The value of cardiopulmonary exercise testing and stress echocardiography in the prediction of all‐cause mortality in adults with end‐stage renal disease

Abstract

We aimed to assess the prognostic utility of different parameters routinely assessed from cardiopulmonary exercise testing (CPET) and exercise echocardiography in adults with endstage renal disease (ESRD). Forty-two ESRD (37 male) individuals (age: 58 ± 13 years, height: 169.30 ± 8.30 cm, weight: 81 ± 15 kg, body surface area: 1.92 ± 0.20 m 2 ) underwent a maximal/ symptom limited CPET, with a full cross-sectional echocardiogram performed at baseline and peak exercise. All participants were prospectively followed over a 10-year period, with all-cause mortality as the primary endpoint. After the follow-up period, a total of 19 participants (45%) died. Left atrial size (4.70 ± 0.70 vs. 3.65 ± 0.50 cm, P < 0.001) and anteroseptal wall thickness (1.28 ± 0.40 vs. 1.06 ± 0.02 cm, P = 0.002) were significantly greater in those that died, while peak heart rate was significantly lower (108 ± 12 vs. 128 ± 14 bpm, P < 0.001). The prevalence of myocardial ischaemia (13 vs. 8 participants, P = 0.03) was significantly greater, while peak VO 2 (9.80 ± 2.10 vs. 15.90 ± 4.30 ml•kg −1 •min −1 , P < 0.001) was significantly lower in those that died. Following multivariate cox regression, myocardial ischaemia (Hazard Ratio 3.08; 95% Confidence Interval 1.09-8.70; P = 0.03) and peak VO 2 (HR 0.73; 95% CI 0.64-0.84; P < 0.001) were significant independent predictors of 10-year all-cause mortality. This is the first study to establish peak VO 2 as powerful marker of all-cause mortality when assessed with clinical, resting and stress echocardiography parameters in people with ESRD over a 10-year follow up period. This observation indicates that, in clinical practice, CPET and exercise echocardiography may serve as valuable tools for the risk stratification of individuals with ESRD. HIGHLIGHTS. We aimed to assess the prognostic utility of cardiopulmonary exercise testing (CPET) and exercise echocardiography in end-stage renal disease (ESRD) with 10-year mortality. . Peak aerobic capacity and the presence of ischaemic heart disease were independently associated with all-cause mortality. . This observation indicates that, in clinical practice, CPET and exercise echocardiography may serve as valuable tools for the risk stratification of individuals with end-stage renal disease.

Exploring the utility of bedside tests for predicting cardiorespiratory fitness in older adults

“…None of the US-derived measures of muscle architecture were predictive of measures of CRF. Assessment of CRF parameters using CPET is the gold standard and low CPET-determined CRF has been associated with increased mortality in many clinical contexts including major elective surgery, 22 lung cancer, 23 renal failure, 24 and chronic obstructive pulmonary disease 25 , many of which are commonly associated with advancing age. However, CPET requires specialized equipment and significant training, resource, and expertise in order for it to be undertaken.…”