title: Exercise hyperventilation in chronic heart failure is not caused by systemic lactic acidosis.
abstract: BACKGROUND
  Patients with heart failure have an abnormally high ventilatory response to exercise associated with gas exchange defects and reduced arterial pCO(2).
  
  
  OBJECTIVE
  We examined the possibility of lactic acidosis as the stimulus to this increased ventilation that abnormally depresses pCO(2) during exercise in heart failure.
  
  
  RESULTS
  We studied 18 patients with chronic heart failure. We measured VE/VCO(2) slope during exercise, arterial blood gases and lactate concentrations during cardiopulmonary exercise testing (rest, peak exercise and one minute after the end of exercise). Neither VE/VCO(2) slope nor arterial pCO(2) were related to arterial lactate concentrations at peak exercise (r = -0.16, p = 0.65 and r = -0.15, p = 0.6). During early recovery, patients with a high VE/VCO(2) slope had a particularly pronounced rise in arterial lactate and hydrogen ion concentrations (r = 0.57, p < 0.05 and r = 0.84, p < 0.0001) and yet their arterial pCO(2) rose rather than fell (r = 0.79, p < 0.001). The rise in arterial pCO(2) correlated with the increase in arterial hydrogen concentration (r = 0.78, p < 0.001) and with arterial pCO(2) at peak exercise (r = -0.76, p < 0.001).
  
  
  CONCLUSIONS
  In heart failure VE/VCO(2) slope and low arterial pCO(2) at peak exercise are not related to the degree of systemic lactic acidosis. Lactic acidosis is therefore not a plausible mechanism of exercise induced hyperventilation.
authors.affiliation: National Heart and Lung Institute, Imperial College of Science, Technology and Medicine, London, UK. roland.wensel@klinik.uni-regensburg.de
authors.forename: Roland
authors.initials: R
authors.lastname: Wensel
authors.forename: Darrel P
authors.initials: DP
authors.lastname: Francis
authors.forename: Panagiota
authors.initials: P
authors.lastname: Georgiadou
authors.forename: Adam
authors.initials: A
authors.lastname: Scott
authors.forename: Sabine
authors.initials: S
authors.lastname: Genth-Zotz
authors.forename: Stefan D
authors.initials: SD
authors.lastname: Anker
authors.forename: Andrew J S
authors.initials: AJ
authors.lastname: Coats
authors.forename: Massimo F
authors.initials: MF
authors.lastname: Piepoli
mesh_terms: D000140:Acidosis, Lactic / Q000097:blood* / Q000209:etiology; D001784:Blood Gas Analysis; D005080:Exercise Test / Q000009:adverse effects*; D017079:Exercise Tolerance; D005260:Female; D006333:Heart Failure / Q000097:blood*; D006801:Humans; D006985:Hyperventilation / Q000097:blood / Q000209:etiology*; D008297:Male; D008875:Middle Aged