{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,16]],"date-time":"2026-07-16T21:42:09Z","timestamp":1784238129879,"version":"3.55.0"},"reference-count":48,"publisher":"European Respiratory Society (ERS)","issue":"4","license":[{"start":{"date-parts":[[2019,2,14]],"date-time":"2019-02-14T00:00:00Z","timestamp":1550102400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/www.ersjournals.com\/user-licence"}],"content-domain":{"domain":["publications.ersnet.org"],"crossmark-restriction":true},"short-container-title":["Eur Respir J"],"accepted":{"date-parts":[[2019,1,22]]},"published-print":{"date-parts":[[2019,4]]},"abstract":"<jats:p>Impaired aerobic function is a potential mechanism of exercise intolerance in patients with combined cardiorespiratory disease. We investigated the pathophysiological and sensory consequences of a low change in oxygen uptake (\u0394<jats:italic>V<\/jats:italic>\u2032<jats:sub>O<jats:sub>2<\/jats:sub><\/jats:sub>)\/change in work rate (\u0394WR) relationship during incremental exercise in patients with coexisting chronic obstructive pulmonary disease (COPD) and systolic heart failure (HF).<\/jats:p><jats:p>After clinical stabilisation, 51 COPD\u2013HF patients performed an incremental cardiopulmonary exercise test to symptom limitation. Cardiac output was non-invasively measured (impedance cardiography) in a subset of patients (n=18).<\/jats:p><jats:p>27 patients presented with \u0394<jats:italic>V<\/jats:italic>\u2032<jats:sub>O<jats:sub>2<\/jats:sub><\/jats:sub>\/\u0394WR below the lower limit of normal. Despite similar forced expiratory volume in 1\u2005s and ejection fraction, the low \u0394<jats:italic>V<\/jats:italic>\u2032<jats:sub>O<jats:sub>2<\/jats:sub><\/jats:sub>\/\u0394WR group showed higher end-diastolic volume, lower inspiratory capacity and lower transfer factor compared to their counterparts (p&lt;0.05). Peak WR and peak<jats:italic>V<\/jats:italic>\u2032<jats:sub>O<jats:sub>2<\/jats:sub><\/jats:sub>were \u223c15% and \u223c30% lower, respectively, in the former group: those findings were associated with greater symptom burden in daily life and at a given exercise intensity (leg discomfort and dyspnoea). The low \u0394<jats:italic>V<\/jats:italic>\u2032<jats:sub>O<jats:sub>2<\/jats:sub><\/jats:sub>\/\u0394WR group presented with other evidences of impaired aerobic function (sluggish<jats:italic>V<\/jats:italic>\u2032<jats:sub>O<jats:sub>2<\/jats:sub><\/jats:sub>kinetics, earlier anaerobic threshold) and cardiocirculatory performance (lower oxygen pulse, lower stroke volume and cardiac output) (p&lt;0.05). Despite similar exertional hypoxaemia, they showed worse ventilatory inefficiency and higher operating lung volumes, which led to greater mechanical inspiratory constraints (p&lt;0.05).<\/jats:p><jats:p>Impaired aerobic function due to negative cardiopulmonary\u2013muscular interactions is an important determinant of exercise intolerance in patients with COPD\u2013HF. Treatment strategies to improve oxygen delivery to and\/or utilisation by the peripheral muscles might prove particularly beneficial to these patients.<\/jats:p>","DOI":"10.1183\/13993003.02386-2018","type":"journal-article","created":{"date-parts":[[2019,2,14]],"date-time":"2019-02-14T15:17:07Z","timestamp":1550157427000},"page":"1802386","update-policy":"https:\/\/doi.org\/10.1183\/ers-crossmark-policy","source":"Crossref","is-referenced-by-count":23,"title":["Exercise intolerance in comorbid COPD and heart failure: the role of impaired\u00a0aerobic function"],"prefix":"10.1183","volume":"53","author":[{"given":"Alcides","family":"Rocha","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Flavio F.","family":"Arbex","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Priscila A.","family":"Sperandio","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Frederico","family":"Mancuso","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mathieu","family":"Marillier","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anne-Catherine","family":"Bernard","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria Clara N.","family":"Alencar","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Denis\u00a0E.","family":"O'Donnell","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J. Alberto","family":"Neder","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"81","published-online":{"date-parts":[[2019,2,14]]},"reference":[{"key":"2024102100484971000_53.4.1802386.1","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehi291"},{"key":"2024102100484971000_53.4.1802386.2","doi-asserted-by":"publisher","DOI":"10.1136\/thoraxjnl-2014-205770"},{"key":"2024102100484971000_53.4.1802386.3","doi-asserted-by":"crossref","first-page":"407","DOI":"10.3109\/15412555.2015.1117435","article-title":"Heart failure impairs muscle blood flow and endurance exercise tolerance in COPD","volume":"13","author":"Oliveira","year":"2016","journal-title":"COPD"},{"key":"2024102100484971000_53.4.1802386.4","doi-asserted-by":"crossref","first-page":"693","DOI":"10.1080\/15412555.2016.1174985","article-title":"Exercise ventilation in COPD: influence of systolic heart failure","volume":"13","author":"Arbex","year":"2016","journal-title":"COPD"},{"key":"2024102100484971000_53.4.1802386.5","doi-asserted-by":"crossref","first-page":"1264","DOI":"10.1164\/rccm.201704-0675OC","article-title":"Excess ventilation in chronic obstructive pulmonary disease-heart failure overlap: implications for dyspnea and exercise intolerance","volume":"196","author":"Rocha","year":"2017","journal-title":"Am J Respir Crit Care Med"},{"key":"2024102100484971000_53.4.1802386.6","doi-asserted-by":"crossref","first-page":"653","DOI":"10.1080\/14779072.2018.1510319","article-title":"Current challenges in managing comorbid heart failure and COPD","volume":"16","author":"Neder","year":"2018","journal-title":"Expert Rev Cardiovasc Ther"},{"key":"2024102100484971000_53.4.1802386.7","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijcard.2015.03.422"},{"key":"2024102100484971000_53.4.1802386.8","doi-asserted-by":"crossref","first-page":"447","DOI":"10.1016\/j.ijcard.2016.09.077","article-title":"Physiological and sensory consequences of exercise oscillatory ventilation in heart failure-COPD","volume":"224","author":"Rocha","year":"2016","journal-title":"Int J Cardiol"},{"key":"2024102100484971000_53.4.1802386.9","doi-asserted-by":"crossref","first-page":"514","DOI":"10.3389\/fphys.2014.00514","article-title":"Does impaired O2 delivery during exercise accentuate central and peripheral fatigue in patients with coexistent COPD-CHF?","volume":"5","author":"Oliveira","year":"2015","journal-title":"Front Physiol"},{"key":"2024102100484971000_53.4.1802386.10","doi-asserted-by":"publisher","DOI":"10.1183\/16000617.0048-2016"},{"key":"2024102100484971000_53.4.1802386.11","doi-asserted-by":"crossref","first-page":"175","DOI":"10.1242\/jeb.100.1.175","article-title":"Cardiopulmonary coupling during exercise","volume":"100","author":"Whipp","year":"1982","journal-title":"J Exp Biol"},{"key":"2024102100484971000_53.4.1802386.12","doi-asserted-by":"crossref","first-page":"173","DOI":"10.1016\/S0272-5231(21)01067-4","article-title":"The bioenergetic and gas exchange basis of exercise testing","volume":"15","author":"Whipp","year":"1994","journal-title":"Clin Chest Med"},{"key":"2024102100484971000_53.4.1802386.13","doi-asserted-by":"publisher","DOI":"10.1016\/j.pupt.2006.03.001"},{"key":"2024102100484971000_53.4.1802386.14","doi-asserted-by":"publisher","DOI":"10.1016\/j.ccm.2013.09.008"},{"key":"2024102100484971000_53.4.1802386.15","first-page":"217","article-title":"A test to determine parameters of aerobic function during exercise","volume":"50","author":"Whipp","year":"1981","journal-title":"J Appl Physiol Respir Environ Exerc Physiol"},{"key":"2024102100484971000_53.4.1802386.16","doi-asserted-by":"publisher","DOI":"10.1007\/BF00640653"},{"key":"2024102100484971000_53.4.1802386.17","doi-asserted-by":"publisher","DOI":"10.1164\/rccm.201204-0596PP"},{"key":"2024102100484971000_53.4.1802386.18","doi-asserted-by":"publisher","DOI":"10.1164\/rccm.167.2.211"},{"key":"2024102100484971000_53.4.1802386.19","doi-asserted-by":"publisher","DOI":"10.1007\/s004210000226"},{"key":"2024102100484971000_53.4.1802386.20","doi-asserted-by":"crossref","first-page":"2020","DOI":"10.1152\/jappl.1986.60.6.2020","article-title":"A new method for detecting anaerobic threshold by gas exchange","volume":"60","author":"Beaver","year":"1986","journal-title":"J Appl Physiol"},{"key":"2024102100484971000_53.4.1802386.21","doi-asserted-by":"publisher","DOI":"10.1183\/09031936.00135514"},{"key":"2024102100484971000_53.4.1802386.22","doi-asserted-by":"publisher","DOI":"10.1183\/09031936.00046906"},{"key":"2024102100484971000_53.4.1802386.23","doi-asserted-by":"publisher","DOI":"10.1164\/ajrccm.164.8.2103007"},{"key":"2024102100484971000_53.4.1802386.24","doi-asserted-by":"publisher","DOI":"10.1002\/ejhf.592"},{"key":"2024102100484971000_53.4.1802386.25","doi-asserted-by":"crossref","first-page":"255","DOI":"10.1016\/S0749-0704(18)30435-4","article-title":"Oxygen delivery and uptake by peripheral tissues: physiology and pathophysiology","volume":"5","author":"Schumacker","year":"1989","journal-title":"Crit Care Clin"},{"key":"2024102100484971000_53.4.1802386.26","doi-asserted-by":"publisher","DOI":"10.1152\/ajpheart.00943.2011"},{"key":"2024102100484971000_53.4.1802386.27","doi-asserted-by":"crossref","first-page":"1013","DOI":"10.1152\/jappl.2001.90.3.1013","article-title":"Limitation of lower limb VO2 during cycling exercise in COPD patients","volume":"90","author":"Simon","year":"2001","journal-title":"J Appl Physiol"},{"key":"2024102100484971000_53.4.1802386.28","doi-asserted-by":"publisher","DOI":"10.1152\/ajpregu.00404.2014"},{"key":"2024102100484971000_53.4.1802386.29","doi-asserted-by":"publisher","DOI":"10.1097\/00005768-200106000-00010"},{"key":"2024102100484971000_53.4.1802386.30","doi-asserted-by":"crossref","first-page":"354","DOI":"10.1590\/S0100-879X2011000400013","article-title":"Relationship between work rate and oxygen uptake in mitochondrial myopathy during ramp-incremental exercise","volume":"44","author":"Gimenes","year":"2011","journal-title":"Braz J Med Biol Res"},{"key":"2024102100484971000_53.4.1802386.31","doi-asserted-by":"publisher","DOI":"10.1016\/0002-9149(87)91190-8"},{"key":"2024102100484971000_53.4.1802386.32","doi-asserted-by":"crossref","first-page":"504","DOI":"10.1253\/jcj.56.504","article-title":"Changes in oxygen uptake-work rate relationship as a compensatory mechanism in patients with heart failure","volume":"56","author":"Itoh","year":"1992","journal-title":"Jpn Circ J"},{"key":"2024102100484971000_53.4.1802386.33","doi-asserted-by":"publisher","DOI":"10.1016\/S0167-5273(02)00013-X"},{"key":"2024102100484971000_53.4.1802386.34","doi-asserted-by":"crossref","first-page":"366","DOI":"10.1177\/2047487317750437","article-title":"Characteristics and prognosis of heart failure with improved compared with persistently reduced ejection fraction: a systematic review and meta-analyses","volume":"25","author":"J\u00f8rgensen","year":"2018","journal-title":"Eur J Prev Cardiol"},{"key":"2024102100484971000_53.4.1802386.35","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa0808836"},{"key":"2024102100484971000_53.4.1802386.36","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.113.001653"},{"key":"2024102100484971000_53.4.1802386.37","doi-asserted-by":"crossref","first-page":"223","DOI":"10.1097\/RLI.0b013e318281057d","article-title":"Quantitative and semiquantitative measures of regional pulmonary microvascular perfusion by magnetic resonance imaging and their relationships to global lung perfusion and lung diffusing capacity: the Multiethnic Study of Atherosclerosis Chronic Obstructive Pulmonary Disease Study","volume":"48","author":"Hueper","year":"2013","journal-title":"Invest Radiol"},{"key":"2024102100484971000_53.4.1802386.38","doi-asserted-by":"crossref","first-page":"416","DOI":"10.1016\/j.mehy.2009.09.030","article-title":"Breathing strategy to preserve exercising cardiac function in patients with heart failure","volume":"74","author":"Lalande","year":"2010","journal-title":"Med Hypotheses"},{"key":"2024102100484971000_53.4.1802386.39","doi-asserted-by":"crossref","first-page":"S30","DOI":"10.1513\/AnnalsATS.201610-834FR","article-title":"The link between reduced inspiratory capacity and exercise intolerance in chronic obstructive pulmonary disease","volume":"14","author":"O'Donnell","year":"2017","journal-title":"Ann Am Thorac Soc"},{"key":"2024102100484971000_53.4.1802386.40","doi-asserted-by":"publisher","DOI":"10.1161\/hc4401.098491"},{"key":"2024102100484971000_53.4.1802386.41","doi-asserted-by":"publisher","DOI":"10.1164\/rccm.201203-0404OC"},{"key":"2024102100484971000_53.4.1802386.42","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijcard.2004.01.002"},{"key":"2024102100484971000_53.4.1802386.43","doi-asserted-by":"publisher","DOI":"10.1378\/chest.14-0800"},{"key":"2024102100484971000_53.4.1802386.44","doi-asserted-by":"publisher","DOI":"10.1164\/rccm.201504-0841OC"},{"key":"2024102100484971000_53.4.1802386.45","doi-asserted-by":"crossref","first-page":"368","DOI":"10.1016\/S2213-2600(18)30054-7","article-title":"Effect of lung deflation with indacaterol plus glycopyrronium on ventricular filling in patients with hyperinflation and COPD (CLAIM): a double-blind, randomised, crossover, placebo-controlled, single-centre trial","volume":"6","author":"Hohlfeld","year":"2018","journal-title":"Lancet Respir Med"},{"key":"2024102100484971000_53.4.1802386.46","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijcard.2009.03.041"},{"key":"2024102100484971000_53.4.1802386.47","doi-asserted-by":"crossref","first-page":"208","DOI":"10.1152\/japplphysiol.00747.2017","article-title":"Exercise limitations in heart failure with reduced and preserved ejection fraction","volume":"124","author":"Poole","year":"2018","journal-title":"J Appl Physiol"},{"key":"2024102100484971000_53.4.1802386.48","doi-asserted-by":"publisher","DOI":"10.1152\/japplphysiol.00195.2013"}],"container-title":["European Respiratory Journal"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1183\/13993003.02386-2018","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,2,24]],"date-time":"2025-02-24T07:35:06Z","timestamp":1740382506000},"score":1,"resource":{"primary":{"URL":"https:\/\/publications.ersnet.org\/lookup\/doi\/10.1183\/13993003.02386-2018"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2019,2,14]]},"references-count":48,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2019,4,18]]},"published-print":{"date-parts":[[2019,4]]}},"alternative-id":["10.1183\/13993003.02386-2018"],"URL":"https:\/\/doi.org\/10.1183\/13993003.02386-2018","relation":{},"ISSN":["0903-1936","1399-3003"],"issn-type":[{"value":"0903-1936","type":"print"},{"value":"1399-3003","type":"electronic"}],"subject":[],"published":{"date-parts":[[2019,2,14]]}}}