1. The role of cardiac output limitation in the pathophysiology of exercise in patients with chronic failure remains undefined. During steady-state submaximal exercise, oxygen uptake is similar in patients and control subjects, but it is not known if cardiac output is also similar. We wished to determine if the reduced exercise tolerance of patients with chronic cardiac failure during such exercise is related to reduced cardiac output, or to peripheral factors.

2. Ten male patients with stable chronic failure and ten age-matched male normal controls were studied at rest and during exercise. Each subject performed a familiarization exercise test, a symptom-limited maximal exercise test and two submaximal exercise tests. Cardiac output was measured by a carbon dioxide rebreathing method. We also measured oxygen consumption, ventilation, Borg score of perceived exertion and venous lactate concentration, and ejection fractions.

3. As expected, patients had lower peak oxygen consumption [median (range) 1.18 (0.98–1.76) versus 1.935 (1.53–2.31) 1/min; P < 0.001], lower peak venous lactate concentration but a similar overall level of perceived exertion. At the same submaximal workload, patients and control subjects had similar oxygen consumption [0.67 (0.59–0.80) versus 0.62 (0.52–0.82) 1/min] and cardiac output [6.92 (5.79–9.76) versus 7.3 (5.99–10.38) 1/min] but the patients had a greater perceived level of exertion [Borg score: 4 (1–6) versus 3 (1–5); P < 0.005], higher venous lactate concentration [1.6 (1–3.3) versus 1.14 (0.7–1.7) mmol/l; P < 0.05] and higher heart rate [106 (89–135) versus 87 (69–112) beats/min;P < 0.005].

4. During submaximal exercise at a similar absolute workload, patients with cardiac failure have a similar oxygen uptake and cardiac output but greater anaerobiosis and increased fatigue when compared with normal subjects. These findings appear to relate predominantly to changes that occur in the periphery rather than abnormalities of central cardiac function.

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