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Combining low-intensity and maximal exercise test results improves prognostic prediction in chronic heart failure.
- Source :
-
Journal of the American College of Cardiology (JACC) . Jul2003, Vol. 42 Issue 1, p116-122. 7p. - Publication Year :
- 2003
-
Abstract
- <bold>Objectives: </bold>This study investigated the combination of maximal and low-intensity exercise testing in predicting prognosis in chronic heart failure (CHF), using one single exercise test (two-step protocol).<bold>Background: </bold>Risk assessment based on any single factor has limited accuracy and reproducibility.<bold>Methods: </bold>Treadmill exercise testing was performed in 202 consecutive CHF patients (174 male; mean age 52 +/- 11 years) using "breath-by-breath" gas exchange monitoring. Oxygen uptake (VO(2)) kinetics were defined as oxygen deficit (DeltaVO(2) x time [rest to steady state] - Sigma VO(2) [rest to steady state]) and mean response time (MRT = oxygen-deficit/DeltaVO(2)). Peak VO(2) (VO(2)max) was defined as the highest VO(2). Mean follow-up was 873 +/- 628 days. The primary end point was cardiac mortality and the need for urgent heart transplantation.<bold>Results: </bold>Forty-four patients (22%) died and 15 (7%) were urgently transplanted. In both univariate and multivariate analyses, MRT >50 s was the most powerful predictor of the primary end point (hazard ratio [HR] 4.44), followed by predicted VO(2)max <50% (HR 3.50) and resting systolic blood pressure <105 mm Hg (HR 2.49, all p < 0.001). A majority (n = 130 [64%]) had one or none of these risk factors, with a one-year event rate of only 3%. Patients with two risk factors (n = 45 [22%]) were at medium risk (one-year event rate of 33%). Twenty-seven patients (13%) had all three risk factors, with a one-year event rate of 59%. The area under the curve, using the number of risk factors, was 0.86 +/- 0.04 for the primary end point at one year. These results were independent of medication, in particular, beta-blockade.<bold>Conclusions: </bold>A combination of low-intensity and maximal exercise test results improves assessment of prognosis in patients with CHF. [ABSTRACT FROM AUTHOR]
Details
- Language :
- English
- ISSN :
- 07351097
- Volume :
- 42
- Issue :
- 1
- Database :
- Academic Search Index
- Journal :
- Journal of the American College of Cardiology (JACC)
- Publication Type :
- Academic Journal
- Accession number :
- 106691569
- Full Text :
- https://doi.org/10.1016/s0735-1097(03)00502-3