Comparison of the prognostic value of cardiopulmonary exercise testing between male and female patients with heart failure (original) (raw)
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CHEST Journal, 2005
Background: Peak oxygen consumption (V O 2) and minute ventilation (V E)/carbon dioxide production (V CO 2) slope have been widely demonstrated to have strong prognostic value in patients with heart failure (HF). In the present study, we investigated the effect of HF etiology on the prognostic applications of peak V O 2 and V E/V CO 2 slope. Methods: Two hundred sixty-eight subjects underwent symptom-limited cardiopulmonary exercise testing (CPX). The population was divided into ischemic (115 men and 22 women) and nonischemic (108 men and 23 women) subgroups. The occurrence of cardiac-related events over the year following CPX was compared between groups using receiver operating characteristic curve (ROC) analysis Results: Mean age ؎ SD was significantly higher (61.0 ؎ 10.0 years vs 50.3 ؎ 16.2 years) while mean peak V O 2 was significantly lower (15.0 ؎ 5.2 mL/kg/min vs 17.5 ؎ 6.7 mL/kg/min) in the ischemic HF group (p < 0.05). ROC curve analysis demonstrated that both peak V O 2 and V E/V CO 2 slope were significant predictors of cardiac events in both the ischemic group (peak V O 2 , 0.74; V E/V CO 2 slope, 0.76; p < 0.001) and the nonischemic group (peak V O 2 , 0.75; V E/V CO 2 slope, 0.86; p < 0.001). Optimal prognostic threshold values for peak V O 2 were 14.1 mL/kg/min and 14.6 mL/kg/min in the ischemic and nonischemic groups, respectively. Optimal prognostic threshold values for the V E/V CO 2 slope were 34.2 and 34.5 in the ischemic and nonischemic groups, respectively. Conclusions: Baseline and exercise characteristics were different between ischemic and nonischemic patients with HF. However, the prognostic power of the major CPX variables was strikingly similar. Different prognostic classification schemes based on HF etiology may therefore not be necessary when analyzing CPX responses in clinical practice.
The Open Cardiovascular Medicine Journal, 2010
Background: Cardiopulmonary exercise testing with ventilatory expired gas analysis (CPET) has proven to be a valuable tool for assessing patients with chronic heart failure (CHF). The maximal oxygen uptake (peak V02) is used in risk stratification of patients with CHF. The minute ventilation-carbon dioxide production relationship (VE/VCO2 slope) has recently demonstrated prognostic significance in patients with CHF. Methods: Between January 2006 and December 2007 we performed CPET in 184 pts (146 M, 38 F, mean age 59.8 + 12.9 years), with stable CHF (96 coronary artery disease, 88 dilated cardiomyopathy), in NYHA functional class II (n.107)-III (n.77), with left ventricular ejection fraction (LVEF) < 45%,. The ability of peak VO2 and VE/VCO2 slope to predict cardiac related mortality and cardiac related hospitalization within 12 months after evaluation was examined. Results: Peak VO2 and VE/VCO2 slope were demonstrated with univariate Cox regression analysis both to be significant predictor of cardiac-related mortality and hospitalization (p < 0.0001, respectively). Non survivors had a lower peak VO2 (10.49 + 1.70 ml/kg/min vs. 14.41 + 3.02 ml/kg/min, p < 0.0001), and steeper Ve/VCO2 slope (41.80 + 8.07 vs. 29.84 + 6.47, p < 0.0001) than survivors. Multivariate survival analysis revealed that VE/VCO2 slope added additional value to VO2 peak as an independent prognostic factor (2: 56.48, relative risk: 1.08, 95% CI: 1.03-1.13, p = 0.001). The results from Kaplan-Meier analysis revealed a 1-year cardiac-related mortality of 75% in patients with VE/VCO2 slope > 35.6 and 25% in those with VE/VCO2 slope < 35.6 (log rank 2: 67.03, p < 0.0001) and 66% in patients with peak VO2 < 12.2 ml/kg/min and 34% in those with peak VO2 > 12.2 ml/kg/min (log rank 2: 50.98, p < 0.0001). One-year cardiac-related hospitalization was 77% in patients with VE/VCO2 slope > 32.5 and 23% in those with VE/VCO2 slope < 32.5 (log rank 2: 133.80, p < 0.0001) and 63% in patients with peak VO2 < 12.3 ml/kg/min and 37% in those with peak VO2 > 12.3 ml/kg/min (log rank 2: 72.86, p < 0.0001). The VE/VCO2 slope was demonstrated with receiver operating characteristic curve analysis to be equivalent to peak VO2 in predicting cardiac-related mortality (0.89 vs. 0.89). Although area under the receiver operating characteristic curve for the VE/VCO2 slope was greater than peak VO2 in predicting cardiacrelated hospitalization (0.88 vs 0.82), the difference was no statistically significant (p = 0.13). Conclusion: These results add to the present body of knowledge supporting the use of CPET in CHF patients. The VE/VCO2 slope, as an index of ventilatory response to exercise, is an excellent prognostic parameter and improves the risk stratification of CHF patients. It is easier to obtain than parameters of maximal exercise capacity and is of equivalent prognostic importance than peak VO2.
The lowest VE/VCO2 ratio during exercise as a predictor of outcomes in patients with heart failure
Journal of cardiac …, 2009
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)
Peak oxygen consumption and prognosis in heart failure
International Journal of Cardiology, 2013
Background: Peak oxygen consumption (VO2) predictive authority in heart failure (HF) has been established from male cohorts. We evaluated the gender impact on the prognostic meaning of low peak VO2. Methods: We followed 529 HF patients (116 female), with peak VO2 ≤ 14 mL/kg/min, until cardiovascular death (CVD) and urgent heart transplantation. Results: During follow up, 156 (29%) patients had cardiac events. Female gender, age, left ventricular ejection fraction, peak VO2, peak systolic blood pressure, and beta-blocker treatment all contributed to increase the risk ability of the hierarchical multivariate model. Two-year survival was higher in women: 85 vs 66%; χ 2 = 15.7, p b 0.0001. Peculiarly, outcome results were similar when only CVD was considered. Females showed a multivariate adjusted hazard ratio (HR) of 0.46. Since a 1-mL/kg/min increment in peak VO2 was equated with a 12% improvement in prognosis, the same gender adjusted HR was achieved when mean peak VO2 was reduced by 5 units in women: thus, a HF woman with peak VO2 of 9 mL/kg/min has the same 2-year outcome as a HF man with peak VO2 of 14 mL/kg/min. Conclusions: Although HF women have a comparatively lower peak VO2 than men, they live longer. We discovered that the traditional cut point value for peak VO2, i.e. ≤ 14 mL/kg/min is not a "gender-neutral" reference since lumping HF men and women together with the same VO2 value is unlikely to describe the true risk. These preliminary findings do underline the need to assimilate gender-specific issues into clinical practice in HF, when appropriate.
Cardiopulmonary and Noninvasive Hemodynamic Responses to Exercise Predict Outcomes in Heart Failure
Journal of Cardiac Failure, 2013
Background: An impaired cardiac output response to exercise is a hallmark of chronic heart failure (HF). We determined the extent to which noninvasive estimates of cardiac hemodynamics during exercise in combination with cardiopulmonary exercise test (CPX) responses improved the estimation of risk for adverse events in patients with HF. Methods and Results: CPX and impedance cardiography were performed in 639 consecutive patients (mean age 48 6 14 years), evaluated for HF. Clinical, hemodynamic, and CPX variables were acquired at baseline and subjects were followed for a mean of 460 6 332 days. Patients were followed for the composite outcome of cardiac-related death, hospitalization for worsening HF, cardiac transplantation, and left ventricular assist device implantation. Cox proportional hazards analyses including clinical, noninvasive hemodynamic, and CPX variables were performed to determine their association with the composite endpoint. There were 113 events. Among CPX variables, peak oxygen uptake (VO 2) and the minute ventilation (VE)/carbon dioxide production (VCO 2) slope were significant predictors of risk for adverse events (age-adjusted hazard ratio [HR] 1.08, 95% confidence interval [CI] 1.05e1.11 for both; P ! .001). Among hemodynamic variables, peak cardiac index was the strongest predictor of risk (HR 1.08, 95% CI 1.0e1.16; P 5 .01). In a multivariate analysis including CPX and noninvasively determined hemodynamic variables, the most powerful predictive model included the combination of peak VO 2 , peak cardiac index, and the VE/VCO 2 slope, with each contributing significantly and independently to predicting risk; an abnormal response for all 3 yielded an HR of 5.1 (P ! .001). Conclusions: These findings suggest that noninvasive indices of cardiac hemodynamics complement established CPX measures in quantifying risk in patients with HF.
Risk stratification in hf with mid-range LVEF: the role of cardiopulmonary exercise testing
European Heart Journal, 2020
Background Cardiopulmonary exercise testing (CPET) is recommended in the evaluation of selected patients with Heart Failure (HF). Notwithstanding, its prognostic significance has mainly been ascertained in those with left ventricular ejection fraction (LVEF) <40% (i.e., HFrEF). The main goal of our study was to assess the role of CPET in risk stratification of HF with mid-range (40–49%) LVEF (i.e., HFmrEF) compared to HFrEF. Methods We conducted a single-center retrospective study of consecutive patients with HF and LVEF <50% who underwent CPET from 2003–2018. The primary composite endpoint of death, heart transplant or HF hospitalization was assessed. Results Overall, 404 HF patients (mean age 57±11 years, 78.2% male, 55.4% ischemic HF) were included, of whom 321 (79.5%) had HFrEF and 83 (20.5%) HFmrEF. Compared to the former, those with HFmrEF had a significantly higher mean peak oxygen uptake (pVO2) (20.2±6.1 vs 16.1±5.0 mL/kg/min; p<0.001), lower median minute ventilati...
A cardiopulmonary exercise testing score for predicting outcomes in patients with heart failure
American Heart Journal, 2008
Objective The aim of this study is to evaluate the predictive accuracy of a cardiopulmonary exercise test (CPX) score. Background Cardiopulmonary exercise test responses, including peak VO 2 , markers of ventilatory inefficiency (eg, the VE/VCO 2 slope and oxygen uptake efficiency slope [OUES]), and hemodynamic responses, such as heart rate recovery (HRR) and chronotropic incompetence (CRI) are strong predictors of outcomes in patients with heart failure (HF). However, there is a need for simplified approaches that integrate the additive prognostic information from CPX.
2011
Background: Previous research has demonstrated the prognostic value of cardiopulmonary exercise testing (CPX) in elderly patients with heart failure (HF). Investigations that have comprehensively examined the value of CPX across different age groups are lacking. The purpose of the present investigation was to evaluate the prognostic value of CPX in young, middle-aged and older patients with HF. Methods: A total of 1605 subjects (age: 59.2 ± 13.7 years, 78% male) underwent CPX and were subsequently tracked for major cardiac events. Ventilatory efficiency (VE/VCO 2 slope) and peak oxygen consumption (VO 2 ), both absolute and percent-predicted, were determined. The prognostic value of these CPX variables was assessed in ≤ 45, 46-65 and ≥66 year subgroups.