Type of Exercise Alters VE/VCO₂Slope in CAD Patients

Abstract

The exercise carbon dioxide equivalent slope predicts prognosis in coronary artery disease patients. However, no study examined whether the carbon dioxide equivalent slope in coronary artery disease patients is dependent on the type of exercise. Twenty-nine coronary artery disease patients performed maximal cardiopulmonary exercise tests on bike, treadmill and arm cycle, with assessment of oxygen uptake, carbon dioxide output , and expiratory volume. The carbon dioxide equivalent slope was calculated from rest till peak exercise. The carbon dioxide equivalent slope was significantly different between walking, cycling, and arm cranking exercises (P<0.05), i.e. the carbon dioxide equivalent slope was the lowest during walking and the highest during arm cranking. Bland-Altman plots revealed that the difference of the carbon dioxide equivalent slope between exercises was greater in the case of a higher averaged carbon dioxide equivalent slope and overall peak oxygen uptake. In conclusion, the carbon dioxide equivalent slope is significantly dependent on the type of exercise in coronary artery disease patients. Additionally, the averaged carbon dioxide equivalent slope and peak oxygen uptake affect the difference of the carbon dioxide equivalent slopes between exercises.

Key words

carbon dioxide equivalent slope - exercise - heart disease

References

• 1 Ajisaka R, Watanabe S, Yamanouchi T, Mauoka T, Sugishita Y. Effect of percutaneous transluminal coronary angioplasty on exercise ventilation in patients with coronary artery disease and normal left ventricular function.  Am Heart J. 1996;  132 48-53
• 2 Cerny FJ, Ucer C. Arm work interferes with normal ventilation.  Appl Ergon. 2004;  35 411-415
• 3 Fletcher GF, Balady GJ, Amsterdam EA, Chaitman B, Eckel R, Fleg J, Froelicher VF, Leon AS, Pina IL, Rodney R, Simons-Morton DA, Williams MA, Bazzarre T. Exercise standards for testing and training: a statement for healthcare professionals from the American Heart Association.  Circulation. 2001;  104 1694-2740
• 4 Hamm LF, Crow RS, Stull GA, Hannan P. Safety and characteristics of exercise testing early after acute myocardial infarction.  Am J Cardiol. 1989;  63 1193-1197
• 5 Hansen D, Dendale P, Berger J, Meeusen R. Low agreement of ventilatory threshold between training modes in cardiac patients.  Eur J Appl Physiol. 2007;  101 547-554
• 6 Hansen D, Dendale P, Berger J, Meeusen R. Importance of an exercise testing protocol for detecting changes of peak oxygen uptake in cardiac rehabilitation.  Arch Phys Med Rehabil. 2007;  88 1716-1719
• 7 Hansen D, Dendale P, Berger J, Onkelinx S, Reyckers I, Hermans A, Vaes J, Reenaers V, Meeusen R. Importance of exercise training session duration in the rehabilitation of coronary artery disease patients.  Eur J Cardiovasc Prev Rehabil. 2008;  15 453-459
• 8 Kavanagh T, Mertens DJ, Hamm L, Beyene J, Kennedy J, Corey P, Shephard RJ. Prediction of long-term prognosis in 12169 men referred for cardiac rehabilitation.  Circulation. 2002;  106 666-671
• 9 Keyser RE, Andres FF, Wojta DM, Gullet SL. Variations in cardiovascular response accompanying differences in arm-cranking rate.  Arch Phys Med Rehabil. 1988;  69 941-945
• 10 Kimura M, Haraguchi M, Fujii K, Harada M, Ono K, Kubo M, Tada T, Matsuda M, Matsuzaki M. Relationship between exercise capacity and ventilatory equivalent for carbon dioxide in patients with stable old myocardial infarction.  Jpn Heart J. 1999;  40 127-134
• 11 Martin TW, Zeballos RJ, Weisman IM. Gas exchange during maximal upper extremity exercise.  Chest. 1991;  99 420-425
• 12 Oren A, Whipp BJ, Wasserman K. Effect of acid-base status on the kinetics of the ventilatory response to moderate exercise.  J Appl Physiol. 1982;  52 1013-1017
• 13 Ramonatxo M, Prioux J, Prefaut C. Differences in mouth occlusion pressure and breathing pattern between arm and leg incremental exercise.  Acta Physiol Scand. 1996;  158 333-341
• 14 Satoh T, Okano Y, Takaki H, Matsumoto T, Yasamura Y, Aihara N, Goto Y. Excessive ventilation after acute myocardial infarction and its improvement in 4 months.  Jpn Circ J. 2001;  65 399-403
• 15 Smith PM, Price MJ, Doherty M. The influence of crank rate on peak oxygen consumption during arm crank ergometry.  J Sports Sci. 2001;  19 955-960
• 16 Sun XG, Hansen JE, Garatachea N, Storer TW, Wasserman K. Ventilatory efficiency during exercise in healthy subjects.  Am J Respir Crit Care Med. 2002;  166 1443-1448
• 17 Tabet JY, Beauvais F, Thabut G, Tartière JM, Logaert D, Cohen-Solal A. A critical appraisal of the prognostic value of the VE/VCO₂ slope in chronic heart failure.  Eur J Cardiovasc Prev Rehabil. 2003;  10 267-272
• 18 Tsurugaya H, Adachi H, Kurabayashi M, Ohshima S, Taniguchi K. Prognostic impact of ventilatory efficiency in heart disease patients with preserved exercise tolerance.  Circ J. 2006;  70 1332-1336
• 19 Veire NR Van de, Laethem C Van, Philippé J, Winter O De, Backer G De, Vanderheyden M, Sutter J De. VE/VCO₂ slope and oxygen uptake efficiency slope in patients with coronary artery disease and intermediate peakVO₂.  Eur J Cardiovasc Prev Rehabil. 2006;  13 916-923
• 20 Wasserman K, Hansen JE, Sue DY, Casaburi R, Whipp BJ. Principles of exercise testing and interpretation, 3rd edition. Lippincott Williams & Wilkins 1999: 556
• 21 Williams J, Cottrell E, Powers SK, MacKnight T. Arm ergometry: a review of published protocols and the introduction of a new weight adjusted protocol.  J Sports Med Phys Fitness. 1983;  23 107-112

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