Íscar Urrutia Marta, Huertas Julia Herrero, Castro Marina Acebo, Fernández Álvarez Ramón, Molina Beatriz Díaz, Clemente Marta García
Department of Pneumology, Asturias Central University Hospital, 33011 Oviedo, Spain.
Department of Pneumology, Fundación Jiménez Díaz University Hospital, 28040 Madrid, Spain.
J Clin Med. 2025 Apr 8;14(8):2538. doi: 10.3390/jcm14082538.
Heart failure with reduced ejection fraction (HFrEF) frequently coexists with chronic obstructive pulmonary disease (COPD), and both conditions share symptoms such as exertional dyspnea. The cardiopulmonary exercise test (CPET) is an essential tool for assessing ventilatory and cardiovascular function and plays a key role in the differential diagnosis of dyspnea. However, the impact of exercise modality on the ventilatory and cardiovascular parameters obtained remains unclear in these groups. Our aim is to compare the oxygen consumption (VO) and breathing reserve (BR) values obtained from CPET on a treadmill and a cycle ergometer in patients with HFrEF-COPD and those with HFrEF alone. A prospective observational study included 65 patients with HFrEF (LVEF ≤ 40%), 18 of whom had COPD. Two CPETs were performed, the first on a treadmill and the second 48-72 h later on a cycle ergometer. In the group with HFrEF-COPD, peak oxygen consumption (VO/kg) and maximum ventilation (VE) values were significantly higher on the treadmill (20 ± 5 vs. 17 ± 4 mL/kg/min, < 0.001 and 55 ± 19 vs. 45 ± 11 L/min, < 0.001, respectively), while breathing reserve (BR%) was lower on the treadmill (16 ± 21 vs. 33 ± 20, < 0.001). Compared to the HFrEF group, patients with HFrEF-COPD had a lower BR in both exercise modalities ( = 0.01). Treadmill CPET demonstrates greater oxygen consumption and a more pronounced ventilatory response. BR is consolidated as a differential parameter in ventilatory limitation. The choice of exercise modality should be considered based on the underlying pathologies and the objective of the test.
射血分数降低的心力衰竭（HFrEF）常与慢性阻塞性肺疾病（COPD）共存，且这两种疾病都有劳力性呼吸困难等共同症状。心肺运动试验（CPET）是评估通气和心血管功能的重要工具，在呼吸困难的鉴别诊断中起关键作用。然而，运动方式对这些人群所获得的通气和心血管参数的影响尚不清楚。我们的目的是比较HFrEF-COPD患者和单纯HFrEF患者在跑步机和自行车测力计上进行CPET所获得的耗氧量（VO）和呼吸储备（BR）值。一项前瞻性观察性研究纳入了65例HFrEF患者（左心室射血分数≤40%），其中18例患有COPD。进行了两次CPET，第一次在跑步机上进行，第二次在48 - 72小时后在自行车测力计上进行。在HFrEF-COPD组中，跑步机上的峰值耗氧量（VO/kg）和最大通气量（VE）值显著更高（分别为20±5 vs. 17±4 mL/kg/min，P<0.001和55±19 vs. 45±11 L/min，P<0.001），而跑步机上的呼吸储备（BR%）更低（16±21 vs. 33±20，P<0.001）。与HFrEF组相比，HFrEF-COPD患者在两种运动方式下的BR均较低（P = 0.01）。跑步机CPET显示出更高的耗氧量和更明显的通气反应。BR被确认为通气受限的鉴别参数。应根据潜在病理情况和检查目的考虑运动方式的选择。
