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Kinetics of skeletal muscle O2 delivery and utilization at the onset of heavy-intensity exercise in pulmonary arterial hypertension

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Abstract

Impaired O2 delivery relative to O2 demands at the onset of exercise might influence the response profile of muscle fractional O2 extraction (≅Δ[deoxy-Hb/Mb] by near-infrared spectroscopy) either by accelerating its rate of increase or creating an “overshoot” (OS) in patients with pulmonary arterial hypertension (PAH). We therefore assessed the kinetics of O2 uptake \( \left( {\dot{V}{\text{O}}_{2} } \right), \) Δ[deoxy-Hb/Mb] in the vastus lateralis, and heart rate (HR) at the onset of heavy-intensity exercise in 14 females with PAH (connective tissue disease, IPAH, portal hypertension, and acquired immunodeficiency syndrome) and 11 age- and gender-matched controls. Patients had slower \( \dot{V}{\text{O}}_{2} \) and HR dynamics than controls (τ\( \dot{V}{\text{O}}_{2} \) = 62.7 ± 15.2 s vs. 41.0 ± 13.8 s and t 1/2-HR = 61.3 ± 16.6 s vs. 43.4 ± 8.8 s, respectively; p < 0.01). No study participant had a significant reduction in oxyhemoglobin saturation. In OS(−) subjects (6 patients and 7 controls), the kinetics of Δ[deoxy-Hb/Mb] relative to \( \dot{V}{\text{O}}_{2} \) were faster in patients (p = 0.05). Larger area under the OS and slower kinetics (MRT) of the “downward” component indicated greater O2 delivery-to-utilization mismatch in OS(+) patients versus OS(+) controls (477.4 ± 330.0 vs. 78.1 ± 65.6 a.u. and 74.6 ± 18.8 vs. 46.0 ± 17.0 s, respectively; p < 0.05). Resting pulmonary vascular resistance was higher in OS(+) than OS(−) patients (23.1 ± 12.0 vs. 10.7 ± 4.0 Woods, respectively; p < 0.05). We conclude that microvascular O2 delivery-to-utilization inequalities slowed the rate of adaptation of aerobic metabolism at the start of heavy-intensity exercise in women with PAH.

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Acknowledgments

The authors would like to thank Dr Leonardo Ferreira (University of Kentucky, Lexington, USA) for his intellectual input and useful commentaries on the topic. They are also grateful to all colleagues from the Pulmonary Function and Clinical Exercise Physiology Unit [Division of Respiratory Diseases, Department of Medicine, Federal University of Sao Paulo (UNIFESP, Brazil)] for their friendly collaboration.

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Authors and Affiliations

  1. Pulmonary Function and Clinical Exercise Physiology Unit (SEFICE), Respiratory Division, Department of Medicine, Federal University of São Paulo, Paulista School of Medicine (UNIFESP-EPM), Rua Professor Francisco de Castro 54, Vila Clementino, São Paulo, CEP 04020-050, Brazil

    Priscila B. Barbosa, Eloara M. V. Ferreira, Jaquelina S. O. Arakaki, Luciana S. Takara, Juliana Moura, Rúbia B. Nascimento, Luiz E. Nery & J. Alberto Neder

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  1. Priscila B. Barbosa
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  2. Eloara M. V. Ferreira
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  3. Jaquelina S. O. Arakaki
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  4. Luciana S. Takara
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  5. Juliana Moura
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  6. Rúbia B. Nascimento
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  8. J. Alberto Neder
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Correspondence to J. Alberto Neder.

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Communicated by Susan A. Ward.

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Barbosa, P.B., Ferreira, E.M.V., Arakaki, J.S.O. et al. Kinetics of skeletal muscle O2 delivery and utilization at the onset of heavy-intensity exercise in pulmonary arterial hypertension. Eur J Appl Physiol 111, 1851–1861 (2011). https://doi.org/10.1007/s00421-010-1799-6

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