Cardiopulmonary exercise testing in patients with asymptomatic left ventricular dysfunction: lack of prognostic
Ugo Corrà1, Andrea Giordano2, Fabiana Isabella Gambarin1
1Cardiology Department, Istituti Clinici Scientifici Maugeri, Institute of VERUNO, Via per Revislate, 13, 28013 Veruno, NO, Italy.
Insights
Cardiopulmonary exercise testing (CPET) can predict outcomes in asymptomatic left ventricular dysfunction (ALVD) patients, but uses different parameters than in heart failure (HF) patients. Further research is needed to fully understand CPET
Area of Science:
- Cardiology
- Exercise Physiology
- Prognostic Biomarkers
Background:
- Cardiopulmonary exercise testing (CPET) is increasingly used for asymptomatic left ventricular dysfunction (ALVD) patients, extending beyond its established role in chronic heart failure (HF).
- The prognostic value of CPET in ALVD remains less clear compared to HF patients.
Purpose of the Study:
- To determine if CPET can predict clinical outcomes in patients with ALVD.
- To identify which CPET parameters predictive of outcomes in HF patients are also effective in ALVD patients.
Main Methods:
- A cohort of 585 ALVD patients (LVEF ≤ 40% without HF symptoms) and 695 HF patients were screened for cardiac death.
- Key CPET parameters including peak oxygen consumption (pVO2), exertional oscillatory ventilation (EOV), and ventilatory response (VE/VCO2 slope) were compared between survivors and non-survivors.
Main Results:
- ALVD patients were younger and had a lower incidence of cardiac death compared to HF patients.
- Non-survivors in the ALVD group showed a significantly higher incidence of EOV, lower pVO2, and a higher VE/VCO2 slope compared to survivors.
- No single ventilatory parameter demonstrated prognostic value in multivariable analysis for ALVD patients.
Conclusions:
- CPET can predict adverse events in ALVD patients, but the specific parameters for risk stratification differ from those used in HF.
- Further multi-center trials are necessary to precisely quantify the predictive impact of CPET parameters in ALVD.
Aims:
The indication for cardiopulmonary exercise testing (CPET) in predictive evaluation has been extended beyond chronic heart failure (HF) patients to include asymptomatic left ventricular dysfunction (ALVD) patients, but its prognostic value is still unclear. We aimed to verify if CPET can predict outcome in ALVD and to identify which of the CPET parameters predictive in chronic HF are also effective in ALVD patients.
Methods And Results:
We screened ALVD (LVEF ≤ 40% without HF symptoms) and HF patients for cardiac death, and compared peak oxygen consumption (pVO2), exertional oscillatory ventilation (EOV), and ventilatory response (VE/VCO2 slope) between survivors and non-survivors. Asymptomatic left ventricular dysfunction and HF patients formed the study population (585 ALVD and 695 HF). Both groups had similar male prevalence (98% vs. 98%; P = 0.345) but ALVD patients were younger (52 ± 10 vs. 60 ± 10 years, P = 0.004). Cardiac death was observed in 142 patients (5% of ALVD, 15% of HF). Exertional oscillatory ventilation occurred in 4% of ALVD, whereas VE/VCO2 slope was significantly lower (30 ± 7 vs. 35 ± 4) and pVO2 higher (16 ± 4 vs. 14 ± 3 mL/kg/min) than in chronic HF patients. Asymptomatic left ventricular dysfunction non-survivors had a significantly greater EOV incidence (13% vs. 3%, P = 0.003), lower pVO2 (13 ± 4 vs. 16 ± 3 mL/kg/min P = 0.000) and higher VE/VCO2 slope (33 ± 7 vs. 31 ± 5, P = 0.032). No ventilatory parameter had prognostic value at multivariable analysis in ALVD patients.
Conclusions:
Cardiopulmonary exercise testing can predict events in ALVD patients, but the risk stratification relies on different parameters than in HF patients. Further analysis in a multi-centre trial is required to better quantify the predictive impact of CPET risk parameters in ALVD patients.
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