Exercise responses of elderly patients with diastolic versus systolic heart failure

BRUBAKER, P. H.. C. T. MARBURGER, T. M. MORGAN, B. FRAY, and D. W. KITZMAN. Exercise Responses of Elderly Patients with Diastolic versus Systolic Heart Failure. Med. Sci. Sports Exerc.. Vol. 35, No. 9, pp. 1477-1485, 2003. Purpose: Little information is available regarding peak and submaximal exercise performance in elderly heart failure (HE) patients, particularly in those with diastolic dysfunction (DD). Therefore, the purpose of this investigation was to compare exercise responses of elderly patients with HE due to either systolic dysfunction (SD) or DD, to age-matched healthy volunteers (HV). Methods: Patients with chronic HF greater than or equal to 60 yr (N = 119) due to SD (N = 60) or primary DD (N 59) underwent a maximal cycle crgornctry test with expired,as analysis and venous lactate measurement. Twenty-eight HV greater than or equal to 60 yr served as a control group. Anaerobic threshold was determined by gas analysis (AT(VEN)) and by plasma lactate rise (AT(LAC)), Results: Peak oxygen consumption (VO2peak was significantly (P < 0.001) reduced in both SD and DD patients (13 +/- 0.4 vs 14 +/- 0.4 mL . kg(-1) . min(-1), respectively) versus HV (20 +/- 0.6 mL.kg(-1) . min(-1)). Peak heart rate was reduced in patients versus HV (131 +/- 3 bpm vs 145 +/- 4, respectively; P less than or equal to 0.01). but heart Fate at a given submaximal work rate was significantly lower (P less than or equal to 0.01) in HV than in SD and DD patients. AT(VEN) of 11.8 +/- 0.3 mL.kg(-1).min(-1) for HV was significantly higher than SD (8.9 +/- 10.2) and DD (9.2 +/- 10.3). Peak lactate concentration was 6.6 +/- 0.6 mmol.kg(-1).L-1 in HV and was significantly reduced in both SD and DD HE patients. ATVEN Correlated well with ATLAC in HV and in DD patients, but not in SD patients. Conclusions: Submaximal and peak exercise performance are markedly altered in elderly HE patients compared with age-matched HV but do not appear to be different between SD and DD patients.