Predictive Value of Cardiopulmonary Exercise Testing Parameters in Ambulatory Advanced Heart Failure.

Abstract

OBJECTIVES:

This study sought to determine cardiopulmonary exercise (CPX) predictors of the combined outcome of durable mechanical circulatory support (MCS), transplantation, or death at 1 year among patients with ambulatory advanced heart failure (HF).

BACKGROUND:

Optimal CPX predictors of outcomes in contemporary ambulatory advanced HF patients are unclear.

METHODS:

REVIVAL (Registry Evaluation of Vital Information for ventricular assist devices [VADs] in Ambulatory Life) enrolled 400 systolic HF patients, INTERMACS (Interagency Registry for Mechanically Assisted Circulatory Support) profiles 4-7. CPX was performed by 273 subjects 2 ± 1 months after study enrollment. Discriminative power of maximal (peak oxygen consumption [peak VO2]; VO2 pulse, circulatory power [CP]; peak systolic blood pressure • peak VO2], peak end-tidal pressure CO2 [PEtCO2], and peak Borg scale score) and submaximal CPX parameters (ventilatory efficiency [VE/VCO2 slope]; VO2 at anaerobic threshold [VO2AT]; and oxygen uptake efficiency slope [OUES]) to predict the composite outcome were assessed by univariate and multivariate Cox regression and Harrell's concordance statistic.

RESULTS:

At 1 year, there were 39 events (6 transplants, 15 deaths, 18 MCS implantations). Peak VO2, VO2AT, OUES, peak PEtCO2, and CP were higher in the no-event group (all p < 0.001), whereas VE/VCO2 slope was lower (p < 0.0001); respiratory exchange ratio was not different. CP (hazard ratio [HR]: 0.89; p = 0.001), VE/VCO2 slope (HR: 1.05; p = 0.001), and peak Borg scale score (HR: 1.20; p = 0.005) were significant predictors on multivariate analysis (model C-statistic: 0.80).

CONCLUSIONS:

Among patients with ambulatory advanced HF, the strongest maximal and submaximal CPX predictor of MCS implantation, transplantation, or death at 1 year were CP and VE/VCO2, respectively. The patient-reported measure of exercise effort (Borg scale score) contributed substantially to the prediction of outcomes, a surprising and novel finding that warrants further investigation. (Registry Evaluation of Vital Information for VADs in Ambulatory Life [REVIVAL]; NCT01369407).

• Authors: Anuradha Lala, Keyur B Shah, David E Lanfear, Jennifer T Thibodeau, Maryse Palardy, Amrut V Ambardekar, Dennis M McNamara, Wendy C Taddei-Peters, J Timothy Baldwin, Neal Jeffries, Shokoufeh Khalatbari, Cathie Spino, Blair Richards, Douglas L Mann, Garrick C Stewart, Keith D Aaronson, Donna M Mancini, REVIVAL Investigators
• Journal: JACC. Heart failure (JACC Heart Fail) Vol. 9 Issue 3 Pg. 226-236 (03 2021) ISSN: 2213-1787 [Electronic] United States
• PMID: 33549559 (Publication Type: Journal Article, Research Support, N.I.H., Extramural)
• Copyright: Copyright © 2021 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

Topics

• Anaerobic Threshold
• Exercise Test
• Heart Failure (diagnosis, therapy)
• Heart Failure, Systolic
• Heart-Assist Devices
• Humans
• Oxygen Consumption
• Prognosis