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Prognostic Value of Cardiopulmonary Exercise Testing in Heart Failure With Reduced, Midrange, and Preserved Ejection Fraction.
- Source :
-
Journal of the American Heart Association [J Am Heart Assoc] 2017 Oct 31; Vol. 6 (11). Date of Electronic Publication: 2017 Oct 31. - Publication Year :
- 2017
-
Abstract
- Background: This study aimed to compare the independent and incremental prognostic value of peak oxygen consumption (VO <subscript>2</subscript> ) and minute ventilation/carbon dioxide production (VE/VCO <subscript>2</subscript> ) in heart failure (HF) with preserved (HFpEF), midrange (HFmEF), and reduced (HFrEF) ejection fraction (LVEF).<br />Methods and Results: In 195 HFpEF (LVEF ≥50%), 144 HFmEF (LVEF 40-49%), and 630 HFrEF (LVEF <40%) patients, we assessed 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 of 4.2 years), and 2-year incident HF hospitalization (244 events). In multivariable Cox regression analysis, greater association with outcomes in HFpEF than HFrEF were noted with peak VO <subscript>2</subscript> (HR [95% confidence interval]: 0.76 [0.67-0.87] versus 0.87 [0.83-0.90] for the composite outcome, P <subscript>interaction</subscript> =0.052; 0.77 [0.69-0.86] versus 0.92 [0.88-0.95], respectively for HF hospitalization, P <subscript>interaction</subscript> =0.003) and VE/VCO <subscript>2</subscript> slope (1.11 [1.06-1.17] versus 1.04 [1.03-1.06], respectively for the composite outcome, P <subscript>interaction</subscript> =0.012; 1.10 [1.05-1.15] versus 1.04 [1.03-1.06], respectively for HF hospitalization, P <subscript>interaction</subscript> =0.019). In HFmEF, peak VO <subscript>2</subscript> and VE/VCO <subscript>2</subscript> slope were associated with the composite outcome (0.79 [0.70-0.90] and 1.12 [1.05-1.19], respectively), while only peak VO <subscript>2</subscript> was related to HF hospitalization (0.81 [0.72-0.92]). In HFpEF and HFrEF, peak VO <subscript>2</subscript> and VE/VCO <subscript>2</subscript> slope provided incremental prognostic value beyond clinical variables based on the C-statistic, net reclassification improvement, and integrated diagnostic improvement, with models containing both measures demonstrating the greatest incremental value.<br />Conclusions: Both peak VO <subscript>2</subscript> and VE/VCO <subscript>2</subscript> slope provided incremental value beyond clinical characteristics and LVEF for predicting outcomes in HFpEF. Cardiopulmonary exercise testing variables provided greater risk discrimination in HFpEF than HFrEF.<br /> (© 2017 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley.)
- Subjects :
- Adult
Aged
Carbon Dioxide metabolism
Cardiorespiratory Fitness
Disease Progression
Echocardiography
Female
Heart Failure mortality
Heart Failure therapy
Heart Transplantation
Heart-Assist Devices
Humans
Lung physiopathology
Male
Middle Aged
Oxygen Consumption
Predictive Value of Tests
Prognosis
Pulmonary Ventilation
Time Factors
Exercise Test
Exercise Tolerance
Heart Failure diagnosis
Heart Failure physiopathology
Stroke Volume
Ventricular Function, Left
Subjects
Details
- Language :
- English
- ISSN :
- 2047-9980
- Volume :
- 6
- Issue :
- 11
- Database :
- MEDLINE
- Journal :
- Journal of the American Heart Association
- Publication Type :
- Academic Journal
- Accession number :
- 29089342
- Full Text :
- https://doi.org/10.1161/JAHA.117.006000