Recumbent ergometer vs treadmill cardiopulmonary exercise test in HFpEF: implications on chronotropic response and exercise capacity.

Le JN; Zhou R; Tao R; Dharmavaram N; Dhingra R; Runo J; Forfia P; Raza F;

Journal of cardiac failure [J Card Fail] 2022 Oct 12.
Date of Electronic Publication: 2022 Oct 12.

Background: While cardiopulmonary exercise testing (CPET) can identify mechanisms of exercise intolerance in heart failure with preserved ejection fraction (HFpEF), exercise modalities with different body positions (e.g. recumbent ergometer, treadmill) are broadly utilized. In this study, we aim to determine if body position affects CPET parameters in patients with HFpEF.
Methods: Subjects with stable HFpEF (n=23) underwent non-invasive treadmill CPET, followed by an invasive recumbent cycle ergometer CPET within three months. A comparison group, undergoing similar studies, included: healthy subjects (n=5) and pulmonary arterial hypertension (n=6).
Results: The peak oxygen consumption (VO 2 peak) and peak heart rate were significantly lower in recumbent versus upright position (10.1 vs 13.1 ml/kg/min [Δ – 3 ml/kg/min], p < 0.001; and 95 vs 113 bpm [Δ – 18 bpm], p < 0.001, respectively). No significant differences were found with V E /VCO 2 , ETCO 2 , and RER. A similar pattern was observed in the comparison groups.
Conclusions: Compared to recumbent ergometer, treadmill CPET revealed higher VO 2 peak and peak heart rate response. While determining chronotropic incompetence to adjust beta blockers in HFpEF, body position should be taken into account.