Document Detail


Defining the optimal prognostic window for cardiopulmonary exercise testing in patients with heart failure.
MedLine Citation:
PMID:  20200329     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Ventilatory efficiency (VE/VCO(2) slope) and peak oxygen consumption (VO) provide robust prognostic information in patients with heart failure undergoing cardiopulmonary exercise testing (CPX). The purpose of this study is to assess the change in prognostic characteristics of CPX at different time intervals.
METHODS AND RESULTS: Seven hundred ninety-one subjects (74% male, mean age: 60.7+/-12.9 years, ejection fraction: 34.6+/-15.0%, ischemic etiology: 51%) underwent CPX and were tracked for major cardiac events over a 4-year period. All event-free subjects were tracked for at least 3 years. Mean VE/VCO(2) slope and peak VO(2) were 35.0+/-10.0 and 16.0+/-6.4 mL O(2) . kg(-1) . min(-1), respectively. There were a total of 263 major cardiac events (199 deaths, 45 transplants, and 19 left ventricular assist device implantations). Both continuous and dichotomous expressions of the VE/VCO(2) slope and peak VO(2) were prognostically significant up to 18 months post-CPX. Continuous and dichotomous expressions of the VE/VCO(2) slope remained prognostically significant up to 36 months post-CPX, whereas peak VO(2) was not predictive during the third and fourth year of follow-up. In a multivariate analysis, the VE/VCO(2) slope was consistently the superior prognostic marker, whereas peak VO(2) added predictive value and was retained in the regression up to 18 months post-CPX.
CONCLUSIONS: These results indicate that commonly assessed CPX variables retain prognostic value for at least 2 years. The VE/VCO(2) slope is the superior predictor of adverse events throughout follow-up, although peak VO(2) provides additive prognostic information during the first 2 years of follow-up.
Authors:
Ross Arena; Jonathan Myers; Joshua Abella; Sherry Pinkstaff; Peter Brubaker; Dalane Kitzman; Mary Ann Peberdy; Daniel Bensimhon; Paul Chase; Daniel E Forman; Marco Guazzi
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Publication Detail:
Type:  Clinical Trial; Journal Article; Multicenter Study; Research Support, N.I.H., Extramural     Date:  2010-03-03
Journal Detail:
Title:  Circulation. Heart failure     Volume:  3     ISSN:  1941-3297     ISO Abbreviation:  Circ Heart Fail     Publication Date:  2010 May 
Date Detail:
Created Date:  2010-05-20     Completed Date:  2010-07-15     Revised Date:  2012-05-17    
Medline Journal Info:
Nlm Unique ID:  101479941     Medline TA:  Circ Heart Fail     Country:  United States    
Other Details:
Languages:  eng     Pagination:  405-11     Citation Subset:  IM    
Affiliation:
Department of Physical Therapy, Virginia Commonwealth University, Richmond, VA 23298, USA. raarena@vcu.edu
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MeSH Terms
Descriptor/Qualifier:
Adult
Aged
Carbon Dioxide / metabolism
Cohort Studies
Exercise Test*
Female
Heart Failure / diagnosis*,  mortality,  physiopathology*
Humans
Male
Middle Aged
Oxygen Consumption / physiology
Predictive Value of Tests
Prognosis
Pulmonary Ventilation / physiology*
Survival Analysis
Time Factors
Grant Support
ID/Acronym/Agency:
P60 AG010484-10/AG/NIA NIH HHS; P60AG10484/AG/NIA NIH HHS; R37 AG018915/AG/NIA NIH HHS; R37 AG018915-10/AG/NIA NIH HHS; R37AG18915/AG/NIA NIH HHS
Chemical
Reg. No./Substance:
124-38-9/Carbon Dioxide

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