Clinical InvestigationCongestive Heart FailureA cardiopulmonary exercise testing score for predicting outcomes in patients with heart failure
Section snippets
Methods
This study was a multicenter analysis including patients with HF from the exercise laboratories at the VA Palo Alto Health Care System and Stanford University, Palo Alto, CA; San Paolo Hospital, Milan, Italy; Virginia Commonwealth University, Richmond, VA; and the LeBauer Cardiovascular Research Foundation, Greensboro, NC. A total of 710 patients with chronic HF (568 males and 142 females), tested between March 18, 1993 and March 5, 2007, were included. Inclusion criteria consisted of a
Baseline characteristics and development of the summed score
The study sample is composed of 568 males and 142 females with CHF; 331 (49%) had an ischemic etiology. The BMI and ejection fraction were higher among those who survived versus those who died (Table I). Among CPX variables, peak VO2 (17.5 ± 6.6 vs 14.0 ± 4.7 mL kg−1 min−1), peak heart rate, HRR, OUES, and PetCO2 were higher among those who survived. Conversely, the VE/VCO2 slope and the CPX weighted summed score were lower among survivors (P < .001 for both) (Table II).
There were 175 total
Discussion
Beginning in the mid-1990s, consensus guidelines recommended the application of the CPX to supplement other clinical data in the management of patients with HF. However, these guidelines limited their recommendations to the application of peak VO2 achieved in the context of selecting patients for transplantation. In recent years, a broader appreciation of the CPX has occurred, and an expanding number of responses from the test have been applied to predict risk in patients with HF. This has led
Summary
This study further defines the important role of the CPX for predicting outcomes in patients with HF. Rather than relying strictly on peak VO2, the simple summation of several easily obtained responses from the CPX can be used to more accurately describe the spectrum of risk for adverse events in these patients. By including indices that reflect abnormalities in several systems that are related to outcomes, including oxygen delivery and extraction (peak VO2), ventilatory inefficiency (VE/VCO2
References (37)
ACC/AHA 2005 Guideline Update for the Diagnosis and Management of Chronic Heart Failure in the Adult: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Update the 2001 Guidelines for the Evaluation and Management of Heart Failure)
J Am Cole Cardiol
(2005)- et al.
Peak VO2 and VE/VCO2 slope in patients with heart failure: a prognostic comparison
Am Heart J
(2004) - et al.
Ventilatory response to exercise improves risk stratification in patients with chronic heart failure and intermediate functional capacity
Am Heart J
(2002) - et al.
Influence of heart failure etiology on the prognostic value of peak oxygen consumption and minute ventilation/carbon dioxide production slope
Chest
(2005) - et al.
The minute ventilation/carbon dioxide production slope in prognostically superior to the oxygen uptake efficiency slope
J Cardiac Fail
(2007) - et al.
Prognostic significance of oxygen uptake kinetics during low level exercise in patients with heart failure
Am J Cardiol
(1999) - et al.
Prognostic value of resting end-tidal carbon dioxide in patients with heart failure
Int J Cardiol
(2006) - et al.
Prognostic value of end-tidal carbon dioxide during exercise testing in heart failure
Int J Cardiol
(2007) - et al.
Kinetics of oxygen consumption during and after exercise in patients with dilated cardiomyopathy
J Am Coll Cardiol
(1996) - et al.
Exercise oscillatory breathing and increased ventilation to carbon dioxide production slope in heart failure: an unfavorable combination with high prognostic value
Am Heart J
(2007)
Prognostic value of heart rate recovery in patients with heart failure
Am Heart J
Combining low-intensity and maximal exercise test results improves prognostic prediction in chronic heart failure
J Am Coll Cardiol
Use of cardiopulmonary exercise testing with hemodynamic monitoring in the prognostic assessment of ambulatory patients with chronic heart failure
J Am Coll Cardiol
Comparison of the ramp versus standard exercise protocols
J Am Coll Cardiol
Technical considerations related to the minute ventilation/carbon dioxide output slope in patients with heart failure
Chest
Determining the best ventilatory efficiency measure to predict mortality in patients with heart failure
J Heart Lung Transpl
Oxygen uptake efficiency slope: a new index of cardiorespiratory functional reserve derived from the relation between oxygen uptake and minute ventilation during incremental exercise
J Am Coll Cardiol
Exercise and autonomic function in health and cardiovascular disease
Cardiol Clin
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