Journal
JACC-HEART FAILURE
Volume 1, Issue 5, Pages 427-432Publisher
ELSEVIER SCI LTD
DOI: 10.1016/j.jchf.2013.05.008
Keywords
cardiopulmonary exercise test; heart failure; respiratory exchange ratio
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Funding
- RRD VA [IK6 RX002477] Funding Source: Medline
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Objectives The purpose of this analysis was to evaluate the prognostic characteristics of peak oxygen consumption (Vo(2)) and the minute ventilation/carbon dioxide (VE/Vo(2) ) slope of different peak respiratory exchange ratios (RERs) obtained from cardiopulmonary exercise testing in patients with heart failure (HF). Background For patients with HF, peak Vo(2) and the VE/VCo2 slope are used for assessing prognosis. Peak Vo(2) 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. Methods 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). Results 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 Vo(2) 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 Vo(2) (range: 13.8 to 14.0 ml$ kg(-1)$ min(-1); AUC range: 0.68 to 0.75). Conclusions Peak Vo(2) 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 Vo(2), and an elevated VE/VCo2 slope. (J Am Coll Cardiol HF 2013; 1: 427-32) (C) 2013 by the American College of Cardiology Foundation
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