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Abstract: The incidence and prevalence of heart failure increase with age. The cardinal manifestation of heart failure is exercise intolerance. The cardiopulmonary exercise test with determination of peak VO2 provides an integrated measure of both central and peripheral abnormalities in heart failure. It is used to predict prognosis, identify patients for cardiac transplantation and to distinguish cardiac from pulmonary causes of unexplained dyspnea. Most data is derived from middle-aged patients with moderate to severe systolic heart failure. Many elderly patients suffer from diastolic heart failure and the value of cardiopulmonary exercise testing in diastolic heart failure and in the elderly has not been well studied. This review examines the physiology of aging and the clinical utility of exercise testing in elderly patients with heart failure. [Copyright &y& Elsevier]

Objectives/Background In heart failure (HF), pulse pressure (PP) may reflect both vascular stiffness and left ventricular function, but its prognostic role in relation to ejection fraction (EF) is poorly understood. Methods In the Swedish Heart Failure Registry, we investigated the association between PP and 1-year mortality in patients with HF and reduced (HFrEF, < 40%), mid-range (HFmrEF, 40–49%) and preserved EF (HFpEF, ≥ 50%), using multivariable logistic regression and restricted cubic splines. Results Among 36,770 patients discharged alive or enrolled as out-patients with 1-year follow-up (mean age 74 ± 12 years, 63% men, 56% HFrEF, 21% HFmrEF, 23% HFpEF), crude one-year mortality was 18%. Mean PP increased across EF groups: 51 ± 16 in HFrEF, 57 ± 18 in HFmrEF, 60 ± 19 mm Hg in HFpEF. In crude regression splines, the association between PP and mortality was U-shaped in HFmrEF and HFpEF, but curvilinear with only low PP associated with mortality in HFrEF. In multivariable analyses, a significant interaction by EF group and PP was observed (p interaction = 0.015): low PP was associated with higher mortality in HFrEF (adjusted OR [1st vs. 4th quintile] = 1.40, 95% CI 1.18–1.67) and HFpEF (1.43, 1.14–1.81) but only by trend in HFmrEF; high PP had a trend towards higher mortality in HFmrEF (5th vs. 3rd quintile = 1.30, 1.00–1.69) and HFpEF (1.25, 0.98–1.61). Conclusions The association between PP and mortality in HF was influenced by EF. Low PP was independently associated with mortality in HFrEF and HFpEF and by trend in HFmrEF. High PP was independently associated with mortality by trend in HFmrEF and HFpEF. [ABSTRACT FROM AUTHOR]