Abstract | BACKGROUND: Studies demonstrating prognostic value of excessive exercise ventilation in chronic heart failure (CHF) have focused on data derived from the whole cardiopulmonary exercise test ( CPET). Whether ventilatory response to early phase of exercise is useful for risk stratification in CHF is unknown. METHODS AND RESULTS: We evaluated 216 patients with systolic CHF who underwent CPET (age: 60+/-11 years, NYHA class [I/II/III/IV]: 18/104/77/17). Ventilatory response to exercise (slope of regression line relating ventilation to carbon dioxide production) was calculated from the whole exercise test (VE-VCO(2)-all) and from the first 3 min of exercise (early phase - VE-VCO(2)-3 min). During follow-up (mean: 40+/-20 months, >3 years in survivors), 89 (41%) CHF patients died. High VE-VCO(2)-all and VE-VCO(2)-3 min predicted poor outcome in single predictor analyses, and in multivariable models when adjusted for prognosticators (age, NYHA class, ejection fraction, peak VO(2)) (P<0.0001). In receiver operating characteristic curve analysis, areas under curve for 3-year follow-up were similar for VE-VCO(2)-all and VE-VCO(2)-3 min. VE-VCO(2)-3 min maintained its prognostic value in patients taking beta-blockers (P<0.0001) and those unable to perform maximal CPET (P=0.0009). CONCLUSIONS: In CHF patients, excessive ventilation assessed over the first 3 min predicts poor outcome. Assessment of ventilatory response to exercise for prognostic stratification may be extended to patients unable to perform maximal CPET.
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Authors | Ewa A Jankowska, Tomasz Witkowski, Beata Ponikowska, Krzysztof Reczuch, Ludmila Borodulin-Nadzieja, Stefan D Anker, Massimo F Piepoli, Waldemar Banasiak, Piotr Ponikowski |
Journal | European journal of heart failure
(Eur J Heart Fail)
Vol. 9
Issue 10
Pg. 1024-31
(Oct 2007)
ISSN: 1388-9842 [Print] England |
PMID | 17702647
(Publication Type: Journal Article, Research Support, Non-U.S. Gov't)
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Topics |
- Aged
- Chronic Disease
- Exercise Test
- Exercise Therapy
- Female
- Heart Failure, Systolic
(mortality, therapy)
- Humans
- Male
- Middle Aged
- Oxygen Consumption
(physiology)
- Prognosis
- Prospective Studies
- Pulmonary Ventilation
(physiology)
- Stroke Volume
- Time Factors
- Treatment Outcome
- Ventilation-Perfusion Ratio
(physiology)
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