title: Limited value of anaerobic threshold for assessing functional capacity in patients with heart failure.
abstract: Exercise tolerance was assessed in 146 patients with cardiac dysfunction in terms of anaerobic threshold (ATge). Patients were divided into four classes according to the peak oxygen uptake: Class A (72 patients) exceeding 1000 ml/min; Class B (27 patients) 800-999 ml/min; Class C (37 patients) 500-799 ml/min; and Class D (10 patients) below 500 ml/min. An incidence of the ATge breakpoint was lower in patients of Class C (38%) than in those of either Class B (70%, p < 0.05) or Class A (87%, p < 0.05). The ATge could not be determined in any patients in Class D. The V-slope method improved the ability to determine ATge by 20%. In Classes C and D, ATge detection was precluded considerably by the fact that the initial workloads of exercise test involved oxygen uptake levels already close to or above the ATge. An oscillatory hyperventilation pattern was also significantly related to failure in defining ATge in Class C patients. Of the 51 patients whose ATge was undetermined, 9 had an atrial septal defect. In two of these, exercise-induced right-to-left shunting led to progressive arterial hypoxemia, and the consequent hyperventilation masked the appearance of ATge. Thus, ATge is virtually undetectable in patients with severe heart failure largely because of the early onset of anaerobic metabolism or abnormal ventilatory responses to exercise. Accordingly, the clinical application of ATge in the assessment of functional capacity would be limited to patients with mild to moderate heart failure.
authors.affiliation: Second Department of Internal Medicine, Toyama Medical and Pharmaceutical University, Japan.
authors.forename: K
authors.initials: K
authors.lastname: Miyagi
authors.forename: H
authors.initials: H
authors.lastname: Asanoi
authors.forename: S
authors.initials: S
authors.lastname: Ishizaka
authors.forename: T
authors.initials: T
authors.lastname: Kameyama
authors.forename: S
authors.initials: S
authors.lastname: Sasayama
mesh_terms: D000328:Adult; D000368:Aged; D015308:Anaerobic Threshold; D002908:Chronic Disease; D005080:Exercise Test; D017079:Exercise Tolerance; D005260:Female; D006333:Heart Failure / Q000145:classification / Q000150:complications / Q000503:physiopathology*; D006801:Humans; D006985:Hyperventilation / Q000209:etiology; D008297:Male; D008875:Middle Aged; D010101:Oxygen Consumption; D011659:Pulmonary Gas Exchange