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. 2023 Sep 7;12(18):5817.
doi: 10.3390/jcm12185817.

The Mechanism of Effort Intolerance in Patients with Peripheral Arterial Disease: A Combined Stress Echocardiography and Cardiopulmonary Exercise Test

Eihab Ghantous  1 , Aviel Shetrit  1 , Yonatan Erez  1 , Natalie Noam  2 , Ryan S Zamanzadeh  1 , David Zahler  1 , Yoav Granot  1 , Erez Levi  1 , Michal Laufer Perl  1 , Shmuel Banai  1 , Yan Topilsky  1 , Ofer Havakuk  1
Affiliations

The Mechanism of Effort Intolerance in Patients with Peripheral Arterial Disease: A Combined Stress Echocardiography and Cardiopulmonary Exercise Test

Eihab Ghantous et al. J Clin Med. .

Abstract

Aim: We used a combined stress echocardiography and cardiopulmonary exercise test (CPET) to explore effort intolerance in peripheral arterial disease (PAD) patients.

Methods: Twenty-three patients who had both PAD and coronary artery disease (CAD) were compared with twenty-four sex- and age-matched CAD patients and fifteen normal controls using a symptom-limited ramp bicycle CPET on a tilting dedicated ergometer. Echocardiographic images were obtained concurrently with gas exchange measurements along predefined stages of exercise. Oxygen extraction was calculated using the Fick equation at each activity level.

Results: Along the stages of exercise (unloaded; anaerobic threshold; peak), in PAD + CAD patients compared with CAD or controls, diastolic function worsened (p = 0.051 and p = 0.013, respectively), and oxygen consumption (p < 0.001 and p < 0.001, respectively) and oxygen pulse (p = 0.0024 and p = 0.0027, respectively) were reduced. Notably, oxygen pulse was blunted due to an insufficient increase in both stroke volume (p = 0.025 and p = 0.028, respectively) and peripheral oxygen extraction (p = 0.031 and p = 0.038, respectively). Chronotropic incompetence was more prevalent in PAD patients and persisted after correction for beta-blocker use (62% vs. 42% and 11%, respectively).

Conclusions: In PAD patients, exercise limitation is associated with diastolic dysfunction, chronotropic incompetence and peripheral factors.

Keywords: cardiopulmonary exercise test; effort intolerance; peripheral arterial disease; stress echocardiography.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Along the stages of exercise, oxygen consumption was reduced in PAD patients due to a combination of mechanical and peripheral limitations. p *—PAD + CAD vs. CAD, p #—PAD + CAD vs. normal controls.
Figure 2
Figure 2
Compared with either CAD patients or normal controls, a higher prevalence of chronotropic incompetence was found among PAD + CAD patients.
Figure 3
Figure 3
A decreased ratio of oxygen consumption to work rate was shown in PAD + CAD patients compared with either CAD patients or normal controls.
See this image and copyright information in PMC

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