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Six-minute walking test to assess exercise tolerance and cardiorespiratory responses during training program in children with congenital heart disease.

This study assessed the exercise tolerance and the cardiorespiratory responses to a training program by the six-minute walk test (6'WT) in children with congenital heart disease (CHD). Seventeen cardiac and 14 healthy children performed maximal cardiopulmonary exercise test (CPET) and 6'WT. Reliability of 6'WT was assessed in all subjects (test-retest) by Bland-Altman plots. Cardiac subjects were randomly divided in training (T-CHD) and control groups (C-CHD). T-CHD underwent an individualized training exercise at the ventilatory threshold (VT) intensity during 12 weeks. We found that the 6'WT is a reliable and reproducible test. CHD children walked a lower distance than healthy children before training (472.5 +/- 18.1 vs. 548.8 +/- 7.7 m, respectively, p < 0.001). Likewise, power output, oxygen uptake (V.O (2)), and heart rate (HR) at the maximum and the VT levels, were significantly lower in patients (p < 0.001). After training, a significant improvement of walking distance (WD) was shown in T-CHD (529.6 +/- 15.3 vs. 467.7 +/- 17.1 m, p < 0.001). The power output, VO2, HR, and V.E increased slightly (6 to 10 %, p > 0.05) at peak exercise and significantly at ventilatory threshold level (p < 0.05) in T-CHD. Significant relationships between WD and VO2max as well as VO2 at VT were founded (p < 0.05). We concluded that the 6'WT is a useful and reliable tool in the assessment and follow-up of functional capacity during rehabilitation program in children with CHD.

Adolescent↗

Carbimazole and exercise tolerance in chronic airflow obstruction.

Ten patients with severe dyspnoea and chronic airflow obstruction entered a randomised double-blind crossover trial comparing the effect of carbimazole 80 mg daily for two months with that of placebo. Assessment of thyroid function, lung function, and exercise tolerance was performed monthly. The mean free thyroxine index after two months of carbimazole was significantly lower at 64.1 (+/- 10.5, SEM) than the 89.1 (+/- 3.8) while on placebo. Serum tri-iodothyronine was reduced and thyroid stimulating hormone raised while on the active drug. There was no significant difference in the 12-minute walking distance (TMD), the rating of perceived exertion during the TMD, the oxygen cost score, the dyspnoea grade, the resting arterialised capillary blood gas tensions or the resting minute ventilation. During a progressive exercise test to exhaustion on a cycle ergometer, there was no significant difference in the minute ventilation, heart rate, blood gas tensions at exhaustion, or the total work done. There were no symptoms or signs of hypothyroidism. Lung function (FEV1, FVC, TLC, KCO) was unchanged. Thus a 28% reduction in the free thyroxine index produced no symptomatic or objective benefit in exercise tolerance in patients with severe airflow obstruction. These results provide no support for the use of carbimazole in chronic airflow obstruction.

Carbimazole↗

The value of ten common exercise tolerance test measures in predicting coronary disease in symptomatic females.

The diagnostic contribution of ten common exercise tolerance test (ETT) measures compared with coronary angiography was studied in 62 symptomatic females (mean age = 53 +/- 9 years). Logistic regression revealed that maximal ST-segment depression, the percent of predicted maximal heart rate achieved, and test chest pain all contributed unique predictive information and formed a model generating probabilities for coronary disease (CAD). Using a predicted probability for the presence of CAD of 0.50 as a cutpoint, test accuracy was markedly improved (sensitivity = 73%, specificity = 94%, and overall correct classification rate = 90%) over the standard ST response. We conclude that multivariate analysis using these three easily assessed ETT measures provides superior discrimination between symptomatic women with and without CAD when compared to changes in the ST-segment alone.

Coronary Angiography↗

Failure of aminophylline and salbutamol to improve respiratory muscle function and exercise tolerance in healthy humans.

We investigated the effects of intravenously administered aminophylline (A; 6 mg/kg over 20 min, followed by 0.9 mg/kg/h), salbutamol (S; 4 micrograms/kg over 20 min, followed by 3 micrograms/kg/h) and placebo (P; saline solution) on the strength of the respiratory muscles, the ventilatory endurance and the exercise tolerance in 7 healthy humans. Neither A nor S caused bronchodilation, as shown by the lack of change in FEV1. The strength of respiratory muscles, as measured by maximal inspiratory pressure (MIP), and the ventilatory endurance, as measured by sustainable inspiratory pressure (SIP), were not statistically different after A (MIP: 136.5 +/- SE 11.6 cm H2O; SIP: 104.2 +/- 8.4 cm H2O or after S (MIP: 135.7 +/- 11.5; SIP: 107.1 +/- 10.4) compared to after P (MIP: 127.1 +/- 10.1; SIP: 105.0 +/- 5.9). Significant changes in 12-min walking distance, perceived exertion rate, anaerobic threshold, maximal work output, maximal O2 uptake were observed neither after A nor after S. The exchange ratio and heart rate were higher after A and S than after P at some steps of a progressive, symptom-limited, treadmill-based exercise test. This might be the result of metabolic or cardiovascular adaptations elicited by these drugs. We conclude that A or S at therapeutic concentrations have no clinically relevant beneficial effects on ventilatory muscle function and exercise tolerance in healthy subjects.

Adult↗

L-carnitine and exercise tolerance in medium-chain acyl-coenzyme A dehydrogenase (MCAD) deficiency: a pilot study.

Skeletal muscle function may be impaired in patients with medium-chain acyl-CoA dehydrogenase (MCAD) deficiency, but the value of L-carnitine in their long-term management is not clear. This study was designed as a pilot to examine the effects of L-carnitine on exercise tolerance in patients with MCAD deficiency. Four clinically asymoptomatic MCAD-deficient patients, aged 8 to 20 years, were studied. Incremental ramp exercise tests were carried out before and after 4 weeks' treatment with oral L-carnitine (100 mg/kg per day). During exercise without L-carnitine supplementation, plasma carnitine concentrations fell, associated with an increased excretion of urinary acylcarnitines, notably acetylcarnitine, hexanoylcarnitine and octanoylcarnitine. L-carnitine treatment prevented this fall in plasma carnitine and resulted in greater increases in excretion of acylcarnitines. All four patients showed biologically significant improvement in peak oxygen uptake (peak VO2, 18-32% improvement), VO2 at a heart rate of 170 beats/min (15-23% improvement), VO2 at anaerobic threshold (27-42% improvement), and/or oxygen pulse (10-32% improvement). Exercise tolerance in MCAD-deficient patients may be improved by short-term L-carnitine supplementation. This may be the direct result of improved intramitochondrial homeostasis induced by L-carnitine in removing accumulating acyl moieties.

3-Hydroxybutyric Acid↗

Long-term effects of molsidomine on exercise tolerance in patients with exertional angina pectoris.

Molsidomine is a derivative of the sydnonimines and is a long-acting vasodilator that may be effective in the treatment of chronic stable angina pectoris. To evaluate the therapeutic efficacy and drug tolerance, eight men with stable angina pectoris performed a symptom-limited maximal exercise test on a computer-assisted treadmill. After ingesting either placebo or molsidomine administered in single blind fashion 90 min before the exercise test on the first day of treatment, molsidomine decreased the average systolic blood pressure response from 154 +/- 3 (SEM) to 135 +/- 4 mmHg (p less than 0.01). However it did not significantly change the average heart rate response (117 +/- 7 to 124 +/- 8 beats/min) and the rate-pressure product (18.1 +/- 1.2 X 10(3) to 16.8 +/- 1.1 X 10(3]. The average time up to the onset of ischemia at which significant ST-segment deviation (0.1 mV) first appeared was increased from 9.0 +/- 1.7 to 12.8 +/- 1.2 min (p less than 0.001) after molsidomine. At peak exercise after molsidomine, the mean value of ST-segment deviation in V5 or aVF was decreased (p less than 0.001). This result was obtained even though the average exercise duration was increased from 11.4 +/- 1.7 to 13.6 +/- 1.2 min (p less than 0.001). The treadmill score according to Hollenberg was also improved from -47 +/- 24 to 1 +/- 14 after molsidomine administration. After six weeks of continued therapy with molsidomine the favorable effect on exercise tolerance was significantly decreased in terms of exercise duration, the time up to the onset of ischemia, and the treadmill score.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗

[Exercise tolerance in relation to ventilatory drive and respiratory muscle function in COPD].

OBJECTIVE: To assess the relationships between exercise tolerance and respiratory drive and respiratory muscle function in COPD. METHODS: 28 patients with COPD and 26 normal subjects were involved in the study. Routine pulmonary function, pulmonary diffusing capacity, P0.1, PImax were measured at rest. Oxygen consumption (VO2), carbon dioxide production (VCO2), minute ventilation (VE) etc were measured during exercise testing. Borg Scale was recorded simultaneously. Arterial blood gases were measured before and after exercise. RESULTS: (1) PImax in COPD group (40 +/- 15 mm Hg) was significantly lower than that in the normal group [(53 +/- 19) mm Hg, P < 0.05]. P0.1 in COPD group [(2.8 +/- 0.9) mm Hg] was significantly higher than that in the normal group [(2.0 +/- 0.7) mm Hg, P < 0.05]. Inspiratory drive efficacy (VT/P0.1) in COPD group [(0.21 +/- 0.04) L/mm Hg] was significantly lower than that in the normal group [(0.28 +/- 0.07) L/mm Hg, P < 0.05]. P0.1/PImax in COPD group was (0.069 +/- 0.021), significantly higher than that in the normal group [(0.037 +/- 0.009), P < 0.01]. (2) VO2max was correlated with P0.1/Pimax and Borg Scale in COPD patients (r = 0.66, P < 0.01, and r = 0.53, P < 0.05 respectively). Borg Scale was also positively correlated with P0.1/PImax in COPD group (r = 0.49, P < 0.05). CONCLUSION: In addition to airway obstruction and the damaged gas exchange, exercise intolerance in COPD may also be related to the increased respiratory drive and dysfunction of respiratory muscle.

Adult↗

Effect of distractive auditory stimuli on exercise tolerance in patients with COPD.

We tested the hypothesis that a distractive stimulus, such as music, introduced during exercise can reduce perception of respiratory effort at any given level of exercise, whereas sensory deprivation increases effort perception. Thirty-six patients with moderate COPD participated in four sessions of symptom-limited exercise. The first session familiarized the subject with the protocol. The other sessions were performed under partial visual isolation while listening to music (M), or to grey noise (GN), or in silence (SIL), presented in randomized order. Subjects graded their respiratory effort using the Borg rating of perceived exertion (RPE) scale. Total exercise time (EXT) and external work (WT) were objective indices of exercise tolerance. EXT was 22% longer with M than with either GN or SIL (p < 0.001), and WT was 44% and 53% greater with M than with GN or SIL, respectively (p < 0.001). These increases occurred at a heart rate that was only a few beats higher than during GN or SIL (104 +/- 3 bpm for M and 101 +/- 3 bpm for GN and SIL), a minimal difference that was statistically significant (p < 0.001). At every level of exercise, perceived exertion with M was lower than for either GN or SIL (p < 0.001). Although the respective RPE was higher for SIL than for GN (p < 0.01) at every level of exercise, WT and EXT were no different. These data indicate that perceived effort can be significantly influenced by external factors. This in turn suggests that the use of distractive stimuli during exercise training programs with patients with COPD may significantly decrease perceived symptoms of respiratory discomfort, thus allowing the patient to exercise to a higher intensity, and potentially achieving more effective exercise reconditioning training.

Acoustic Stimulation↗

Fibre types in skeletal muscles of chronic obstructive pulmonary disease patients related to respiratory function and exercise tolerance.

This study aimed to investigate the relationship between skeletal muscle, fibre type composition, functional respiratory impairment and exercise tolerance in patients with moderate to severe chronic obstructive pulmonary disease (COPD). A group of 22 COPD patients and 10 healthy control subjects were studied. In COPD patients, vital capacity (VC) and forced expiratory volume in one second (FEV1) were reduced to 79% and 51%, respectively. Diffusion indices (transfer factor of the lung for carbon monoxide (TL,CO) and carbon monoxide transfer coefficient (KCO)) were also reduced. Arterial oxygen tension (Pa,O2) was normal or slightly altered. A maximal exercise test was performed and anaerobic threshold was calculated. Muscle samples from vastus lateralis were obtained by needle biopsy. Myosin heavy chain (MHC) and light chain (MLC) isoforms were separated by gel electrophoresis and quantified by densitometry. MHC isoforms were considered as molecular markers of fibre types. The proportion of the fast MHC-2B isoform was increased in COPD patients. TL,CO, KCO, VC and FEV1 were positively correlated with slow MHC isoform content. TL,CO and KCO were also negatively correlated with the content of the fast MHC-2B isoform. No correlation was found between exercise parameters and MHC isoform composition. The co-ordinated expression between MHC and MLC isoforms was altered in COPD patients. We conclude that reduced oxygen availability, probably in combination with muscle disuse, may determine muscle alterations in chronic obstructive pulmonary disease patients. The altered correlations between myosin heavy chain and light chain isoforms suggest that co-ordinated protein expression is lost in chronic obstructive pulmonary disease muscles.

Adult↗

Exercise tolerance in panic disorder patients.

Sixteen panic patients and fifteen normal controls performed submaximal exercise testing on a bicycle ergometer. Only one patient subject panicked. Biochemical, physiological, and psychological data showed similar exercise tolerance in both patients and controls. Exercise-induced distress and lactate increment do not appear to cause panic attacks.

Adult↗

Exhaled nitric oxide and exercise tolerance in severe COPD patients.

To answer the question as to whether pulmonary rehabilitation programs (PRP) induced increase in exercise tolerance (ET) is associated with increased levels of exhaled nitric oxide (eNO) in COPD patients of different degrees of severity, we designed a prospective and controlled study. Forty-seven stable COPD patients underwent an 8-week outpatient multidisciplinary PRP including supervised incremental exercise. Fractional eNO concentration (FE(NO)) and peak work-rate (W(peak) were assessed baseline (T-1), atthe end of 1-month run-in period (T0), and after (T1) the PRP. Lung function, walking test, health-related quality of life (HRQL) were also recorded. Patients were divided into three groups according to disease severity: 17 severe [FEV1 35 (5)% pred] COPD patients, seven of them with cor pulmonale; 15 mild [FEV1 78 (6)% pred], and 15 moderate [FEV1 56 (6)% pred] COPD patients. FE(NO) did not differ at T-1 and T0 (mean absolute change (SD): 0.03 (0.09) 95% CI-0.01, 0.16, 0.06 (1.03) 95% CI 0.03, 0.75 and 0.05 (0.06) 95% CI 0.02, 0.11 ppb in mild, moderate and severe patients, respectively). As compared to T0, both W(peak) (by 17,15 and 10%, respectively) and FE(NO) (by 29, 24 and 16%, respectively) significantly increased in all groups, but not in patients with cor pulmonale. A significant correlation between pre- and post-PRP changes in Wpeak and FE(NO) was found both in mild to moderate (r = 0.79, P < 0.00001) and severe (r = 0.76, P < 0.001) COPD patients. After a PRP, improvement in ET is associated with an increase in eNO also in most severe COPD patients, but not in those with cor pulmonale.

Aged↗

Improved exercise tolerance by i.v. fructose-1,6-diphosphate in chronic, stable angina pectoris.

The effect of IV fructose-1,6-diphosphate (FDP) on transient, reproducible myocardial ischemia was evaluated in ten patients, aged 50 to 66 years, with chronic, stable exertional angina. FDP or placebo (glucose) were administered between basal and posttreatment ergometric stress testing; an identical procedure was repeated in each patient with the second treatment on the following day according to a single-blind, cross-over design. FDP improved exercise tolerance and total work capacity, significantly delaying the onset of ST-segment depression and angina. Nevertheless, the critical level of the rate x pressure (R X P) product, causing appearance of myocardial ischemia, was not remarkably changed. However, the R X P product at same workload was significantly lower after FDP. These results suggest that improved exercise tolerance might have resulted from peripheral (increased oxygen delivery to skeletal muscle) rather than from central (cardiac) effects of FDP.

Aged↗

Effects of theophylline on breathlessness and exercise tolerance in patients with chronic airflow obstruction.

Theophylline is commonly prescribed for patients with nonasthmatic chronic airflow obstruction (CAO) even though clinical efficacy is not well established. We studied objective and subjective responses to theophylline in 14 men with CAO. Subjects randomly received week-long treatments of placebo or theophylline at two dosages: one that produced low (8.7-13.0 micrograms/ml) and the other high (16.0-23.6 micrograms/ml plasma concentrations. During the final three days of each treatment, we measured spirometric and hemodynamic function. Exercise tolerance was assessed with the 12 minute walk and progressive cycle ergometry. The patients' perception of breathlessness during the usual activities of daily living was evaluated with the oxygen cost diagram and the breathlessness rating. For low and high dose theophylline there were significant (p less than .05) increases in forced vital capacity (7.1 +/- 2.1 percent; 12.0 +/- 1.7 percent), forced expiratory volume at one second (14.6 +/- 4.9 percent; 12.1 +/- 3.3 percent) and in pulse rate (8.3 +/- 1.2 percent; 19.1 +/- 3.1 percent), but no changes in blood pressure. There were also no significant differences among the three treatments for any of the tests which assessed exercise tolerance or breathlessness. These results suggest that most patients with CAO experience little symptomatic benefit from taking theophylline.

Adult↗

Relative contribution of resting haemodynamic profile and lung function to exercise tolerance in male patients with chronic heart failure.

OBJECTIVE: To clarify the relative contribution of resting haemodynamic profile and pulmonary function to exercise capacity in patients with heart failure. SETTING: Cardiology department and cardiac rehabilitation unit in a tertiary centre. DESIGN: 161 male patients (mean (SD) age 59 (9) years) with heart failure (New York Heart Association class II-IV, left ventricular ejection fraction 23 (7)%) underwent spirometry, alveolar capillary diffusing capacity (DLCO), and mouth inspiratory and expiratory pressures (MIP, MEP, respectively, in 100 patients). Right heart catheterisation and a symptom limited cardiopulmonary exercise test were performed in 137 patients within 3-4 days. RESULTS: Mean peak exercise oxygen consumption (VO(2)) was 13 (3.9) ml/kg/min. Among resting haemodynamic variables only cardiac index showed a significant correlation with peak VO(2). There were no differences in haemodynamic variables between patients with peak VO(2) </= or > 14 ml/kg/min. There was a moderate correlation (p < 0.05) between several pulmonary function variables and peak VO(2). Forced vital capacity (3.5 (0.9) v 3.2 (0.8) l, p < 0.05) and DLCO (21.6 (6.9) v 17.7 (5.5) ml/mm Hg/min, p < 0.05) were higher in patients with peak VO(2) > 14 ml/kg/min than in those with peak VO(2) </= 14 ml/kg/min. Using a stepwise regression analysis, the respiratory and haemodynamic variables which correlated significantly with peak VO(2) were DLCO, MEP, and cardiac index, with an overall R value of 0.63. CONCLUSIONS: The data confirm previous studies showing a poor correlation between resting indices of cardiac function and exercise capacity in heart failure. However, several pulmonary function variables were related to peak exercise VO(2). In particular, lung diffusing capacity and respiratory muscle function seem to affect exercise tolerance during heart failure.

Adult↗

Effect of oral salbutamol and slow-release aminophylline on exercise tolerance in chronic bronchitis.

In a double-blind placebo-controlled trial in 24 patients fulfilling the MRC criteria for chronic bronchitis, oral salbutamol 4 mg and slow-release aminophylline (Phyllocontin) 450 mg produced similar and significant (p less than 0.05) mean increases in forced expiratory volume in one second (FEV1). A significantly greater increase in mean FEV1 and forced vital capacity (FVC) was seen when both drugs were given although there was no statistical evidence of synergistic interaction. Salbutamol significantly increased the mean distance walked in 12 minutes (12MD) (p less than 0.02) by 56 metres and a similar increase of 54 metres (p less than 0.001) was seen after Phyllocontin. With both drugs in combination mean 12MD increased by 51 metres (p less than 0.02 cf placebo), a change not significantly different from that observed with either drug alone. Oral salbutamol and Phyllocontin improve exercise tolerance in chronic bronchitis. The significantly greater changes in FEV1 and FVC resulting from simultaneous administration of the two drugs are not associated with further improvement in exercise tolerance.

Adult↗

[Exercise tolerance in patients after acute lymphoblastic leukemia treatment in childhood].

The purpose of the presented study was to define the exercise tolerance in patients after acute lymphoblastic leukemia (ALL) treatment in childhood. Three groups of persons were examined: group A: 20 children, aged 7-19 years (mean 12.4 y), examined immediately after ALL therapy completion, with cumulative anthracycline (ATC) doses administered 155.8-300 mg/m2 and dexrazoxane, as cardioprotectant, group B: 36 patients, aged 12-24 years (mean 15.9), being 3-5 years after ALL treatment, who received ATC in cumulative doses 148.6-416.7 mg/m2, without cardioprotection, group C: 28 healthy volunteers, aged 9-25 years (mean 17.3), as controls. All the examined patients belonged to NYHA functional class I. In all subjects the exercise treadmill test was performed according to modified Bruce protocol. The parameters analysed were: MET--number of metabolic effort units achieved at the test, HRmax--maximal heart rate during exercise, %HRmax--percent of maximal HR for given patient's age achieved during the STdep--depression of ST segment in electrocardiography (ECG) immediately after the maximal exercise. During the exercise members of all 3 groups achieved the required HRmax without serious complaints and ECG abnormalities. Examined persons in group A,B and C presented with effort levels (MET), %HRmax, STdep that did not differ significantly. Only HRmax in groups A and C were higher than that achieved by members of group B.

Adolescent↗

Factors determining constant work rate exercise tolerance in COPD and their role in dictating the minimal clinically important difference in response to interventions.

Constant work rate exercise testing has been used to assess effectiveness of therapeutic interventions in chronic obstructive pulmonary disease. It has been noted to yield larger fractional increases in exercise tolerance than other measures. Reasons for this are rooted in physiological determinants of the time course of pulmonary ventilation. Following exercise onset, ventilation increases in three phases; the slowest phase is seen only at high exercise intensities. In chronic obstructive pulmonary disease exercise proceeds until ventilation reaches a limiting value. Because both ventilatory requirement for exercise and limiting ventilation can be manipulated by several interventions (exercise training, oxygen inhalation, bronchodilator administration), constant work rate tolerance responds to these interventions. The power-duration relationship predicts the effect of the work rate imposed on tolerated duration of a constant work rate test. Arguments are presented that a pre-intervention constant work rate duration of 4-7 minutes is desirable. At present, the recommended strategy to achieve this target duration is to choose a work rate equal to 85% of peak work rate achieved in a constant work rate test. There is clearly insufficient information to reliably determine a minimal clinically important difference for this test. A lower bound of 1.75 minutes is suggested.

Data Interpretation, Statistical↗

Effects of fosinopril on exercise tolerance, symptoms, and clinical outcomes in patients with decompensated heart failure.

The purpose of this prospective, multicenter, randomized, double blind, placebo controlled study was to determine the clinical effects of fosinopril in patients with decompensated or worsening heart failure (HF). Patients >/=18 years with New York Heart Association (NYHA) functional class II-IV HF who had been hospitalized or seen in the ER or outpatient clinic for treatment of worsening or decompensated HF were eligible. Patients had to be on diuretic therapy and have a left ventricular ejection fraction (LVEF) </=35% and a treadmill exercise tolerance test (ETT) duration of </=8 minutes. Randomized patients began 12 weeks of fosinopril 10 mg (or placebo) qAM and were titrated within 4 weeks to fosinopril 20 mg and then to 40 mg (or placebo) qAM (if seated, systolic blood pressure (SBP) >/=90 mm Hg). ETTs (modified Naughton protocol) were performed at weeks 1, 3, 6, and 12. A total of 206 patients (mean age 62 years) were randomized to fosinopril (n=102) or placebo (n=104). Most patients were NYHA functional class III (58%) or IV (30%) at presentation; 145 patients completed 12 weeks of treatment (fosinopril, n=85; placebo, n=60). After adjustment for baseline imbalances and investigator effects, fosinopril-treated patients had a 513 second mean exercise duration at endpoint vs. a 489 second duration in placebo-treated patients (p=0.353). When the analysis was adjusted for the impact of dropouts on ETT time, fosinopril-treated patients had a greater exercise duration than those treated with placebo (p=0.043). Fewer patients in the fosinopril group were discontinued from study medication (p=0.008) or hospitalized (p=0.005) for worsening HF. At endpoint, more patients improved their NYHA Functional Class and fewer had worsened with fosinopril vs. placebo (p=0.018); fosinopril-treated patients showed improvements in dyspnea (p=0.054), fatigue (p=0.052), edema (p=0.012), and paroxysmal nocturnal dyspnea (p=0.003) vs. the placebo group. Once-daily fosinopril had a favorable effect on dropout-adjusted exercise tolerance, reduced the frequency of discontinuations or hospitalizations for worsening HF, improved HF signs and symptoms, and was safe and well tolerated. (c)1999 by CHF, Inc.

Journal Article↗