Noninvasive Ventilation Before Maximum Exercise Test Increases Exercise Tolerance in Subjects With Heart Failure: A Crossover Study.

Abstract

To evaluate the effect of noninvasive ventilation (NIV) on exercise performance in individuals with heart failure (HF). Crossover, blind, randomized controlled trial with allocation concealment. University-based research laboratory. Participants (N=24) with New York Heart Association class II and III left heart failure and with a mean age of 51.8±10.2 years (women: n=8; men: n=16). Ventilatory support attached to the face of the individual via a facemask prior to cardiopulmonary exercise test (CPET) was administered at 2 pressure levels for 30 minutes. Inspiratory pressure of 15cmH₂O and expiratory pressure of 5cmH₂O were applied. Maximal oxygen uptake, maximum heart rate, variation between the initial and maximum heart rates, CPET duration, and recovery time oxygen consumption. Differences were observed in maximal oxygen consumption (nonintervention phase: 18.3±4.4mL·kg^-1·min^-1 vs NIV phase: 20.6±4.9mL·kg^-1·min^-1, P=.01), heart rate (nonintervention phase: 127.3±20.9 beats per minute vs NIV phase: 134.7±19.5 beats per minute, P=.04), and heart rate variation (nonintervention phase: 63.3%±19.3% vs NIV phase: 69.7%±16.6%, P=.02). Moreover, differences in cardiopulmonary exercise time (nonintervention phase: 7.4±1.5min vs NIV phase: 8.3±1.7min, P=.01) and oxygen consumption recovery time (nonintervention phase: 2.8±1.0min vs NIV phase: 2.4±0.8min, P=.01) were observed. NIV elicited beneficial effects in the HF population that included increased exercise tolerance, recovery time optimization, and improved chronotropic and respiratory reserves.