Excess ventilation during exercise and prognosis in chronic heart failure

Am J Respir Crit Care Med. 2011 May 15;183(10):1302-10. doi: 10.1164/rccm.201006-0965CI. Epub 2011 Jan 21.


Excess ventilation during exercise with accompanying dyspnea is characteristic of chronic heart failure (CHF), and these patients often exhibit increased Ve relative to the Vco(2) compared with normal subjects. This can be measured in several ways, including using such variables as the slope of Ve versus Vco(2), the lowest ratio of Ve/Vco(2), and the ratio of Ve/Vco(2) at the lactic acidosis threshold or peak exercise. There is now considerable evidence that the degree of excess ventilation during exercise in patients with CHF is a robust predictor of outcome and identifies higher-risk patients requiring aggressive treatment, including heart transplantation. The mechanism of excess ventilation in patients with CHF during exercise is not completely understood. It may be related to enhanced output of chemoreceptors or peripheral muscle ergoreceptors, increased dead space/Vt ratio due to increased contribution of high ventilation-perfusion lung regions or rapid shallow breathing caused by earlier onset of lactic acidosis, or likely resulting from a combination of these causes.

Publication types

  • Review

MeSH terms

  • Acidosis, Respiratory / complications
  • Acidosis, Respiratory / diagnosis
  • Acidosis, Respiratory / physiopathology
  • Blood Gas Analysis
  • Carbon Dioxide / metabolism
  • Chronic Disease
  • Exercise Test / methods*
  • Exercise Tolerance
  • Exercise*
  • Heart Failure / complications
  • Heart Failure / diagnosis*
  • Heart Failure / physiopathology
  • Humans
  • Oxygen Consumption
  • Predictive Value of Tests
  • Prognosis
  • Pulmonary Ventilation*
  • Respiratory Dead Space


  • Carbon Dioxide