Journal of Cardiac Failure
Volume 16, Issue 1 , Pages 76-83 , January 2010

The Ventilatory Anaerobic Threshold in Heart Failure: A Multicenter Evaluation of Reliability

  • Jonathan Myers, PhD

      Affiliations

    • VA Palo Alto Health Care System/Stanford University, Palo Alto CA
    • Corresponding Author InformationReprint requests: Jonathan Myers, PhD, VA Palo Alto Health Care System, Cardiology 111C, 3801 Miranda Ave, Palo Alto CA 94304. Tel: (650) 493-5000 x64661; Fax: (650) 852-3473.
  • ,
  • Rochelle L. Goldsmith, PhD

      Affiliations

    • Columbia University, New York Presbyterian Medical Center, New York, NY
  • ,
  • Steven J. Keteyian, PhD

      Affiliations

    • Henry Ford Hospital, Detroit, MI
  • ,
  • Clinton A. Brawner, MS

      Affiliations

    • Henry Ford Hospital, Detroit, MI
  • ,
  • Deirdre A. Brazil, BS

      Affiliations

    • Columbia University, New York Presbyterian Medical Center, New York, NY
  • ,
  • Heather Aldred, PhD

      Affiliations

    • Henry Ford Hospital, Detroit, MI
  • ,
  • Jonathan K. Ehrman, PhD

      Affiliations

    • Henry Ford Hospital, Detroit, MI
  • ,
  • Daniel Burkhoff, MD

      Affiliations

    • Columbia University, New York Presbyterian Medical Center, New York, NY

Received 25 May 2009 ,Revised 7 July 2009 ,Accepted 13 July 2009.

References 

  1. Hill AV, Lupton H. Muscular exercise, lactic acid, and the supply and utilization of oxygen. Q J Med. 1923;16:135–171
  2. Wasserman K, McElroy MB. Detecting the threshold of anaerobic metabolism in cardiac patients during exercise. Am J Cardiol. 1964;14:844–852
  3. Myers J, Ashley E. Dangerous curves. A perspective on exercise, lactate, and the anaerobic threshold. Chest. 1997;111:787–795
  4. Ohira Y, Tabata I. Muscle metabolism during exercise: anaerobic threshold does not exist. Ann Physiol Anthropol. 1992;11:319–323
  5. Balady G, Arena R, Coke L, Fletcher G, Forman D, Franklin B, et al. A clinician's guide to cardiopulmonary exercise testing. A Scientific Statement from the American Heart Association Subcommittee on Exercise, Prevention, and Rehabilitation. Circulation. In press.
  6. Svedahl K. MacIntosh BR. Anaerobic threshold: the concept and methods of measurement. Can J Appl Physiol. 2003;28:299–323
  7. Wasserman K, Sun XG, Hansen JE. Effect of biventricular pacing on the exercise pathophysiology of heart failure. Chest. 2007;132:250–261
  8. Myers J, Gullestad L, Vagelos R, Do D, Bellin D, Ross H, et al. Clinical hemodynamic, and cardiopulmonary exercise test determinants of survival in patients referred for evaluation of heart failure. Ann Intern Med. 1998;129:286–292
  9. Dougherty CM, Glenny R, Kudenchuk PJ. Aerobic exercise improves fitness and heart rate variability after an implantable cardioverter defibrillator. J Cardiopulm Rehabil Prev. 2008;28:307–311
  10. Wonisch M, Hofmann P, Fruhwald FM, Kraxner W, Hodl R, Pokan R, et al. Influence of beta-blocker use on percentage of target heart rate exercise prescription. Eur J Cardiovasc Prev Rehabil. 2003;10:296–301
  11. Hughson RL, Weisiger KH, Swanson GD. Blood lactate concentration increases as a continuous function during progressive exercise. J Appl Physiol. 1987;62:1975–1981
  12. Myers J, Walsh D, Buchanan N, McAuley P, Bowes E, Froelicher VF. Increase in blood lactate during ramp exercise: comparison of continuous versus threshold models. Med Sci Sports Exerc. 1994;26:1413–1419
  13. Dennis SC, Noakes TD, Bosch AN. Ventilation and blood lactate increase exponentially during incremental exercise. J Sports Sci. 1992;10:437–449
  14. Gladden LB, Yates JW, Stremel RW, Stamford BA. Gas exchange and lactate anaerobic thresholds: inter- and intra-evaluator agreement. J Appl Physiol. 1985;58:2082–2089
  15. Yeh MP, Gardner RM, Adams TD, Yanowitz FG, Crapo RO. “Anaerobic threshold”: problems of determination and validation. J Appl Physiol. 1983;55:1178–1186
  16. Shimizu M, Myers J, Buchanan N, Walsh D, Kraemer M, McAuley P, et al. The ventilatory threshold: method, protocol, and evaluator agreement. Am Heart J. 1991;122:509–516
  17. Sullivan M, Genter F, Savvides M, Roberts M, Myers J, Froelicher VF. The reproducibility of hemodynamic, electrocardiographic, and gas exchange data during treadmill exercise in patients with stable angina pectoris. Chest. 1984;86:375–381
  18. Ekkekakis P, Lind E, Hall EE, Petruzzello SJ. Do regression-based computer algorithms for determining the ventilatory threshold agree?. J Sports Sci. 2008;26:967–976
  19. Abraham WT, Burkhoff D, Nademanee K, Carson P, Bourge R, Ellenbogen KA, et al. A randomized controlled trial to evaluate the safety and efficacy of cardiac contractility modulation in patients with systolic heart failure: rationale, design, and baseline patient characteristics. Am Heart J. 2008;156:641–648
  20. Goldsmith RL, Trufant JW, Mueller GM, Arwady MA, Burkhoff DB. Optimizing exercise protocols for heart failure trials. J Amer Coll Cardiol. 2004;44:169A
  21. Borg GAV. Borg's perceived exertion and pain scales. Champaign, IL: Human Kinetics; 1998;
  22. Beaver W, Wasserman K, Whipp BJ. A new method for detecting anaerobic threshold by gas exchange. J Appl Physiol. 1986;60:2020–2027
  23. Chase P, Arena R, Myers J, Abella J, Peberdy MA, Guazai M, et al Prognostic usefulness of dyspnea versus fatigue as reason for exercise test termination in patients with heart failure. Am J Cardiol. 2008;102:879–882
  24. Laveneiana P, O'Donnel DE, Ofir D, Agostoni P, Padletti L, Riccardi G, et al. Effect of biventricular pacing on ventilatory and perceptual responses to exercise in patients with stable chronic angina. J Appl Physiol. 2009;Feb 26 (e-pub ahead of print)
  25. Curnier D, Galinier M, Pathak A, Fourcade J, Bousquet M, Senard JM, et al. Rehabilitation of patients with congestive heart failure with or without beta blockade therapy. J Card Fail. 2001;7:241–248
  26. Van Laethem C, Van De Veire N, De Backer G, Bihija S, Seghers T, et al. Response of the oxygen uptake efficiency slope to exercise training in patients with chronic heart failure. Eur J Heart Fail. 2007;9:625–629
  27. Frigiola A, Tsang V, Bull C, Coats L, Khambadkone S, Derrick G, et al. Biventricular response after pulmonary valve replacement for right ventricular outflow tract dysfunction: is age a predictor of outcome?. Circulation. 2008;118:S182–S190
  28. Kothmann E, Danjoux G, Owen SJ, Turley AJ, Batterham AM. Reliability of the anaerobic threshold in cardiopulmonary exercise testing of patients with abdominal aortic aneurysms. Anaesthesia. 2009;64:9–13
  29. Garrard CS, Das R. Sources of error and variability in the determination of the anaerobic threshold in humans. Respiration. 1987;51:137–145
  30. Thin AG, Kelly GE, Daly L, McLoughlin P. Repeated measurement of the gas exchange threshold: relative size of measurement and biological variabilities. Comp Biol Med. 2005;35:703–716
  31. Simonton CA, Higginbotham MB, Cobb FR. The ventilatory threshold: quantitative analysis of reproducibility and relation to arterial lactate concentration in normal subjects and in patients which chronic congestive heart failure. Am J Cardiol. 1988;62:100–107
  32. Cohen-Solal A, Zannad F, Kayanakis JG, Aupetit JF, Kolsky H. Multicentre study of the determination of peak oxygen uptake and ventilatory threshold during bicycle exercise in chronic heart failure. Comparison of graphical methods, interobserver variability and influence of the exercise protocol. The VO2 French Study Group. Eur Heart J. 1991;10:1055–1063
  33. Bensimhon DR, Leifer ES, Ellis SJ, et al. for the HF-ACTION Trial Investigators. Reproducibility of peak oxygen uptake and other cardiopulmonary exercise testing parameters in patients with heart failure. Am J Cardiol. 2008;102:712–717
  34. Caiozzo VJ, Davis JA, Ellis JF, Vandagriff R, Prietto CA, McMaster WD. A comparison of gas exchange indices used to detect the anaerobic threshold. J Appl Physiol. 1982;53:1184–1189
  35. Crescencio JC, Martins LEB, Murta LO, Antloga CM, Kozuki RT, Santos MDB, et al. Measurement of anaerobic threshold during dynamic exercise in healthy subjects: comparison among visual analysis and mathematical models. Comp Cardiol. 2003;30:801–804
  36. Wasserman K, Beaver WL, Whipp BJ. Gas exchange theory and the lactic acidosis (anaerobic) threshold. Circulation. 1990;81(II):14–30

 The authors have no conflicts of interest.

PII: S1071-9164(09)00999-3

doi: 10.1016/j.cardfail.2009.08.009

Journal of Cardiac Failure
Volume 16, Issue 1 , Pages 76-83 , January 2010