Chest, Vol 83, 446-453, Copyright © 1983 by American College of Chest Physicians

ARTICLES

Contrasting cardiovascular and respiratory responses to exercise in mitral valve and chronic obstructive pulmonary diseases

LE Nery, K Wasserman, W French, A Oren and JA Davis

The role of cardiovascular and pulmonary limitation in performing maximal exercise is contrasted in patients with mitral valve disease (MVD) and chronic obstructive pulmonary disease (COPD). The ventilatory (VE) gas exchange (VO2 and VCO2) and heart rate (HR) responses to an incremental cycle ergometer exercise were measured in six patients with MVD, seven patients with COPD, and six normal subjects. The VE requirement for the work (VE-VO2 relationship) was increased in both COPD and MVD groups compared with control subjects, but the breathing reserve was significantly lower in COPD (13 percent) compared with MVD (49 percent) and control groups (44 percent). In contrast, the VO2 at the anaerobic threshold was significantly lower in MVD (12.2 +/- .5 ml/kg) compared with COPD (15.7 +/- 1.2 ml/kg) and control subjects (16.6 +/- .9 ml/kg). Also, the heart rate reserve and the VO2-HR slope were significantly reduced in MVD (9 +/- 6 percent and 6.9 +/- 1.0 ml/min/beat, respectively) compared with COPD patients (44 +/- 7 percent and 2.0 ml/min/beat, respectively). Both patient groups experienced an acidosis in their terminal work rate, but the acidosis was primarily respiratory in the COPD and totally metabolic in the MVD group. These studies indicate that at maximal work rate, MVD but not COPD patients, manifest compromised O2 delivery to the muscles, while COPD but not MVD patients were unable to increase VE sufficiently to match the exercise-induced CO2 production.

This article has been cited by other articles:

				J. E. Hansen, G. Ulubay, B. F. Chow, X.-G. Sun, and K. Wasserman Mixed-Expired and End-Tidal CO2 Distinguish Between Ventilation and Perfusion Defects During Exercise Testing in Patients With Lung and Heart Diseases Chest, September 1, 2007; 132(3): 977 - 983. [Abstract] [Full Text] [PDF]

				F. Gigliotti, C. Coli, R. Bianchi, I. Romagnoli, B. Lanini, B. Binazzi, and G. Scano Exercise Training Improves Exertional Dyspnea in Patients With COPD: Evidence of the Role of Mechanical Factors Chest, June 1, 2003; 123(6): 1794 - 1802. [Abstract] [Full Text] [PDF]

				J.A. Barbera, V.I. Peinado, and S. Santos Pulmonary hypertension in chronic obstructive pulmonary disease Eur. Respir. J., May 1, 2003; 21(5): 892 - 905. [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]

				S. MIYAMOTO, N. NAGAYA, T. SATOH, S. KYOTANI, F. SAKAMAKI, M. FUJITA, N. NAKANISHI, and K. MIYATAKE Clinical Correlates and Prognostic Significance of Six-minute Walk Test in Patients with Primary Pulmonary Hypertension . Comparison with Cardiopulmonary Exercise Testing Am. J. Respir. Crit. Care Med., February 1, 2000; 161(2): 487 - 492. [Abstract] [Full Text]

				J. O. BENDITT, S. LEWIS, D. E. WOOD, L. KLIMA, and R. K. ALBERT Lung Volume Reduction Surgery Improves Maximal O2 Consumption, Maximal Minute Ventilation, O2 Pulse, and Dead Space-to-Tidal Volume Ratio during Leg Cycle Ergometry Am. J. Respir. Crit. Care Med., July 1, 1997; 156(2): 561 - 566. [Abstract] [Full Text]

				A. Cohen, M. Katz, R. Katz, E. Hauptman, and A. Schachner Chronic obstructive pulmonary disease in patients undergoing coronary artery bypass grafting J. Thorac. Cardiovasc. Surg., March 1, 1995; 109(3): 574 - 581. [Abstract] [Full Text]