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Background: The lowest minute ventilation (VE) and carbon dioxide production (VCO(2)) ratio during exercise has been suggested to be the most stable and reproducible marker of ventilatory efficiency in patients with heart failure (HF). However, the prognostic power of this index is unknown.Methods and Results: A total of 847 HF patients underwent cardiopulmonary exercise testing (CPX) and were followed for 3 years. The associations between the lowest VE/VCO(2) ratio, maximal oxygen uptake (peak VO(2)), the VE/VCO(2) slope, and major events (death or transplantation) were evaluated using proportional hazards analysis; adequacy of the predictive models was assessed using Akaike information criterion (AIC) weights. There were 147 major adverse events. In multivariate analysis, the lowest VE/VCO(2) ratio (higher ratio associated with greater risk) was similar to the VE/VCO(2) slope in predicting risk (hazard ratios [HR] per unit increment 2.0, 95% CI 1.1-3.4, and 2.2, 95% CI 1.3-3.7, respectively; P < .01), followed by peak VO(2) (HR 1.6, 95% CI 1.1-2.4, P=.01). Patients exhibiting abnormalities for all 3 responses had an 11.6-fold higher risk. The AIC weight for the 3 variables combined (0.94) was higher than any single response or any combination of 2. The model including all 3 responses remained the most powerful after adjustment for beta-blocker use, type of HF, and after applying different cut points for high risk.Conclusions: The lowest VE/VCO(2) ratio adds to the prognostic power of conventional CPX responses in HF. [ABSTRACT FROM AUTHOR]

Objective: The purpose of this study was to determine the effects of pregnancy and of maximal exercise on left ventricular diastolic filling response.Study Design: Transmitral pulsed Doppler echocardiography was obtained in 10 healthy women during each trimester of pregnancy and at 12 weeks after delivery. Doppler studies were performed at rest and at each exercise workload. The P-R interval, the early and atrial peak flow velocities, the mitral early deceleration time, and the isovolumetric relaxation time were analyzed. Data are expressed as the mean and standard deviation of the mean. Values obtained during the last trimester of pregnancy were used as the pregnant value; values at the 12 weeks after delivery were used as the nonpregnant value. Paired t -test, analysis of variance, and mixed models were used to determine significance with a probability value of <.05.Results: Pregnancy significantly increased the early and atrial peak flow velocities. Pregnancy decreased the P-R interval, the early deceleration time, and the isovolumetric relaxation time. Exercise significantly decreased these diastolic functions; but pregnancy, in any of the 3 trimesters, did not significantly affect this response.Conclusion: Pregnancy increased left ventricular diastolic camber stiffness at rest and shifted left ventricular diastolic filling during exercise from predominantly early to atrial filling. This finding suggests that there is an increase in left ventricular chamber stiffness during maximal upright bicycle exercise in pregnancy. [ABSTRACT FROM AUTHOR]

Objective: Our purpose was to examine the nature and the frequency of electrocardiographic changes at rest and after bicycle exercise in early and late gestation compared with a group of nonpregnant subjects.Study Design: Thirty-nine pregnant subjects had electrically braked bicycle exercise early and late in gestation. Eight nonpregnant subjects served as controls. Twelve-lead electrocardiograms were obtained during rest, exercise, and recovery. All electrocardiograms were analyzed by a cardiologist blinded to subject group and stage of the pregnancy. Data were analyzed by analysis of variance for repeated measures, and contingency tables were used to compare findings at rest and during exercise between the time periods. A p value < 0.05 was considered significant.Results: T-wave inversion in V2 was more frequent in the pregnant than the nonpregnant subjects (p < 0.01). Subjects "late" in pregnancy had significantly fewer Q waves in II, III, and aVF than the nonpregnant group did. With exercise the time to onset of maximum ST depression was significantly shorter during pregnancy.Conclusion: Although minor electrocardiographic charges were found at rest and during exercise between the two groups, these should be considered normal unless associated with significant symptoms. [ABSTRACT FROM AUTHOR]