Age-Stratified Prognostic Value of Cardiopulmonary Exercise Testing Parameters in Patients With Heart Failure

The prognostic value of cardiopulmonary exercise testing (CPET) parameters, particularly peak oxygen consumption (VO₂) and minute ventilation/carbon dioxide production (VE/VCO₂) slope, in patients aged ≥80 years with heart failure (HF) remains unclear.

The study evaluated the age-stratified prognostic value of CPET parameters for adverse outcomes in patients with HF.

In this retrospective multicenter cohort study, we included 830 patients with HF who underwent CPET. The primary outcome was a composite of all-cause death or HF hospitalization within 3 years. CPET parameters were examined in 3 age groups: 20 to 64, 65 to 79, and ≥80 years.

During a median follow-up time of 2.8 years, 176/830 patients experienced adverse outcomes. Peak VO₂ was associated with adverse outcomes in patients 65 years or older (≥80 years: HR: 0.72; 95% CI: 0.62-0.85; 65-79 years: HR: 0.90; 95% CI: 0.84-0.96). VE/VCO₂ slope was consistently associated across age groups (P < 0.05 for all). The area under the curves (95% CI) of peak VO₂ tended to increase with age (20-64 years: 0.61 [0.53-0.69], 65-79 years: 0.74 [0.67-0.81], ≥80 years: 0.81 [0.70-0.91]), whereas VE/VCO₂ slope was comparable across age groups (20-64 years: 0.64 [0.56-0.72], 65-79 years: 0.68 [0.60-0.76], ≥80 years: 0.68 [0.55-0.81]).

Although CPET parameters were associated with adverse outcomes across age groups, the prognostic contribution of peak VO₂ was most pronounced in older patients with HF, highlighting the importance of CPET-based risk stratification in this population.