Failure to Attain Peak Aerobic Capacity During Maximal Bicycle Exercise in Patients With Severe Congestive Heart Failure

Background. In addition to depressed cardiac reserve, peripheral factors may contribute to limit maximal exercise capacity in patients with congestive heart failure (CHF). To investigate the role of reduced active skeletal muscle mass, peak oxygen uptake (Vo2, milligrams per kilogram per minute) was determined during maximal symptom-limited exercise involving the lower limbs (LL) alone and the lower limbs and upper limbs (LL+UL) combined in patients with CHF and in normal subjects of similar age and sex. Methods and Results. LL bicycle exercise was performed upright with a ramp protocol and continuous expired gas analysis. When respiratory exchange ratio (RER) reached 1.0, UL exercise was initiated at constant load with the use of a cranking device positioned at shoulder level. LL exercise alone and combined LL+UL exercise were performed on separate days in randomized order by 24 patients with CHF and seven normal subjects. In patients with CHF, peak Vo2 was greater during combined LL+UL exercise than during LL exercise alone, i.e., 15.8±0.8 versus 14.2±0.9 ml * kg-' min` (p<0.001), whereas in normal subjects, maximal Vo2 was similar during the two tests, i.e., 26.7 versus 26.2 ml * kg' * min` (NS). The increase in peak Vo2 during combined LL+UL exercise relative to LL exercise alone was almost exclusively observed in patients with peak Vo2 <15 ml * kg`. min' (mean increase, 21.7+4.1%). Peak Vo0 during combined LL and UL exercise did not increase relative to LL exercise alone in patients with peak Vo2 >15 ml kg' min` and in normal subjects of similar age and sex, i.e., 0.1 ±4.0%o and 2.0±2.3% respectively. Conclusions. In contrast to normal subjects and patients with moderate CHF, patients with severe CHF do not exhaust their cardiopulmonary reserve during symptom-limited maximal LL exercise on a bicycle. (Circulation 1992;86:1351-1356)