Cardiopulmonary exercise testing and prognosis in heart failure due to systolic left ventricular dysfunction: a validation study of the European Society of Cardiology Guidelines and Recommendations (2008) and further developments.

Abstract

AIMS:

The study aims were to validate the cardiopulmonary exercise testing (CPET) parameters recommended by the European Society of Cardiology 2008 Guidelines for risk assessment in heart failure (HF) (ESC-predictors) and to verify the predictive role of 11 supplementary CPET (S-predictors) parameters.

METHODS AND RESULTS:

We followed 749 HF patients for cardiovascular death and urgent heart transplantation for 3 years: 139 (19%) patients had cardiac events. ESC-predictors - peak oxygen consumption (VO(2)), slope of minute ventilation vs carbon dioxide production (VE/VCO(2)) and exertional oscillatory ventilation - were all related to outcome at univariate and multivariable analysis. The ESC/2008 prototype based on ESC-predictors presented a Harrell's C concordance index of 0.725, with a likely χ2 of 98.31. S-predictors - predicted peak VO(2), peak oxygen pulse, peak respiratory exchange ratio, peak circulatory power, peak VE/VCO(2), VE/VCO(2) slope normalized by peak VO(2), VO(2) efficiency slope, ventilatory anaerobic threshold detection, peak end-tidal CO(2) partial pressure, peak heart rate, and peak systolic arterial blood pressure (SBP) - were all linked to outcome at univariate analysis. When individually added to the ESC/2008 prototype, only peak SBP and peak O(2) pulse significantly improved the model discrimination ability: the ESC + peak SBP prototype had a Harrell's C index 0.750 and reached the highest likely χ2 (127.16, p < 0.0001).

CONCLUSIONS:

We evaluated the longest list of CPET prognostic parameters yet studied in HF: ESC-predictors were independent predictors of cardiovascular events, and the ESC prototype showed a convincing predictive capacity, whereas none of 11 S-predictors enhanced the prognostic performance, except peak SBP.

• Authors: Ugo Corrà, Andrea Giordano, Alessandro Mezzani, Marco Gnemmi, Massimo Pistono, Roberto Caruso, Pantaleo Giannuzzi
• Journal: European journal of preventive cardiology (Eur J Prev Cardiol) Vol. 19 Issue 1 Pg. 32-40 (Feb 2012) ISSN: 2047-4881 [Electronic] England
• PMID: 21450614 (Publication Type: Journal Article, Validation Study)

Topics

• Aged
• Blood Pressure
• Chi-Square Distribution
• Exercise Test (standards)
• Female
• Heart Failure (diagnosis, etiology, mortality, physiopathology, surgery)
• Heart Rate
• Heart Transplantation
• Humans
• Italy (epidemiology)
• Male
• Middle Aged
• Multivariate Analysis
• Oxygen Consumption
• Practice Guidelines as Topic
• Predictive Value of Tests
• Prognosis
• Pulmonary Ventilation
• Reproducibility of Results
• Retrospective Studies
• Risk Assessment
• Risk Factors
• Societies, Medical (standards)
• Time Factors
• Ventricular Dysfunction, Left (complications, mortality, physiopathology)
• Ventricular Function, Left