Additive prognostic value of cardiopulmonary exercise testing in elderly patients with heart failure

Area of Science:

• Cardiology
• Geriatrics
• Pulmonology

Background:

• Risk stratification is crucial for managing elderly heart failure (HF) patients.
• The utility of cardiopulmonary exercise testing (CPET) in this demographic remains under-evaluated.
• HF presents with diverse ventricular function profiles, complicating prognostic assessment.

Purpose of the Study:

• To determine if CPET can predict clinical outcomes in elderly patients with HF.
• To assess the prognostic value of CPET parameters, including enhanced ventilatory response (EVR), in this population.
• To investigate the influence of ventricular function on prognosis in elderly HF patients undergoing CPET.

Main Methods:

• A cohort of 220 elderly HF patients (age ≥70) with New York Heart Association (NYHA) class I-III underwent maximal CPET.
• Key CPET metrics included peak oxygen uptake and VE/VCO2 slope, with EVR defined as VE/VCO2 slope ≥34.
• Patients were followed for 19 months for a composite endpoint of death or HF-related hospital admission.

Main Results:

• The composite endpoint occurred in 43% of patients over 19 months.
• Cox multivariable analysis identified creatinine clearance <50 ml/min and EVR as the strongest predictors of adverse outcomes.
• Ventricular systolic function (preserved or depressed) did not significantly influence prognosis.

Conclusions:

• CPET, particularly the VE/VCO2 slope and EVR, provides valuable prognostic information in elderly HF patients.
• EVR is a significant predictor of poor outcomes, irrespective of ventricular systolic function.
• These findings suggest CPET can refine risk stratification for elderly HF patients, identifying high-risk individuals often missed by traditional guidelines.