title: Noninvasive measurement of cardiac performance in recovery from exercise in heart failure patients.
abstract: OBJECTIVE
  To examine the association between cardiac performance during recovery and the severity of heart failure, as determined by clinical and cardiopulmonary exercise test responses.
  
  
  METHODS
  As part of a retrospective cohort study, 46 heart failure patients and 13 normal subjects underwent cardiopulmonary exercise testing while cardiac output was measured using a noninvasive device. Cardiac output in recovery was expressed as the slope of a single exponential relationship between cardiac output and time; the recovery-time constant was assessed in relation to indices of cardiac function, along with clinical, functional, and cardiopulmonary exercise responses.
  
  
  RESULTS
  The recovery time constant was delayed in patients with heart failure compared with normal subjects (296.7 ± 238 vs. 110.1 ±27 seconds, p <0.01), and the slope of the decline of cardiac output in recovery was steeper in normal subjects compared with heart failure patients (p<0.001). The slope of the decline in cardiac output recovery was inversely related to peak VO(2) (r = -0.72, p<0.001) and directly related to the VE/VCO(2) slope (r = 0.57, p,0.001). Heart failure patients with abnormal recovery time constants had lower peak VO(2), lower VO(2) at the ventilatory threshold, lower peak cardiac output, and a heightened VE/VCO(2) slope during exercise.
  
  
  CONCLUSIONS
  Impaired cardiac output recovery kinetics can identify heart failure patients with more severe disease, lower exercise capacity, and inefficient ventilation. Estimating cardiac output in recovery from exercise may provide added insight into the cardiovascular status of patients with heart failure.
authors.affiliation: VA Palo Alto Health Care System, California, United States. drj993@aol.com
authors.forename: Jonathan N
authors.initials: JN
authors.lastname: Myers
authors.forename: Pradeep
authors.initials: P
authors.lastname: Gujja
authors.forename: Suresh
authors.initials: S
authors.lastname: Neelagaru
authors.forename: Leon
authors.initials: L
authors.lastname: Hsu
authors.forename: Daniel
authors.initials: D
authors.lastname: Burkhoff
mesh_terms: D000222:Adaptation, Physiological / Q000502:physiology*; D002302:Cardiac Output / Q000502:physiology*; D004812:Epidemiologic Methods; D015444:Exercise / Q000502:physiology*; D005080:Exercise Test / Q000379:methods; D006333:Heart Failure / Q000503:physiopathology*; D006801:Humans; D007700:Kinetics; D008875:Middle Aged; D008991:Monitoring, Physiologic / Q000379:methods; D010101:Oxygen Consumption / Q000502:physiology; D013815:Thermodilution / Q000379:methods; D013997:Time Factors