Clinical, Hemodynamic, and Cardiopulmonary Exercise Test Determinants of Survival in Patients Referred for Evaluation of Heart Failure

Myers, Jonathan

doi:10.7326/0003-4819-129-4-199808150-00004

Cited by 234 publications

(175 citation statements)

References 22 publications

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“…Although some have proposed using percent-predicted V O 2 based on age and sex, this value has not been shown to be more effective at predicting survival than the simple value. 3 Furthermore, in our supplementary analyses, results were essentially equivalent when using the percent-predicted value.…”

Section: Discussionmentioning

confidence: 74%

Peak Oxygen Consumption as a Predictor of Death in Patients With Heart Failure Receiving β-Blockers

O’Neill¹,

Young²,

Pothier³

et al. 2005

ACC Current Journal Review

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Background-Peak oxygen uptake (peak V O 2 ) is a strong predictor of mortality and is commonly used in the evaluation of patients for cardiac transplantation. ␤-Blockers reduce mortality in patients with heart failure, without influencing peak V O 2 , raising the possibility that peak V O 2 is no longer suitable as an indicator of prognosis in these patients. Methods and Results-We analyzed prospectively gathered data on 2105 patients referred for cardiopulmonary testing for all-cause mortality and for occurrence of death or transplantation. Patients receiving ␤-blockers were younger, more likely to have coronary disease, and had a greater mean ejection fraction but had a similar peak V O 2 . There were 555 deaths (26%) and 194 (9%) transplants during a median follow-up of 3.5 years. Peak V O 2 was a predictor of mortality irrespective of ␤-blocker use; a decrease of 1 mL · kg Ϫ1 · min Ϫ1 resulted in an adjusted hazard ratio (HR) of 1.13 (95% CI 1.09 to 1.17, PϽ0.0001) in patients not receiving ␤-blockers and 1.27 (95% CI 1.18 to 1.36, PϽ0.0001) in patients receiving ␤-blockers. Similar findings were noted when considering death or transplantation as an end point. ␤-Blocker use was associated with better outcomes until peak V O 2 values became very low (Ϸ10 mL · kg Ϫ1 · min Ϫ1 ), at which level survival rates were equally poor. Conclusion-Peak V O 2 is a determinant of survival in patients in heart failure even in the setting of ␤-blockade. Because of improved survival in patients treated with ␤-blockers, the cut point value of 14 mg · kg Ϫ1 · min Ϫ1 for referral for cardiac transplantation in these patients requires reevaluation, and a lower cut point may be more appropriate.

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Section: Discussionmentioning

confidence: 74%

Peak Oxygen Consumption as a Predictor of Death in Patients With Heart Failure Receiving β-Blockers

O’Neill¹,

Young²,

Pothier³

et al. 2005

ACC Current Journal Review

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“…Most previous studies of cardiopulmonary exercise testing in CHF were conducted in preselected patients evaluated for heart transplantation. 9,11,14,15,25 In comparison, the patients in our study were approximately 10 years older (mean age, 63 years) and had a higher mortality rate. The underlying cause was ischemic and nonischemic heart disease in approximately equal distribution, in contrast to a higher number of dilated cardiomyopathy in earlier studies.…”

Section: Study Populationmentioning

confidence: 79%

Exercise Anaerobic Threshold and Ventilatory Efficiency Identify Heart Failure Patients for High Risk of Early Death

et al. 2002

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Background-The maximal oxygen uptake (peak V O 2 ) is used in risk stratification of patients with chronic heart failure (CHF). Peak V O 2 might be lower than maximally possible if exercise is stopped early because of lack of patient motivation or premature cessation by the investigator. In contrast, the anaerobic threshold (V O 2 AT) and the ventilatory efficiency (V E versus V CO 2 slope) are less subject to these influences. Thus, we compared these parameters with peak V O 2 in identifying patients with CHF at increased risk for death within 6 months after evaluation. Methods and Results-We performed cardiopulmonary exercise tests with gas exchange measurements in 223 consecutive patients with CHF (114 coronary artery disease, 92 dilated cardiomyopathy, 17 others) at the Herzzentrum Ludwigshafen between 1995 and 1998. We measured peak V O 2 , V O 2 AT and V E versus V CO 2 slope. We selected peak V O 2 of Յ14 mL/kg per minute, V O 2 AT of Ͻ11 mL/kg per minute, and V E versus V CO 2 slope of Ͼ34 as threshold values for high risk of death. The median follow-up time was 644 days. Patients with peak V O 2 of Յ14 mL/kg per minute had a Ͼ3-fold-increased risk (ORϭ3.4; CI, 1.3 to 9.1), with V O 2 AT Ͻ11 mL/min per kg or V E versus V CO 2 slope Ͼ34 a 5-fold increased risk for early death (ORϭ5.3; CI, 1.5 to 19.0; ORϭ4.8; CI, 1.7 to 13.8, respectively). In patients with both V O 2 AT Ͻ11 mL/kg per minute and V E versus V CO 2 slope Ͼ34, the risk of early death was 10-fold higher (ORϭ9.6; CI, 2.1 to 44.7). After correction for age, sex, left ventricular ejection fraction, and New York Heart Association class in a multivariate analysis, the combination of V O 2 AT Ͻ11 mL/kg per minute and V E versus V CO 2 slope Ͼ34 was the best predictor of 6-month mortality (RRϭ5.1, Pϭ0.001). Conclusions-V O 2 AT of Ͻ11 mL/kg per minute and slope of V E versus V CO 2 Ͼ34, combined, better identified patients at high risk for early death from CHF than did peak V O 2 and should therefore be considered when prioritizing patients for heart transplantation. (Circulation. 2002;106:3079-3084.)

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“…Low peak VO 2 implies a poor outcome, independently of other risk factors [8,10,28,31,32]. Nevertheless, its optimal cut-off point for risk stratification is still debated [28,31,32].…”

Section: Cardiopulmonary Exercise (Cpx) Testingmentioning

confidence: 99%

“…Low peak VO 2 implies a poor outcome, independently of other risk factors [8,10,28,31,32]. Nevertheless, its optimal cut-off point for risk stratification is still debated [28,31,32]. It is generally agreed that peak VO 2 N 18 ml/kg/min identifies low risk patients, whereas values ≤10 ml/kg/min indicate those with severe functional impairment, poor outcome and a potential indication for Htx [10,28,31].…”

Section: Cardiopulmonary Exercise (Cpx) Testingmentioning

confidence: 99%

“…Useful prognostic indicators are outlined in Table 2 [1,2,7,8,10,[19][20][21]24,28,31,32,[37][38][39][40]. Signs of increased LV filling pressure and/or of right ventricular dysfunction, assessed by Dopplerechocardiography or cardiac catheterisation, are more important in ACHF with a greater predictive power when these data are collected after optimisation of therapy [6,24,41].…”

Section: Assessment Of Prognosismentioning

confidence: 99%

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Advanced chronic heart failure: A position statement from the Study Group on Advanced Heart Failure of the Heart Failure Association of the European Society of Cardiology

Metra

Ponikowski²,

Dickstein

et al. 2007

European J of Heart Fail

347

242

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Therapy has improved the survival of heart failure (HF) patients. However, many patients progress to advanced chronic HF (ACHF). We propose a practical clinical definition and describe the characteristics of this condition.Patients that are generally recognised as ACHF often exhibit the following characteristics: 1) severe symptoms (NYHA class III to IV); 2) episodes with clinical signs of fluid retention and/or peripheral hypoperfusion; 3) objective evidence of severe cardiac dysfunction, shown by at least one of the following: left ventricular ejection fraction b 30%, pseudonormal or restrictive mitral inflow pattern at Dopplerechocardiography; high left and/or right ventricular filling pressures; elevated B-type natriuretic peptides; 4) severe impairment of functional capacity demonstrated by either inability to exercise, a 6-minute walk test distance b 300 m or a peak oxygen uptake b 12-14 ml/kg/min; 5) history of N1 HF hospitalisation in the past 6 months; 6) presence of all the previous features despite optimal therapy. This definition identifies a group of patients with compromised quality of life, poor prognosis, and a high risk of clinical events. These patients deserve effective therapeutic options and should be potential targets for future clinical research initiatives.

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Clinical, Hemodynamic, and Cardiopulmonary Exercise Test Determinants of Survival in Patients Referred for Evaluation of Heart Failure

Cited by 234 publications

References 22 publications

Peak Oxygen Consumption as a Predictor of Death in Patients With Heart Failure Receiving β-Blockers

Peak Oxygen Consumption as a Predictor of Death in Patients With Heart Failure Receiving β-Blockers

Exercise Anaerobic Threshold and Ventilatory Efficiency Identify Heart Failure Patients for High Risk of Early Death

Advanced chronic heart failure: A position statement from the Study Group on Advanced Heart Failure of the Heart Failure Association of the European Society of Cardiology

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