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Ambulatory Monitoring of Left Ventricular Function: Walk and Bicycle Exercise in Congestive Heart Failure

Nuclear Medicine Center of the National Council of Research (CNR) and Internal Medicine, University "Federico II", Napoli; Mediterranean Institute of Neurosciences, "Sanatrix," Pozzilli, Italy

Correspondence: For correspondence or reprints contact: Alberto Cuocolo, MD. Centra per la Medicina Nucleare del CNR, Università Federico II, Via Pansini, 5, 8013 Napoli Italy.

ABSTRACT

The aim of this study was to assess changes in left ventricular (LV) function during 6-min walk test and cardiopulmonary exercise by continuous radionuclide monitoring in patients with congestive heart failure (CHF). Methods: Seventeen patients with CHF and 10 normal subjects underwent monitoring of LV function (Vest) during 6-min walk test and during bicycle exercise with combined analysis of pulmonary gas exchange. During cardiopulmonary exercise, all parameters of LV function were measured at rest, at the anaerobic threshold (AT) and at peak oxygen uptake (peak VO₂). Results: In the normal subjects, during the walk test, heart rate (HR), ejection fraction (EF), end-diastolic volume (EDV), cardiac output (CO) and stroke volume (SV) significantly increased from rest to peak (all p < 0.001), while end-systolic volume (ESV)significantly decreased from rest to peak (p < 0.001). In patients with CHF, during the walk test, HR, EDV, ESV and CO significantly increased from rest to peak (p < 0.001), EF significantly decreased from rest to peak (p < 0.001) and SV did not show significant change. During cardiopulmonary exercise, normal subjects showed a significant increase in HR and CO, from rest to AT and from AT to the peak VO₂ (p < 0.001). EF, EDV and SV significantly increased from rest to AT (p < 0.001), with no significant change from AT to peak VO₂. ESV decreased from rest to AT (p < 0.001), showing no significant change from AT to peak VO₂. In patients with CHF, HR, CO, ESV and EDV increased significantly from rest to AT (p < 0.001) and from AT to peak VO₂ (p < 0.001). EF and SV did not show significant changes from rest to AT, showing a significant decrease from AT to peak VO₂ (p < 0.001). Conclusion: Vest can be used to evaluate cardiac responses during 6-min walk test and cardiopulmonary exercise in patients with CHF. In such patients, significant impairment of LV function is already present during submaximal physical exercise becoming more evident during the anaerobic phases of bicycle exercise.

Key Words: Vest • physical exercise • left ventricular dysfunction • congestive heart failure

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