Proportional Assist Ventilation Improves Leg Muscle Reoxygenation After Exercise in Heart Failure With Reduced Ejection Fraction

Author(s)

Borghi-Silva, Audrey ^{[1, 2]} ; Goulart, Cassia da Luz ^[1] ; Carrascosa, Claudia R. ^[2] ; Oliveira, Cristino Carneiro ^[3] ; Berton, Danilo C. ^[4] ; de Almeida, Dirceu Rodrigues ^[5] ; Nery, Luiz Eduardo ^[2] ; Arena, Ross ^[6] ; Neder, J. Alberto ^{[7, 2, 8]}

Affiliation

^[1] Fed Univ Sao Carlos UFSCar, Cardiopulmonary Physiotherapy Lab, Sao Paulo - Brazil

^[2] Fed Univ Sao Paulo UNIFESP, Pulm Funct & Clin Exercise Physiol Unit, Div Resp Dis, Dept Med, Sao Paulo - Brazil

^[3] Univ Fed Juiz de Fora, Postgrad Program Collect Hlth, Juiz De Fora - Brazil

^[4] Fed Univ Rio Grande, Pulm Physiol Unit, Porto Alegre - Brazil

^[5] Fed Univ Sao Paulo UNIFESP, Div Cardiol, Dept Med, Sao Paulo - Brazil

^[6] Univ Illinois, Dept Phys Therapy, Coll Appl Hlth Sci, Chicago, IL - USA

^[7] Queens Univ, Kingston, ON - Canada

^[8] Kingston Hlth Sci Ctr, Resp Invest Unit, Div Respirol, Dept Med, Kingston, ON - Canada

• Document type: Journal article
• Source: FRONTIERS IN PHYSIOLOGY; v. 12, JUN 21 2021.
• Web of Science Citations: 0

Abstract

Background: Respiratory muscle unloading through proportional assist ventilation (PAV) may enhance leg oxygen delivery, thereby speeding off-exercise oxygen uptake ((V)over dotO(2)) kinetics in patients with heart failure with reduced left ventricular ejection fraction (HFrEF). Methods: Ten male patients (HFrEF = 26 +/- 9%, age 50 +/- 13 years, and body mass index 25 +/- 3 kg m(2)) underwent two constant work rate tests at 80% peak of maximal cardiopulmonary exercise test to tolerance under PAV and sham ventilation. Post-exercise kinetics of (V)over dotO(2), vastus lateralis deoxyhemoglobin ({[}deoxy-Hb + Mb]) by near-infrared spectroscopy, and cardiac output (Q(T)) by impedance cardiography were assessed. Results: PAV prolonged exercise tolerance compared with sham (587 +/- 390 s vs. 444 +/- 296 s, respectively; p = 0.01). PAV significantly accelerated (V)over dotO(2) recovery (tau = 56 +/- 22 s vs. 77 +/- 42 s; p < 0.05), being associated with a faster decline in Delta{[}deoxy-Hb + Mb] and Q(T) compared with sham (tau = 31 +/- 19 s vs. 42 +/- 22 s and 39 +/- 22 s vs. 78 +/- 46 s, p < 0.05). Faster off-exercise decrease in Q(T) with PAV was related to longer exercise duration (r = -0.76; p < 0.05). Conclusion: PAV accelerates the recovery of central hemodynamics and muscle oxygenation in HFrEF. These beneficial effects might prove useful to improve the tolerance to repeated exercise during cardiac rehabilitation. (AU)

• FAPESP's process: 15/26501-1 - Study of limiting factors to physical exercise and adjunct effects to rehabilitation on cardiorespiratory disease: a multicentre approach
• Grantee: Audrey Borghi e Silva
• Support Opportunities: Research Projects - Thematic Grants
• FAPESP's process: 18/03233-0 - Study of cardiorespiratory interaction and the supply of peripheral and cerebral oxygen as modulators of exercise capacity during bilevel application in the coexistence of COPD-CHF
• Grantee: Cássia da Luz Goulart
• Support Opportunities: Scholarships in Brazil - Doctorate (Direct)