controlled for workload, VO2 deficit, debt and uptake at steady state were greater in patients than controls for the tests at 15% and 25% of peak. BE was inversely related to peak oxygen consumption in controls and patients.

CONCLUSIONS

Patients with CHF have impaired BE at low work loads when compared with normal subjects.