Effect of increased inspired oxygen on exercise performance in patients with heart failure and normal ejection fraction

Introduction: We investigated whether increased concentrations of inspired oxygen (Fio(2)) affects exercise tolerance in patients with heart failure and normal ejection fraction (HeFNEF). Methods: 46 patients (mean age 75 years (63% male) and median NTproBNP 1432 (interquartile range: 543-2378 ng/l)) with HeFNEF (defined as signs or symptoms of heart failure requiring treatment with diuretics, with a left ventricular ejection fraction of >45% by echocardiography and amino terminal pro brain natriuretic peptide (NTproBNP) >220 ng/l) completed three maximal incremental exercise tests with different Fio(2) (21%, 28% and 40%) in random order. Fio(2) was controlled by investigator but blinded to patients. The primary outcome was exercise time (ET). Results: Increasing Fio(2) significantly increased exercise time (522 +/- 180 seconds for 21% to 543 +/- 176 seconds, and 542 +/- 177 seconds, for 28% and 40%, respectively, P=0.04) with no difference in peak workload (57 +/- 25 W, 58 +/- 25 W and 57 +/- 25 W, for 21%, 28% and 40%, respectively, P=0.50). There was an increase in oxygen saturation but no change in peak heart rate with increasing Fio(2). Compared to patients with LVEF >= 50%, patients with LVEF between 45 and 49% had a significantly greater exercise time and peak workload. There was a correlation between the difference in exercise time between Fio(2) 21% and 40% and age; but not with BMI, haemoglobin, creatinine or NTproBNP. Conclusion: Increasing Fio(2) during exertion leads to a small increase in exercise time in patients with HeFNEF. (C) 2017 Published by Elsevier B.V.