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

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

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

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.

Original languageEnglish
Article number5817
JournalJournal of Clinical Medicine
Volume12
Issue number18
DOIs
StatePublished - Sep 2023

Keywords

  • cardiopulmonary exercise test
  • effort intolerance
  • peripheral arterial disease
  • stress echocardiography

Fingerprint

Dive into the research topics of 'The Mechanism of Effort Intolerance in Patients with Peripheral Arterial Disease: A Combined Stress Echocardiography and Cardiopulmonary Exercise Test'. Together they form a unique fingerprint.

Cite this