Genese der Atemeffizienzstörung unter Belastung bei Patienen mit chronischer Herzinsuffizienz: Rolle der pulmonalen Perfusion und einer veränderten kardiorespiratorischen Reflexaktivierung

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Reduced ventilatory efficiency (as measured as the slope of the linear regression line relating ventilation to carbon dioxide output [VE/VCO2-slope]) is a key feature of chronic heart failure. It is closely associated with patients¿ symptom state and eclipses even peak oxygen consumption in the prognostic assessment of these patients. Alveolar dead space ventilation, which results from an uneven pulmonary blood flow distribution, is the major contributor to the increased VE/VCO2-slope in heart failure. It is unclear whether it reflects a primary pulmonary vascular pathology or simply the failure to adequately increase cardiac output during exercise. Hyperventilation another contributor to an increased VE/VCO2-slope is thought to arise from abnormal ventilatory stimuli, namely muscle-ergoreflex activation, during exercise. Its relation to cardiac output has not been investigated so far. We, therefore, aim to investigate the effects of acute and chronic changes in cardiac output on alveolar dead space ventilation, ergoreflex activation and exercise induced hyperventilation in patients with chronic heart failure.