Clinical Edge

Summaries of Must-Read Clinical Literature, Guidelines, and FDA Actions

Cardiopulmonary Exercise Testing in HF Patients

J Am Heart Assoc; ePub 2017 Oct 31; Nadruz, et al

Both peak oxygen consumption (VO2) and minute ventilation/carbon dioxide production (VE/VCO2) slope provided incremental value beyond clinical characteristics and left ventricular ejection fraction (LVEF) for predicting outcomes in patients with heart failure with preserved ejection fraction (HFpEF). Further, cardiopulmonary exercise testing variables provider greater risk discrimination in HFpEF than heart failure with reduced ejection fraction (HFrEF). In 195 HFpEF (LVEF ≥50%), 144 HFmEF (LVEF 40-49%), and 630 HFrEF (LVEF <40%) patients, the association of cardiopulmonary exercise testing variables with the composite outcome of death, left ventricular assist device implantation, or heart transplantation (256 events; median follow-up 4.2 years), and 2-year incident HF hospitalization (244 events) was assessed. Among the findings:

  • Peak oxygen consumption is predictive of worse prognosis in HFpEF, HFmEF, and HFrEF.
  • Among patients with HFpEF, both VO2 and VE/VCO2 slope provided incremental prognostic value beyond relevant clinical covariates for long‐term adverse outcomes.
  • Cardiopulmonary exercise testing variables provided greater risk discrimination in HFpEF vs HFrEF.

Citation:

Nadruz W, West E, Sengeløv M, et al. Prognostic value of cardiopulmonary exercise testing in heart failure with reduced, midrange, and preserved ejection fraction. [Published online ahead of print October 31, 2017]. J Am Heart Assoc. doi:10.1161/JAHA.117.006000.