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(Chest. 1994;106:1007-1013.)
© 1994 American College of Chest Physicians

A Characteristic Change in Ventilation Mode During Exertional Dyspnea in Patients With Chronic Heart Failure

Hiroshi Yokoyama M.D.1; Hideyuki Sato M.D.1; Masatsugu Hori M.D.1; Hiroshi Takeda M.D.1; and Takenobu Kamada M.D.1

1 From the First Department of Medicine, Osaka University School of Medicine, Osaka, Japan

Although exertional dyspnea is an important symptom limiting daily lives in patients with chronic heart failure, there is no objective assessment of this symptom. To characterize the exertional dyspnea, ventilatory responses to exercise were studied in relation to exertional dyspnea. Gas exchange data were obtained during a maximal bicycle exercise in 43 patients with chronic heart failure and 20 normal subjects. In addition to standard ventilatory variables, the ventilation mode was assessed from the tidal volume-ventilation rate (VT-f) relationship. The exercise was performed again after sublingual administration of 5 mg of isosorbide dinitrate. In normal subjects, the f and VT increased almost proportionally with exercise intensity. In 17 (85 percent) of 20 patients with exertional dyspnea, the VT-f relationship abruptly lost linearity at the onset of exertional dyspnea. This change resulted from an inadequate increase in VT and a further increase in f. In 8 of these 17 patients, isosorbide dinitrate improved exertional dyspnea with normalization of the VT-f relationship; however, in 9 patients whose dyspnea was not improved, the abnormal VT-f relationship was unaltered. Only 2 (9 percent) of 23 patients without exertional dyspnea showed the abnormal VT-f relationship. Other ventilatory variables were not different between patients with and without dyspnea. Thus, exertional dyspnea is characterized by simultaneous appearance of rapid and shallow ventilation. The VT-f relationship appears to be a simple and useful objective assessment of exertional dyspnea in patients with chronic heart failure.

Key Words: anaerobic threshold • chronic heart failure • exercise • exertional dyspnea • isosorbide dinitrate • ventilation • ventilation mode

Submitted on December 28, 1993
Accepted on March 7, 1994




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K K A Witte, S D R Thackray, N P Nikitin, J G F Cleland, and A L Clark
Pattern of ventilation during exercise in chronic heart failure
Heart, June 1, 2003; 89(6): 610 - 614.
[Abstract] [Full Text] [PDF]


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