The population consisted of 32 men and 18 women. No gender-related differences were found. Two groups could be distinguished in terms of prognosis: G1: n = 31 living patients with no events, and G2: n = 19 deceased or with major events. G1 and G2 were comparable with regard to age, sex ratio and ejection fraction. Several of the 52 parameters tested were different in the two groups, in particular peak VO2, exercise duration, the workload developed during the cardiopulmonary test and all the invasive exercise haemodynamic parameters except heart rate (P < 0.0001). Haemodynamic parameters at rest had no prognostic value in this series. The ROC curves, the survival curves and the Cox analysis showed that exercise cardiac power output, exercise left ventricular work indices and exercise peak VO2 were the most useful factors for assessing the prognosis of patients with NYHA II or III chronic heart failure. An exercise cardiac power output < 2 watts accurately identified those patients with a short-term poor prognosis, and exercise peak VO2 was almost as accurate. To a lesser extent, the NYHA functional class was also an independent prognostic parameter during multivariate analysis. In conclusion, it appears that invasive haemodynamic parameters are best for determining the prognosis of patients with chronic heart failure. Peak VO2 can, however, be as useful. Moreover this is an easily obtainable non-invasive parameter, which makes it more useful in the evaluation and the follow up of such patients.

The prognostic value of exercise peak VO2 is still controversial. We therefore prospectively studied 75 patients in New York Heart Association functional class II or III with chronic heart failure stabilized by drug treatment. The patients (mean age of 58 +/- 10 years) were submitted to a clinical examination, a radionuclide determination of left ventricular ejection fraction, and a haemodynamic study at rest (right side catheterization); their plasma sodium, plasma creatinine and blood urea nitrogen levels were measured in addition to exercise peak VO2. An exercise peak VO2 threshold value of 14 ml.kg-1.min-1 was used to define two groups: GI (23 patients), with an exercise peak VO2 < or = 14 ml.kg-1.min-1 and G2 (52 patients) with an exercise peak VO2 > 14 m.kg-1.min-1. G1 and G2 were comparable in terms of age, heart rate, left ventricular ejection fraction, cardiac index and mean arterial pressure. Apart from exercise peak VO2, G1 and G2 also showed differences in right and left ventricular filling pressures, plasma sodium, plasma creatinine, blood urea nitrogen levels and exercise duration (all P < 0.01). Moreover the prognosis was worse in G1 than in G2: nine deaths vs 0, and seven major events--major events being defined as pulmonary oedema, hospitalization for heart failure, or severe ventricular arrhythmias--vs three (P < 0.001). A sub-group analysis (deceased patients, living patients with and without major events) was performed. Out of 20 clinical and paraclinical parameters, exercise peak VO2 proved to have the greatest prognostic value.(ABSTRACT TRUNCATED AT 250 WORDS)

This study provides information on dual chamber pacemakers' longevity and highlights the impact of devices' reprogramming on expected longevities.

No abstract

The survival rate of heart transplant patients has increased considerably since the development of new immunosuppressive drugs. In the long term, however, cardiac transplantation results in a high incidence of osteoporosis which represents a major functional handicap. To examine whether patients in the early stages have impaired phosphocalcic metabolism, intact parathyroid hormone (PTH 1-84), native osteocalcin, ionized Ca++ and pH were measured at rest and during muscular exercises a dynamic test used to override circadian and ultradian PTH variations. A group of 12 patients receiving the usual immunosuppressive therapy, which is mainly an association of cyclosporin and prednisolone, and 8 sedentary control subjects performed a square-wave endurance test at the same relative intensity for 30 min. No patient had previous bone disease and the period since transplantation was 12.2 +/- 2.7 months. For the transplant patients, initial PTH concentrations and responses to exercise were higher (P < 0.01) compared to the control subjects with a dramatic increase after 10 min of recovery. From higher (P < 0.001) resting concentrations, osteocalcin further increased during exercise (P < 0.01) in the heart transplant group but not in the control subjects. In both groups pH showed the same time-course with a rapid fall during exercise (P < 0.05) and Ca++ concentrations increased during the exercise period. (P < 0.01 for patients; P < 0.05 for controls) with a significant fall in both groups after 10 min of recovery (P < 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)