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Patients With Heart Failure in the "Intermediate Range" of Peak Oxygen Uptake: ADDITIVE VALUE OF HEART RATE RECOVERY AND THE MINUTE VENTILATION/CARBON DIOXIDE OUTPUT SLOPE IN PREDICTING MORTALITY.
MedLine Citation:
PMID:  22487616     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
PURPOSE:: While patients with heart failure who achieve a peak oxygen uptake (peak VO2) of 10 mL·kg·min or less are often considered for intensive surveillance or intervention, those achieving 14 mL·kg·min or more are generally considered to be at lower risk. Among patients in the "intermediate" range of 10.1 to 13.9 mL·kg·min, optimally stratifying risk remains a challenge. METHODS:: Patients with heart failure (N = 1167) referred for cardiopulmonary exercise testing were observed for 21 ± 13 months. Patients were classified into 3 groups of peak VO2 (≤10, 10.1-13.9, and ≥14 mL·kg·min). The ability of heart rate recovery at 1 minute (HRR1) and the minute ventilation/carbon dioxide output (VE/VCO2) slope to complement peak VO2 in predicting cardiovascular mortality were determined. RESULTS:: Peak VO2, HRR1 (<16 beats per minute), and the VE/VCO2 slope (>34) were independent predictors of mortality (hazard ratio 1.6, 95% CI: 1.2-2.29, P = .006; hazard ratio 1.7, 95% CI: 1.1-2 .5, P = .008; and hazard ratio 2.4, 95% CI: 1.6-3.4, P < .001, respectively). Compared with those achieving a peak VO2 ≥ 14 mL·kg·min, patients within the intermediate range with either an abnormal VE/VCO2 slope or HRR1 had a nearly 2-fold higher risk of cardiac mortality. Those with both an abnormal HRR1 and VE/VCO2 slope had a higher mortality risk than those with a peak VO2 ≤ 10 mL·kg·min. Survival was not different between those with a peak VO2 ≤ 10 mL·kg·min and those in the intermediate range with either an abnormal HRR1 or VE/VCO2 slope. CONCLUSIONS:: HRR1 and the VE/VCO2 slope effectively stratify patients with peak VO2 within the intermediate range into distinct groups at high and low risk.
Authors:
Luiz Eduardo Ritt; Ricardo Brandão Oliveira; Myers Jonathan; Ross Arena; Mary Ann Peberdy; Daniel Bensimhon; Paul Chase; Daniel Forman; Marco Guazzi
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2012-4-6
Journal Detail:
Title:  Journal of cardiopulmonary rehabilitation and prevention     Volume:  -     ISSN:  1932-751X     ISO Abbreviation:  -     Publication Date:  2012 Apr 
Date Detail:
Created Date:  2012-4-10     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  101291247     Medline TA:  J Cardiopulm Rehabil Prev     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Affiliation:
Hospital Santa Izabel, Salvador, BA, and São Paulo Federal University, São Paulo, Brazil (Dr Ritt); Rio de Janeiro State University, Rio de Janeiro, Brazil Dr Oliveira); VA Palo Alto Health Care System, Cardiology Division, Stanford University, Palo Alto, California (Dr Myers); Physical Therapy Program, Department of Orthopaedics and Division of Cardiology, Department of Internal Medicine, University of New Mexico, Albuquerque (Dr Arena); Department of Internal Medicine, Virginia Commonwealth University, Richmond (Dr Peberdy); LeBauer Cardiovascular Research Foundation, Greensboro, North Carolina (Dr. Bensimhon and Mr. Chase); Brigham and Women's Hospital, Cardiovascular Division, and VA Boston Healthcare System, Geriatric Research, Education, and Clinical Center, Boston, Massachusetts (Dr Forman); and University of Milano, San Paolo Hospital, Cardiology Division, Milano, Italy (Dr Guazzi).
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