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Cardiopulmonary Exercise Testing in Patients with Heart Failure: Impact of Gender in Predictive Value for Heart

Pedro Garcia Brás1, António Valentim Gonçalves1, João Ferreira Reis1

  • 1Cardiology Department, Santa Marta Hospital, Central Lisbon Hospital University Center, 1169-024 Lisbon, Portugal.

Life (Basel, Switzerland)
|October 28, 2023
PubMed

Insights

Cardiopulmonary exercise testing (CPET) effectively predicts outcomes in heart failure (HF) patients. Sex-specific thresholds for peak VO2 and VE/VCO2 slope may enhance risk stratification and heart transplantation (HTx) selection in women.

Area of Science:

  • Cardiology
  • Exercise Physiology
  • Transplantation Medicine

Background:

  • Exercise testing is crucial for heart failure (HF) risk stratification.
  • Limited data exist on the prognostic power of exercise testing in women with HF.
  • This study aimed to evaluate heart transplantation (HTx) thresholds in HF patients, comparing predictive value between sexes.

Purpose of the Study:

  • To assess the prognostic value of established heart transplantation (HTx) thresholds in women and men with heart failure (HF).
  • To determine if sex-specific exercise testing parameters improve risk stratification for cardiovascular mortality and urgent HTx.

Main Methods:

  • Prospective evaluation of 458 heart failure (HF) patients undergoing cardiopulmonary exercise testing (CPET) between 2009 and 2018.
  • Composite endpoint: cardiovascular mortality and urgent heart transplantation (HTx).
  • Analysis of peak VO2 (pVO2), VE/VCO2 slope, and percent predicted pVO2 for prognostic discrimination.

Main Results:

  • Composite endpoint occurred in 10.5% of females and 16.0% of males over 36 months.
  • Peak VO2, VE/VCO2 slope, and % predicted pVO2 were independent predictors, especially in women.
  • Recommended HTx thresholds showed higher effectiveness in women; sex-specific cut-offs demonstrated superior prognostic power.

Conclusions:

  • Individualized, sex-specific exercise testing thresholds may optimize patient selection for heart transplantation (HTx).
  • Further research is required to fully elucidate sex differences in HF risk stratification using exercise parameters.
Abstract

Keywords:
cardiopulmonary exercise testinggenderheart failureheart transplantationpeak O2 consumption

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