The Prognostic Utility of Cardiopulmonary Exercise Testing Stands the Test of Time in Patients With Heart Failure

ArticleinJournal of cardiopulmonary rehabilitation and prevention 32(4):198-202 · July 2012with3 Reads
Impact Factor: 1.58 · DOI: 10.1097/HCR.0b013e318259f153 · Source: PubMed

    Abstract

    INTRODUCTION: 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. METHODS: 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 (<(V)over dot>(O2)) and the minute ventilation/carbon dioxide production (<(V)over dot>(E)/<(V)over dot>(CO2)) slope were ascertained for all tests. RESULTS: Both the <(V)over dot>(E)/<(V)over dot>(CO2) slope and peak <(V)over dot>(O2) were strong univariate predictors of adverse events in both subgroups. In the multivariate analysis, the <(V)over dot>(E)/<(V)over dot>(CO2) slope was the strongest predictive marker while peak <(V)over dot>(O2) added predictive value and was retained in the regression for all scenarios. In subjects undergoing CPX before 2006, a <(V)over dot>(E)/<(V)over dot>(CO2) slope 45 or greater and a peak <(V)over dot>(O2) of less than 10 mL.kg(-1).min(-1) 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 <(V)over dot>(E)/<(V)over dot>(CO2) slope 45 or greater and a peak <(V)over dot>(O2) of less than 10 mL.kg(-1). min(-1) generated a hazard ratio of 8.2 (95% CI: 4.7-14.3, P < .001) when considering only mortality as an endpoint. CONCLUSION: The results of this study indicate that CPX continues to be a valuable clinical assessment in the present-day HF management.