Predictive Value of Cardiopulmonary Exercise Testing Parameters in Ambulatory Advanced Heart Failure.

Area of Science:

• Cardiology
• Exercise Physiology
• Heart Failure Management

Background:

• Optimal cardiopulmonary exercise (CPX) predictors for outcomes in ambulatory advanced heart failure (HF) patients are not well-defined.
• Understanding these predictors is crucial for timely clinical decision-making and patient management.

Purpose of the Study:

• To identify cardiopulmonary exercise (CPX) predictors for the combined outcome of durable mechanical circulatory support (MCS), transplantation, or death within one year.
• To evaluate both maximal and submaximal CPX parameters in predicting adverse events in advanced HF patients.

Main Methods:

• The REVIVAL (Registry Evaluation of Vital Information for VADs in Ambulatory Life) study enrolled 400 systolic HF patients (INTERMACS profiles 4-7).
• Cardiopulmonary exercise testing (CPX) was performed on 273 subjects.
• Maximal (peak oxygen consumption, circulatory power) and submaximal (ventilatory efficiency slope) CPX parameters were analyzed using Cox regression and concordance statistics.

Main Results:

• At one year, 39 events (transplantation, death, MCS implantation) occurred.
• Circulatory power (CP) and ventilatory efficiency (VE/VCO2 slope) were significant multivariate predictors of the composite outcome (HR: 0.89, p=0.001 and HR: 1.05, p=0.001, respectively).
• Patient-reported peak Borg scale score also significantly contributed to outcome prediction (HR: 1.20, p=0.005).

Conclusions:

• Circulatory power (CP) and ventilatory efficiency slope (VE/VCO2) are the strongest maximal and submaximal CPX predictors, respectively, for adverse outcomes in ambulatory advanced HF.
• The patient-reported Borg scale score emerged as a novel and significant predictor, highlighting the value of subjective exercise effort assessment.
• These findings offer valuable insights for risk stratification and management strategies in advanced heart failure patients.