Exercise peak VO2 determination in chronic heart failure: is it still of value?

Abstract

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)

Improved Exercise Capacity and Ischemia 6 and 12 Months After Transendocardial Injection of Autologous Bone Marrow Mononuclear Cells for Ischemic Cardiomyopathy

“…24 Heart failure patients with a VO 2 max of Ͻ14 mL/kg per minute also have a higher long-term mortality. 18,25 Thus, the increase in VO 2 max (from 17.3 mL/kg per minute to 25.1 mL/kg per minute) and the trend toward improvement in BNP levels that were observed in the treated group at 12 months will be important if confirmed by larger studies.…”

Low-dose dobutamine responsiveness in idiopathic dilated cardiomyopathy: relation to exercise capacity and clinical outcome

“…In the chronic heart failure patients, the cardiac response to dobutamine worsened proportionally as Weber's class deteriorated, the worst response being observed in Weber's class C patient group. The mean percentage decrease in end-systolic volume index induced by the dobutamine infusion was 28·7 9% in class A, 18·6 8% in class B, and only 6·4 6% in class C. As patients with substantial exercise intolerance are at higher risk for death or clinical deterioration [6][7][8][9] , we also identified the echocardiographic variable during the dobutamine infusion most closely related to a peak VO 2 <15 ml . kg 1 .…”

“…Peak exercise oxygen consumption (VO 2 ) determination permits evaluation of chronic heart failure severity in a more reliable, objective and parametric manner than NYHA classification [2][3][4][5] . In addition, peak VO 2 is a most powerful predictor of prognosis [6][7][8][9] . The aim of this study was to evaluate myocardial contractile reserve by low-dose dobutamine echocardiography in patients with chronic heart failure secondary to idiopathic dilated cardiomyopathy stratified by peak VO 2 .…”

Peak Oxygen Uptake Better Predicts Outcome Than Submaximal Respiratory Data in Heart Transplant Candidates

“…[1][2][3][4][5][6][7][8][9][10][11][12][13] Therefore, current guidelines recommend using maximal exercise testing to select appropriate candidates for heart transplantation (HTx). 14 Peak oxygen uptake (V O 2 ), obtained during maximal exercise testing, has been the gold standard…”