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J Am Coll Cardiol. 2019 May 7;73(17):2209-2225. doi: 10.1016/j.jacc.2019.01.072.

Exercise Intolerance in Patients With Heart Failure: JACC State-of-the-Art Review.

Author information

1
VCU Pauley Heart Center, Virginia Commonwealth University, Richmond, Virginia; Department of Cardiovascular and Thoracic Sciences, Catholic University of the Sacred Heart, Rome, Italy.
2
Department of Physical Therapy, College of Applied Health Sciences, University of Illinois at Chicago, Chicago, Illinois; Total Cardiology Research Network, Calgary, Alberta, Canada.
3
Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota.
4
VCU Pauley Heart Center, Virginia Commonwealth University, Richmond, Virginia.
5
Department of Kinesiology and Health Sciences, Virginia Commonwealth University, Richmond, Virginia.
6
Cardiology University Department, Heart Failure Unit, University of Milan, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy.
7
Department of Cardiovascular Diseases, Ochsner Clinical School, New Orleans, Louisiana.
8
VCU Pauley Heart Center, Virginia Commonwealth University, Richmond, Virginia. Electronic address: antonio.abbate@vcuhealth.org.

Abstract

Exercise intolerance is the cardinal symptom of heart failure (HF) and is of crucial relevance, because it is associated with a poor quality of life and increased mortality. While impaired cardiac reserve is considered to be central in HF, reduced exercise and functional capacity are the result of key patient characteristics and multisystem dysfunction, including aging, impaired pulmonary reserve, as well as peripheral and respiratory skeletal muscle dysfunction. We herein review the different modalities to quantify exercise intolerance, the pathophysiology of HF, and comorbid conditions as they lead to reductions in exercise and functional capacity, highlighting the fact that distinct causes may coexist and variably contribute to exercise intolerance in patients with HF.

KEYWORDS:

HFpEF; HFrEF; aging; cardiorespiratory fitness; comorbidities; exercise capacity; exercise intolerance; exercise training; fatigue; heart failure

PMID:
31047010
DOI:
10.1016/j.jacc.2019.01.072

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