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Variables Measured During Cardiopulmonary Exercise Testing as Predictors of Mortality in Chronic Systolic Heart
Steven J Keteyian1, Mahesh Patel2, William E Kraus2
1Division of Cardiovascular Medicine, Henry Ford Hospital, Detroit, Michigan.
Journal of the American College of Cardiology
|February 20, 2016
Summary
Cardiopulmonary exercise (CPX) test variables like peak oxygen uptake and exercise duration strongly predict mortality in heart failure patients. Prognosis varies by sex, with peak oxygen uptake being a key indicator for men and exercise duration for women.
Area of Science:
- Cardiology
- Exercise Physiology
- Clinical Trials
Background:
- Cardiopulmonary exercise (CPX) testing is crucial for determining prognosis in chronic heart failure (HF) patients.
- Limited research has simultaneously compared the prognostic strength of multiple CPX variables.
Purpose of the Study:
- To assess the association between CPX variables and all-cause mortality in patients with heart failure with reduced ejection fraction (HFrEF).
- To investigate the influence of sex and patient effort (respiratory exchange ratio) on these associations.
Main Methods:
- Analysis of 10 baseline CPX variables from 2,100 patients (29% women) in the HF-ACTION trial.
- Examined variables included peak oxygen uptake (Vo2), exercise duration, and percent predicted peak Vo2 (%ppVo2).
Main Results:
- All CPX variables, except respiratory exchange ratio (RER), significantly predicted mortality (p < 0.0001).
- %ppVo2 and exercise duration showed equal predictive and discriminatory power for mortality.
- Peak Vo2 was the strongest predictor for men, while exercise duration was for women; sex-specific differences in prognosis were observed.
Conclusions:
- Peak Vo2, exercise duration, and %ppVo2 are the strongest predictors of mortality in HFrEF patients.
- The prognostic value of peak Vo2 differs significantly between men and women.
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