Chest
Clinical Investigations: ExerciseBreathing Reserve at the Lactate Threshold to Differentiate a Pulmonary Mechanical From Cardiovascular Limit to Exercise
Section snippets
Study Population
Consecutive maximum incremental cardiopulmonary exercise tests performed at the Massachusetts General Hospital (MGH) from 1991 to 1995, in which arterial blood was sampled during exercise, were evaluated. From this population, three groups were identified based on the type of exercise limit reached: normal (NL), PML, and cardiovascular limit (CVL). NL subjects consisted of individuals with suspected cardiopulmonary disease, but with a >80% predicted, maximum >80%
RESULTS
The demographic characteristics of the three groups are shown in Table 1. There was no significant difference in age or Hb among groups. Weight was reduced in the PML group. There was an equal sex distribution in PML and CVL groups, but there was a male predominance in the NL group, β-Adrenergic blockers were being taken by nine (31%) CVL patients, one (12%) NL subject, and none in the PML group.
The PML group demonstrated a marked reduction in FEV1, with hyperinflation and severely depressed
DISCUSSION
Exertional intolerance is a common but exceedingly nonspecific feature of pulmonary and cardiovascular disease. This has provided incentive for the development of cardiopulmonary exercise testing diagnostic algorithms that can be used to identify the limiting organ system in patients with concurrent disease of the lungs and heart1,2,20 and to direct therapy. Most variables thought to be useful in assessing an organ's functional reserve are measured at peak exercise with the implicit assumption
REFERENCES (36)
- et al.
An integrated approach to the interpretation of cardiopulmonary exercise testing
Clin Chest Med
(1994) - et al.
The response of cardiac and pulmonary disease to exercise testing
Clin Chest Med
(1984) - et al.
Normal values and ranges for ventilation and breathing pattern at maximal exercise
Chest
(1991) - et al.
Prediction of maximal exercise capacity in obstructive and restrictive pulmonary disease
Chest
(1993) - et al.
Metabolic acidosis during exercise in patients with chronic obstructive pulmonary disease: use of the V-slope method for anaerobic threshold determination
Chest
(1988) - et al.
Impact of integrative cardiopulmonary exercise testing on clinical decision making
Chest
(1991) - et al.
Predicting maximal exercise ventilation in patients with chronic obstructive pulmonary disease
Chest
(1987) - et al.
Exercise impairment in chronic obstructive pulmonary disease
Clin Chest Med
(1984) - et al.
Principles of exercise testing and interpretation
(1994) - et al.
Cardiopulmonary exercise testing for evaluation of chronic cardiac failure
Am J Cardiol
(1985)
Ventilatory mechanics and expiratory flow limitation during exercise in normal subjects
J Clin Invest
Exercise performance in marathon runners with airway obstruction
Med Sci Sports Exerc
The ventilatory capacity of patients with chronic airways obstruction
Clin Sci
Pattern of breathing during exercise in patients with interstitial lung disease
Thorax
Lung volumes and expiratory flow limitation during exercise in interstitial lung disease
J Appl Physiol
Improved detection of lactate threshold during exercise using a log-log transformation
J Appl Physiol
Reductions in exercise lactic acidosis and ventilation as a result of exercise training in patients with obstructive lung disease
Am Rev Respir Dis
On-line computer analysis and breath-by-breath graphical display of exercise function tests
J Appl Physiol
Cited by (31)
Cardiopulmonary Exercise Testing in Pulmonary Vascular Disease
2021, Encyclopedia of Respiratory Medicine, Second EditionPulmonary Vascular and Right Ventricular Burden During Exercise in Interstitial Lung Disease
2020, ChestCitation Excerpt :Ventilatory reserve was reduced in ILD + rPH at the AT but similar between ILD + ePH and ILD non-PH both at peak exercise and at the AT. A primary pulmonary mechanical limit to exercise, as identified by the ventilatory reserve at the AT > 0.70,28 was present in four cases, all of them with ILD + rPH. ΔmPAP/Δ cardiac output was 2.0 [1.5-2.8] for ILD non-PH, 3.2 [2.5-4.2] for ILD + ePH, and 5.3 [3.2-8.7] for ILD + rPH (overall, P < .001), being statistically different in the post hoc analysis for ILD + ePH vs ILD non-PH (P = .038) and for ILD + rPH vs ILD non-PH (P < .001).
Oxygen Uptake Efficiency Slope and Breathing Reserve, Not Anaerobic Threshold, Discriminate Between Patients With Cardiovascular Disease Over Chronic Obstructive Pulmonary Disease
2016, JACC: Heart FailureCitation Excerpt :There may be a concern that the number of patients without a measured AT influenced our results. Our results are similar to other studies in terms of numbers of COPD patients failing to achieve AT (8), and we believe representative of patients. In all cases we believe AT had not been achieved rather than being unidentifiable.
Exercise-induced bronchoconstriction in school-aged children who had chronic lung disease in infancy
2013, Journal of PediatricsPreoperative cardiac evaluation: Mechanisms, assessment, and reduction of risk
2005, Thoracic Surgery ClinicsUtility of the Breathing Reserve Index at the Anaerobic Threshold in Determining Ventilatory-Limited Exercise in Adult Cystic Fibrosis Patients
2003, ChestCitation Excerpt :In contrast, this study examined a single patient population with a range of pulmonary function and, to a lesser degree, nutritional status as measured by BMI. Even the NVL group had impaired pulmonary function (albeit mild), and while the pulmonary function of the VL group was significantly lower than that of the NVL group, the FEV1 of the VL group was higher than that of the COPD population in the study by Medoff et al.5 Our study made no attempt to enroll only those subjects with extremes of pulmonary function. In fact, one might expect that if the COPD population in the study by Medoff et al5 had less severe lung disease, the optimal cutoff value obtained may have been different.
Supported by a research fellowship of The Will Rogers Institute (Dr. Oelberg) and an AHA Grant-in-Aid (Dr. Systrom). Manuscript received July 9, 1997; revision accepted September 16, 1997.