Daniel Bensimhon - Academia.edu (original) (raw)

Papers by Daniel Bensimhon

Journal of Cardiopulmonary Rehabilitation and Prevention, 2012

While the medical management strategy for patients with heart failure (HF) has dramatically chang... more While the medical management strategy for patients with heart failure (HF) has dramatically changed, cardiopulmonary exercise testing (CPX) procedures and the data obtained have remained relatively stable. We are unaware of any previous investigation that has assessed differences in the prognostic utility of CPX in HF according to time period, reflecting differences in the clinical management of systolic HF. Subjects (n = 381) underwent CPX between April 1, 1993, and December 31, 2005, and the remaining 511 were tested between January 1, 2006, and October 28, 2010. Peak oxygen uptake ((Equation is included in full-text article.)O2) and the minute ventilation/carbon dioxide production ((Equation is included in full-text article.)E/(Equation is included in full-text article.)CO2) slope were ascertained for all tests. Both the (Equation is included in full-text article.)E/(Equation is included in full-text article.)CO2 slope and peak (Equation is included in full-text article.)O2 were strong univariate predictors of adverse events in both subgroups. In the multivariate analysis, the (Equation is included in full-text article.)E/(Equation is included in full-text article.)CO2 slope was the strongest predictive marker while peak (Equation is included in full-text article.)O2 added predictive value and was retained in the regression for all scenarios. In subjects undergoing CPX before 2006, a (Equation is included in full-text article.)E/(Equation is included in full-text article.)CO2 slope 45 or greater and a peak (Equation is included in full-text article.)O2 of less than 10 mL · kg · min generated a hazard ratio of 4.2 (95% CI: 1.9-9.1, P < .001) when considering only mortality as an endpoint. In subjects undergoing CPX after 2006, a (Equation is included in full-text article.)E/(Equation is included in full-text article.)CO2 slope 45 or greater and a peak (Equation is included in full-text article.)O2 of less than 10 mL · kg · min generated a hazard ratio of 8.2 (95% CI: 4.7-14.3, P < .001) when considering only mortality as an endpoint. The results of this study indicate that CPX continues to be a valuable clinical assessment in the present-day HF management.

Journal de Radiologie, 2008

JACC: Heart Failure, 2013

The purpose of this analysis was to evaluate the prognostic characteristics of peak oxygen consum... more The purpose of this analysis was to evaluate the prognostic characteristics of peak oxygen consumption (Vo2) and the minute ventilation/carbon dioxide (VE/Vco2) slope of different peak respiratory exchange ratios (RERs) obtained from cardiopulmonary exercise testing in patients with heart failure (HF). For patients with HF, peak Vo2 and the VE/Vco2 slope are used for assessing prognosis. Peak Vo2 is assessed in association with peak RER ≥1.10, indicating maximal effort and prognostic sensitivity. Conversely, the VE/Vco2 slope provides effort-independent prognostic discrimination. Patients with HF scheduled to undergo cardiopulmonary exercise testing were enrolled. Patients were subclassified by peak RER (RER <1.00, RER 1.00 to 1.04, RER 1.05 to 1.09, RER ≥1.10) and followed for up to 3 years for major cardiac-related events (death, left ventricular assist device implantation, or cardiac transplantation). Included were 1,728 patients with HF (75% males; 40% ischemic etiology; age: 55 ± 14 years; left ventricular ejection fraction: 28 ± 10%). Two hundred seventy major events occurred, with no proportional differences across the RER subgroups. Multivariate Cox regression analysis indicated that the VE/Vco2 slope and peak Vo2 remained prognostic within each subgroup; the VE/Vco2 slope remained the strongest predictor. Receiver-operating characteristic analysis demonstrated equitable prognostic cutoffs for the VE/Vco2 slope (range: 34.9 to 35.7; area under the curve [AUC] range: 0.69 to 0.75) and peak Vo2 (range: 13.8 to 14.0 ml·kg(-1)·min(-1); AUC range: 0.68 to 0.75). Peak Vo2 provided a sensitive assessment of prognosis in patients with HF in all RER subgroups. The VE/Vco2 slope provided greater prognostic discrimination in all RER subgroups. Clinical consideration may be warranted for patients with low RER, low peak Vo2, and an elevated VE/Vco2 slope.

Journal De Radiologie, 2009

Gastrointestinal stromal tumors (GIST) arising from interstitial cells of Cajal, represent the fi... more Gastrointestinal stromal tumors (GIST) arising from interstitial cells of Cajal, represent the first type of solid tumor, which is very sensitive to a specific molecularly targeted tyrosine kinase receptor blocker (i. e., imatinib). On CT, which is considered as the reference technique, GISTs typically present as large, well-delineated, heterogeneous and sometimes exophytic masses. In contrast with the absence of lymph

Circulation: Heart Failure, 2009

Background-Peak oxygen consumption (VO 2 ) is routinely assessed in patients with heart failure (... more Background-Peak oxygen consumption (VO 2 ) is routinely assessed in patients with heart failure (HF) undergoing cardiopulmonary exercise testing (CPX). The purpose of the present investigation is to determine the prognostic ability of several established peak VO 2 prediction equations in a large HF cohort.

International journal of cardiology, Jan 12, 2014

... elderly patients with heart failure Angela B. Scardovi , Renata De Maria*, Andrea Celestini ,... more ... elderly patients with heart failure Angela B. Scardovi , Renata De Maria*, Andrea Celestini , SilviaPerna°, Claudio Coletta, Mauro Feola**, Nadia Aspromonte, Gian Luca Rosso**, Alessandro Carunchio, Alessandro Ferraironi ,Alessandro Pimpinella, Roberto Ricci ...

Journal of Cardiac Failure - J CARD FAIL, 2009

Dyskinetic segments had significantly better strain compared to akinetic segments. Conclusions: T... more Dyskinetic segments had significantly better strain compared to akinetic segments. Conclusions: TDI based quantitative assessment of LV function is significantly associated with the qualitative assessment of LV WMS. TDI provides quantitative and more precise assessment of LV function. Dyskinetic LV segments have significantly better strain compared to akinetic segments.

Medicine & Science in Sports & Exercise, 2009

Journal of the American College of Cardiology, 2011

The purpose of this study was to assess the impact of changes in symptoms of depression over a 1-... more The purpose of this study was to assess the impact of changes in symptoms of depression over a 1-year period on subsequent clinical outcomes in heart failure (HF) patients.

The Journal of Heart and Lung Transplantation, 2008

Background: Exercise oscillatory ventilation (EOV) occurs in a sub-group of patients with increas... more Background: Exercise oscillatory ventilation (EOV) occurs in a sub-group of patients with increased heart failure (HF) severity and poorer prognosis. The purpose of this investigation was to examine the prognostic value of the largest ventilatory oscillation characteristics in HF patients.

Journal of Cardiac Failure, 2010

Cardiopulmonary exercise testing (CPET) provides powerful information on risk of death in heart f... more Cardiopulmonary exercise testing (CPET) provides powerful information on risk of death in heart failure (HF). We sought to define the relative and additive contribution of the 3 landmark (CPET) prognostic markers--peak oxygen consumption (VO₂), minute ventilation/carbon dioxide production (VE/VCO₂) slope, and exercise periodic breathing (EPB)-to the overall risk of cardiac death and to develop a prognostic score for optimizing risk stratification in HF patients. A total of 695 stable HF patients (average LVEF: 25 ± 8%) underwent a symptom-limited CPET maximum test after familiarization and were prospectively tracked for cardiac mortality. At multivariable Cox analysis EPB emerged as the strongest prognosticator. Using a statistical bootstrap technique (5000 data resamplings), point estimates, and 95% confidence intervals were obtained. Thirty-two configurations were adopted to classify patients into a given cell, according to EPB presence or absence and values of the 2 other covariates. Configurations without EPB and with VE/VCO₂ slope ≤30 were not significantly different from 0 (reference value). Statistical power of configurations increased with higher VE/VCO₂ slope and lower peak VO₂. This prompted us to formulate a score including EPB as a discriminating variable, the (P)e(R)i(O)dic (B)reathing during (E)xercise (PROBE), which ranges between -1 and 1, with zero as reference configuration, that would help to optimize the prognostic accuracy of CPET-derived variables. The greatest PROBE score impact was provided by EPB, followed by VE/VCO₂ slope, whereas peak VO₂ added minimal prognostic power. EPB with an elevated VE/VCO₂ slope leads to the highest and most precise PROBE score, whereas no additional risk information emerges when EPB is present with a peak VO₂ ≤10 mL O₂·kg⁻¹·min⁻¹. PROBE score appears to provide a step forward for optimizing CPET use in HF prognostic definition.

Journal of Cardiac Failure, 2008

10 men, 2 women), (age 67.7 (614.1), (systolic 8, diastolic 4). Time in HFC before referral to ho... more 10 men, 2 women), (age 67.7 (614.1), (systolic 8, diastolic 4). Time in HFC before referral to hospice was 1 day to 7.5 years. Hospitalizations before and after referral to the HFC for this HF EOL cohort increased from 3.0 (63.1) to 6.3 (67.3) over an average of 29.2 months. Total hospital days one year prior to hospice referral were 293 (range 5e92). Total hospice days prior to death were 577 (range 5e270). Hospice care (9.8% inpatient, 94.1% home, 0.5% home continuous care) cost 79% ($365,000) less. Patients and families expressed ''gratitude'' and ''relief'' with hospice services. Conclusions: Healthcare cost for hospice was low and patient and family satisfaction was high. This data supports the operationalization of recommendations in both the ACC/AHA Guidelines for HF EOL and the Consensus Statement: Palliative and Supportive Care in Advanced HF. Further study is needed to identify best predictors for timing of hospice referral. Hospice staff education is essential for patient, family, and cardiologist confidence in transitioning the HF palliative care patient to hospice.

Journal of Cardiac Failure, 2007

Ventilatory efficiency, commonly assessed by the minute ventilation (VE)-carbon dioxide productio... more Ventilatory efficiency, commonly assessed by the minute ventilation (VE)-carbon dioxide production (VCO2) slope, has proven to be a strong prognostic marker in the heart failure (HF) population. Recently, the oxygen uptake efficiency slope (OUES) has demonstrated prognostic value, but additional comparisons to established cardiopulmonary exercise test (CPET) variables are required. A total of 341 subjects were diagnosed with HF participated in this analysis. The VE/VCO2 slope and the OUES were calculated using 50% (VE/VCO2 slope(50) or OUES(50)) and 100% (VE/VCO2 slope(100) or OUES(100)) of the exercise data. Peak oxygen consumption (VO2) was also determined. There were 47 major cardiac-related events during the 3-year tracking period. Receiver operating characteristic (ROC) curve analysis demonstrated the classification schemes for both VE/VCO2 slope and OUES calculations as well as peak VO2 were statistically significant (all areas under the ROC curve: > or = 0.74, P < .001). Area under the ROC curve for the VE/VCO2 slope(100) was, however, significantly greater than OUES(50), OUES(100), and peak VO2 (P < .05). Although the OUES was a significant predictor of mortality, the VE/VCO2 slope maintained optimal prognostic value. An elevated VE/VCO2 slope may be the single best indicator of increased risk for adverse events.

Journal of Cardiac Failure, 2006

Journal of Cardiac Failure, 2006

Journal of Cardiac Failure, 2008

Background: The lowest minute ventilation (VE) and carbon dioxide production (VCO 2 ) ratio durin... more Background: The lowest minute ventilation (VE) and carbon dioxide production (VCO 2 ) ratio during exercise has been suggested to be the most stable and reproducible marker of ventilatory efficiency in patients with heart failure (HF). However, the prognostic power of this index is unknown. Methods and Results: A total of 847 HF patients underwent cardiopulmonary exercise testing (CPX) and were followed for 3 years. The associations between the lowest VE/VCO 2 ratio, maximal oxygen uptake (peak VO 2 ), the VE/VCO 2 slope, and major events (death or transplantation) were evaluated using proportional hazards analysis; adequacy of the predictive models was assessed using Akaike information criterion (AIC) weights. There were 147 major adverse events. In multivariate analysis, the lowest VE/ VCO 2 ratio (higher ratio associated with greater risk) was similar to the VE/VCO 2 slope in predicting risk (hazard ratios [HR] per unit increment 2.0, 95% CI 1.1e3.4, and 2.2, 95% CI 1.3e3.7, respectively; P ! .01), followed by peak VO 2 (HR 1.6, 95% CI 1.1e2.4, P 5 .01). Patients exhibiting abnormalities for all 3 responses had an 11.6-fold higher risk. The AIC weight for the 3 variables combined (0.94) was higher than any single response or any combination of 2. The model including all 3 responses remained the most powerful after adjustment for b-blocker use, type of HF, and after applying different cut points for high risk. Conclusions: The lowest VE/VCO 2 ratio adds to the prognostic power of conventional CPX responses in HF. (J Cardiac Fail 2009;15:756e762)

Journal of Cardiac Failure, 2008

Journal of Cardiac Failure, 2007

Journal of Cardiac Failure, 2007

Journal of Cardiac Failure, 2007

Journal of Cardiopulmonary Rehabilitation and Prevention, 2012

While the medical management strategy for patients with heart failure (HF) has dramatically chang... more While the medical management strategy for patients with heart failure (HF) has dramatically changed, cardiopulmonary exercise testing (CPX) procedures and the data obtained have remained relatively stable. We are unaware of any previous investigation that has assessed differences in the prognostic utility of CPX in HF according to time period, reflecting differences in the clinical management of systolic HF. Subjects (n = 381) underwent CPX between April 1, 1993, and December 31, 2005, and the remaining 511 were tested between January 1, 2006, and October 28, 2010. Peak oxygen uptake ((Equation is included in full-text article.)O2) and the minute ventilation/carbon dioxide production ((Equation is included in full-text article.)E/(Equation is included in full-text article.)CO2) slope were ascertained for all tests. Both the (Equation is included in full-text article.)E/(Equation is included in full-text article.)CO2 slope and peak (Equation is included in full-text article.)O2 were strong univariate predictors of adverse events in both subgroups. In the multivariate analysis, the (Equation is included in full-text article.)E/(Equation is included in full-text article.)CO2 slope was the strongest predictive marker while peak (Equation is included in full-text article.)O2 added predictive value and was retained in the regression for all scenarios. In subjects undergoing CPX before 2006, a (Equation is included in full-text article.)E/(Equation is included in full-text article.)CO2 slope 45 or greater and a peak (Equation is included in full-text article.)O2 of less than 10 mL · kg · min generated a hazard ratio of 4.2 (95% CI: 1.9-9.1, P < .001) when considering only mortality as an endpoint. In subjects undergoing CPX after 2006, a (Equation is included in full-text article.)E/(Equation is included in full-text article.)CO2 slope 45 or greater and a peak (Equation is included in full-text article.)O2 of less than 10 mL · kg · min generated a hazard ratio of 8.2 (95% CI: 4.7-14.3, P < .001) when considering only mortality as an endpoint. The results of this study indicate that CPX continues to be a valuable clinical assessment in the present-day HF management.

Journal de Radiologie, 2008

JACC: Heart Failure, 2013

The purpose of this analysis was to evaluate the prognostic characteristics of peak oxygen consum... more The purpose of this analysis was to evaluate the prognostic characteristics of peak oxygen consumption (Vo2) and the minute ventilation/carbon dioxide (VE/Vco2) slope of different peak respiratory exchange ratios (RERs) obtained from cardiopulmonary exercise testing in patients with heart failure (HF). For patients with HF, peak Vo2 and the VE/Vco2 slope are used for assessing prognosis. Peak Vo2 is assessed in association with peak RER ≥1.10, indicating maximal effort and prognostic sensitivity. Conversely, the VE/Vco2 slope provides effort-independent prognostic discrimination. Patients with HF scheduled to undergo cardiopulmonary exercise testing were enrolled. Patients were subclassified by peak RER (RER <1.00, RER 1.00 to 1.04, RER 1.05 to 1.09, RER ≥1.10) and followed for up to 3 years for major cardiac-related events (death, left ventricular assist device implantation, or cardiac transplantation). Included were 1,728 patients with HF (75% males; 40% ischemic etiology; age: 55 ± 14 years; left ventricular ejection fraction: 28 ± 10%). Two hundred seventy major events occurred, with no proportional differences across the RER subgroups. Multivariate Cox regression analysis indicated that the VE/Vco2 slope and peak Vo2 remained prognostic within each subgroup; the VE/Vco2 slope remained the strongest predictor. Receiver-operating characteristic analysis demonstrated equitable prognostic cutoffs for the VE/Vco2 slope (range: 34.9 to 35.7; area under the curve [AUC] range: 0.69 to 0.75) and peak Vo2 (range: 13.8 to 14.0 ml·kg(-1)·min(-1); AUC range: 0.68 to 0.75). Peak Vo2 provided a sensitive assessment of prognosis in patients with HF in all RER subgroups. The VE/Vco2 slope provided greater prognostic discrimination in all RER subgroups. Clinical consideration may be warranted for patients with low RER, low peak Vo2, and an elevated VE/Vco2 slope.

Journal De Radiologie, 2009

Gastrointestinal stromal tumors (GIST) arising from interstitial cells of Cajal, represent the fi... more Gastrointestinal stromal tumors (GIST) arising from interstitial cells of Cajal, represent the first type of solid tumor, which is very sensitive to a specific molecularly targeted tyrosine kinase receptor blocker (i. e., imatinib). On CT, which is considered as the reference technique, GISTs typically present as large, well-delineated, heterogeneous and sometimes exophytic masses. In contrast with the absence of lymph

Circulation: Heart Failure, 2009

Background-Peak oxygen consumption (VO 2 ) is routinely assessed in patients with heart failure (... more Background-Peak oxygen consumption (VO 2 ) is routinely assessed in patients with heart failure (HF) undergoing cardiopulmonary exercise testing (CPX). The purpose of the present investigation is to determine the prognostic ability of several established peak VO 2 prediction equations in a large HF cohort.

International journal of cardiology, Jan 12, 2014

... elderly patients with heart failure Angela B. Scardovi , Renata De Maria*, Andrea Celestini ,... more ... elderly patients with heart failure Angela B. Scardovi , Renata De Maria*, Andrea Celestini , SilviaPerna°, Claudio Coletta, Mauro Feola**, Nadia Aspromonte, Gian Luca Rosso**, Alessandro Carunchio, Alessandro Ferraironi ,Alessandro Pimpinella, Roberto Ricci ...

Journal of Cardiac Failure - J CARD FAIL, 2009

Dyskinetic segments had significantly better strain compared to akinetic segments. Conclusions: T... more Dyskinetic segments had significantly better strain compared to akinetic segments. Conclusions: TDI based quantitative assessment of LV function is significantly associated with the qualitative assessment of LV WMS. TDI provides quantitative and more precise assessment of LV function. Dyskinetic LV segments have significantly better strain compared to akinetic segments.

Medicine & Science in Sports & Exercise, 2009

Journal of the American College of Cardiology, 2011

The purpose of this study was to assess the impact of changes in symptoms of depression over a 1-... more The purpose of this study was to assess the impact of changes in symptoms of depression over a 1-year period on subsequent clinical outcomes in heart failure (HF) patients.

The Journal of Heart and Lung Transplantation, 2008

Background: Exercise oscillatory ventilation (EOV) occurs in a sub-group of patients with increas... more Background: Exercise oscillatory ventilation (EOV) occurs in a sub-group of patients with increased heart failure (HF) severity and poorer prognosis. The purpose of this investigation was to examine the prognostic value of the largest ventilatory oscillation characteristics in HF patients.

Journal of Cardiac Failure, 2010

Cardiopulmonary exercise testing (CPET) provides powerful information on risk of death in heart f... more Cardiopulmonary exercise testing (CPET) provides powerful information on risk of death in heart failure (HF). We sought to define the relative and additive contribution of the 3 landmark (CPET) prognostic markers--peak oxygen consumption (VO₂), minute ventilation/carbon dioxide production (VE/VCO₂) slope, and exercise periodic breathing (EPB)-to the overall risk of cardiac death and to develop a prognostic score for optimizing risk stratification in HF patients. A total of 695 stable HF patients (average LVEF: 25 ± 8%) underwent a symptom-limited CPET maximum test after familiarization and were prospectively tracked for cardiac mortality. At multivariable Cox analysis EPB emerged as the strongest prognosticator. Using a statistical bootstrap technique (5000 data resamplings), point estimates, and 95% confidence intervals were obtained. Thirty-two configurations were adopted to classify patients into a given cell, according to EPB presence or absence and values of the 2 other covariates. Configurations without EPB and with VE/VCO₂ slope ≤30 were not significantly different from 0 (reference value). Statistical power of configurations increased with higher VE/VCO₂ slope and lower peak VO₂. This prompted us to formulate a score including EPB as a discriminating variable, the (P)e(R)i(O)dic (B)reathing during (E)xercise (PROBE), which ranges between -1 and 1, with zero as reference configuration, that would help to optimize the prognostic accuracy of CPET-derived variables. The greatest PROBE score impact was provided by EPB, followed by VE/VCO₂ slope, whereas peak VO₂ added minimal prognostic power. EPB with an elevated VE/VCO₂ slope leads to the highest and most precise PROBE score, whereas no additional risk information emerges when EPB is present with a peak VO₂ ≤10 mL O₂·kg⁻¹·min⁻¹. PROBE score appears to provide a step forward for optimizing CPET use in HF prognostic definition.

Journal of Cardiac Failure, 2008

10 men, 2 women), (age 67.7 (614.1), (systolic 8, diastolic 4). Time in HFC before referral to ho... more 10 men, 2 women), (age 67.7 (614.1), (systolic 8, diastolic 4). Time in HFC before referral to hospice was 1 day to 7.5 years. Hospitalizations before and after referral to the HFC for this HF EOL cohort increased from 3.0 (63.1) to 6.3 (67.3) over an average of 29.2 months. Total hospital days one year prior to hospice referral were 293 (range 5e92). Total hospice days prior to death were 577 (range 5e270). Hospice care (9.8% inpatient, 94.1% home, 0.5% home continuous care) cost 79% ($365,000) less. Patients and families expressed ''gratitude'' and ''relief'' with hospice services. Conclusions: Healthcare cost for hospice was low and patient and family satisfaction was high. This data supports the operationalization of recommendations in both the ACC/AHA Guidelines for HF EOL and the Consensus Statement: Palliative and Supportive Care in Advanced HF. Further study is needed to identify best predictors for timing of hospice referral. Hospice staff education is essential for patient, family, and cardiologist confidence in transitioning the HF palliative care patient to hospice.

Journal of Cardiac Failure, 2007

Ventilatory efficiency, commonly assessed by the minute ventilation (VE)-carbon dioxide productio... more Ventilatory efficiency, commonly assessed by the minute ventilation (VE)-carbon dioxide production (VCO2) slope, has proven to be a strong prognostic marker in the heart failure (HF) population. Recently, the oxygen uptake efficiency slope (OUES) has demonstrated prognostic value, but additional comparisons to established cardiopulmonary exercise test (CPET) variables are required. A total of 341 subjects were diagnosed with HF participated in this analysis. The VE/VCO2 slope and the OUES were calculated using 50% (VE/VCO2 slope(50) or OUES(50)) and 100% (VE/VCO2 slope(100) or OUES(100)) of the exercise data. Peak oxygen consumption (VO2) was also determined. There were 47 major cardiac-related events during the 3-year tracking period. Receiver operating characteristic (ROC) curve analysis demonstrated the classification schemes for both VE/VCO2 slope and OUES calculations as well as peak VO2 were statistically significant (all areas under the ROC curve: > or = 0.74, P < .001). Area under the ROC curve for the VE/VCO2 slope(100) was, however, significantly greater than OUES(50), OUES(100), and peak VO2 (P < .05). Although the OUES was a significant predictor of mortality, the VE/VCO2 slope maintained optimal prognostic value. An elevated VE/VCO2 slope may be the single best indicator of increased risk for adverse events.

Journal of Cardiac Failure, 2006

Journal of Cardiac Failure, 2006

Journal of Cardiac Failure, 2008

Background: The lowest minute ventilation (VE) and carbon dioxide production (VCO 2 ) ratio durin... more Background: The lowest minute ventilation (VE) and carbon dioxide production (VCO 2 ) ratio during exercise has been suggested to be the most stable and reproducible marker of ventilatory efficiency in patients with heart failure (HF). However, the prognostic power of this index is unknown. Methods and Results: A total of 847 HF patients underwent cardiopulmonary exercise testing (CPX) and were followed for 3 years. The associations between the lowest VE/VCO 2 ratio, maximal oxygen uptake (peak VO 2 ), the VE/VCO 2 slope, and major events (death or transplantation) were evaluated using proportional hazards analysis; adequacy of the predictive models was assessed using Akaike information criterion (AIC) weights. There were 147 major adverse events. In multivariate analysis, the lowest VE/ VCO 2 ratio (higher ratio associated with greater risk) was similar to the VE/VCO 2 slope in predicting risk (hazard ratios [HR] per unit increment 2.0, 95% CI 1.1e3.4, and 2.2, 95% CI 1.3e3.7, respectively; P ! .01), followed by peak VO 2 (HR 1.6, 95% CI 1.1e2.4, P 5 .01). Patients exhibiting abnormalities for all 3 responses had an 11.6-fold higher risk. The AIC weight for the 3 variables combined (0.94) was higher than any single response or any combination of 2. The model including all 3 responses remained the most powerful after adjustment for b-blocker use, type of HF, and after applying different cut points for high risk. Conclusions: The lowest VE/VCO 2 ratio adds to the prognostic power of conventional CPX responses in HF. (J Cardiac Fail 2009;15:756e762)

Journal of Cardiac Failure, 2008

Journal of Cardiac Failure, 2007

Journal of Cardiac Failure, 2007

Journal of Cardiac Failure, 2007