Ludwig V; Technical University of Munich, Munich, Germany
Freiberger A; Muller J; Hock J; Ewert P; Hager A
Journal of Cardiopulmonary Rehabilitation & Prevention. 46(1):16-27, 2026
PURPOSE: Expiratory flow limitation (EFL) and dynamic hyperinflation (DH)
may significantly impact exercise capacity in patients with heart disease.
Although commonly linked to lung diseases, recent evidence highlights
their role in cardiovascular disease (CVD), contributing to exercise
intolerance. This systematic review examines studies from the past decade
on pulmonary function during exercise, measured using inspiratory capacity
(IC) maneuvers, in patients with CVD, emphasizing prevalence and clinical
significance.
REVIEW METHODS: A systematic literature search in PubMed, Scopus, and
Cochrane (January 2014-February 2024) explored pulmonary function during
exercise in patients with CVD. Two independent reviewers assessed studies
using established Quality Assessment Tools.
SUMMARY: Seven studies including 231 patients with CVD (mean age 31-66
yr, predominantly male) used cardiopulmonary exercise testing to evaluate
exercise-induced DH or EFL with varying definitions. Study quality was
mixed. Patients with myocardial infarction showed EFL at moderate
exercise, while patients with stable coronary artery disease exhibited EFL
only at high intensities. Up to 50% of patients with pulmonary arterial
hypertension have DH during peak exercise (P < .05). In patients with
heart failure, 25% experienced DH, while others maintained stable
breathing. Patients who are post-Fontan displayed pulmonary inefficiencies
without DH. Methodological variability precludes definitive conclusions on
DH prevalence in patients with CVD. However, reduced IC during exercise,
DH, and EFL occur in a substantial proportion of patients, indicating a
lower EFL threshold and earlier ventilatory constraints. Further research
into heart-lung integration during exercise is crucial for developing
personalized treatments and improving clinical management in those
patients.