Exercise ventilation inefficiency in heart failure: pathophysiological and clinical significance.
Heart failure (HF) is a complex syndrome characterized by myocardial dysfunction and a poor prognosis. Among multiple markers of severity, an exercise ventilation inefficiency has important clinical and prognostic value. The pathophysiology determining exercise ventilatory inefficiency is complex and not definitively clarified. Three different mechanisms have been identified: (i) increased dead space, (ii) early occurrence of lactic acidosis, and (iii) abnormal chemoreflex and/or metaboreflex activity. Besides its prognostic value, abnormal ventilation can be influenced by pharmacological and non-pharmacological therapies such as beta-blockers, selective cyclic 3'-5' guanosine monosphosphate phosphodiesterase inhibitors, physical training, and nocturnal continuous positive airway pressure. There is an increasing interest for the exercise periodic breathing, which is frequently associated with HF syndrome and has prognostic importance. The precise mechanisms sustaining exercise periodic breathing are not fully defined but ventilatory and metabo-haemodynamic hypotheses have been proposed.
Tumminello
Gabriele
G
Cardiopulmonary Unit, Cardiology Division, University of Milano, San Paolo Hospital, Milano, Italy.
Guazzi
Marco
M
Lancellotti
Patrizio
P
Piérard
Luc A
LA
D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D002245:Carbon Dioxide / Q000032:analysis*; D002302:Cardiac Output / Q000502:physiology; D015444:Exercise / Q000502:physiology*; D005541:Forced Expiratory Volume / Q000502:physiology; D006333:Heart Failure / Q000188:drug therapy / Q000503:physiopathology*; D006801:Humans; D010313:Partial Pressure; D011379:Prognosis; D012119:Respiration; D018487:Ventricular Dysfunction, Left / Q000188:drug therapy / Q000503:physiopathology
D000319:Adrenergic beta-Antagonists; D002245:Carbon Dioxide