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Integration of Brain Tissue Saturation Monitoring in Cardiopulmonary Exercise Testing in Patients with Heart Failure
Published on: October 1, 2019
Cardiopulmonary exercise testing is equally prognostic in young, middle-aged and older individuals diagnosed with
Ross Arena1, Jonathan Myers, Joshua Abella
1Department of Physical Therapy, Virginia Commonwealth University, Richmond, Virginia 23298-0224, USA. raarena@vcu.edu
Insights
Cardiopulmonary exercise testing (CPX) provides valuable prognostic information for heart failure (HF) patients across all age groups. Key metrics like ventilatory efficiency and peak oxygen consumption are significant predictors of cardiac events, regardless of patient age.
Area of Science:
- Cardiology
- Exercise Physiology
- Clinical Medicine
Background:
- Cardiopulmonary exercise testing (CPX) is established as a prognostic tool in elderly heart failure (HF) patients.
- Limited research exists on CPX's prognostic utility across diverse age demographics in HF.
Purpose of the Study:
- To assess the prognostic value of CPX in young, middle-aged, and older individuals diagnosed with heart failure.
- To determine if CPX parameters offer consistent predictive power across different age strata within the HF population.
Main Methods:
- 1605 heart failure patients (mean age 59.2 years, 78% male) underwent CPX.
- Key CPX variables including ventilatory efficiency (VE/VCO2 slope) and peak oxygen consumption (VO2) were analyzed.
- Prognostic value was evaluated across three age subgroups: ≤45, 46-65, and ≥66 years.
Main Results:
- Three-year major cardiac event rates were 8.8% (≤45), 6.0% (46-65), and 5.7% (≥66 years).
- VE/VCO2 slope, peak VO2, and percent-predicted peak VO2 were significant prognostic markers in all age groups.
- Actual peak VO2 was more prognostic in the youngest and oldest groups, while percent-predicted peak VO2 was better in the middle-aged group.
Conclusions:
- CPX offers significant prognostic insights for heart failure patients, irrespective of their age.
- Ventilatory efficiency and peak oxygen consumption are reliable indicators of cardiac event risk across the lifespan in HF.
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.
Results:
The three year event rates for major cardiac events in the ≤ 45, 46-65 and ≥ 66 year subgroups were 8.8%, 6.0% and 5.7%, respectively. The VE/VCO(2) slope (Hazard ratio ≥ 1.07, p<0.001), peak VO(2) (Hazard ratio ≤ 0.87, p<0.001) and percent-predicted peak VO(2) (Hazard ratio 0 ≤ 0.98, p<0.001) were all significant prognostic markers in each age subgroup. While the VE/VCO(2) slope carried the greatest prognostic strength, peak VO(2) and percent-predicted peak VO(2) were retained in multivariate analyses (Residual Chi-Square ≥ 5.2, p<0.05). With respect to peak VO(2), the actual value was the more robust prognostic marker in the ≤ 45 and ≥ 66 year subgroups while the percent-predicted expression provided better predictive resolution in subjects who were 46-65 years old.
Conclusions:
These results indicate that, irrespective of a patient's age at presentation, CPX provides valuable prognostic information in the HF population.
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