A cardiopulmonary exercise testing score for predicting outcomes in patients with heart failure

Jonathan Myers, Ross Arena, Frederick Dewey, Daniel Bensimhon, Joshua Abella, Leon Hsu, Paul Chase, Marco Guazzi, Mary Ann Peberdy

Research output: Contribution to journalArticlepeer-review


Objective: The aim of this study is to evaluate the predictive accuracy of a cardiopulmonary exercise test (CPX) score. Background: Cardiopulmonary exercise test responses, including peak VO2, markers of ventilatory inefficiency (eg, the VE/VCO2 slope and oxygen uptake efficiency slope [OUES]), and hemodynamic responses, such as heart rate recovery (HRR) and chronotropic incompetence (CRI) are strong predictors of outcomes in patients with heart failure (HF). However, there is a need for simplified approaches that integrate the additive prognostic information from CPX. Methods: At 4 institutions, 710 patients with HF (568 male/142 female, mean age 56 ± 13 years, resting left ventricular ejection fraction 33 ± 14%) underwent CPX and were followed for cardiac-related mortality and separately for major cardiac events (death, hospitalization for HF, transplantation, left ventricular assist device implantation) for a mean of 29 ± 25 months. The age-adjusted prognostic power of peak VO2, VE/VCO2 slope, OUES (VO2 = a log10VE + b), resting end-tidal carbon dioxide pressure (PetCO2), HRR, and CRI were determined using Cox proportional hazards analysis, optimal cutpoints were determined, the variables were weighted, and a multivariate score was derived. Results: There were 175 composite outcomes. The VE/VCO2 slope (≥34) was the strongest predictor of risk and was attributed a relative weight of 7, with weighted scores for abnormal HRR (≤6 beats at 1 minute), OUES (>1.4), PetCO2 (2 (≤14 mL kg-1 min-1) having scores of 5, 3, 3, and 2, respectively. Chronotropic incompetence was not a significant predictor and was excluded from the score. A summed score >15 was associated with an annual mortality rate of 27% and a relative risk of 7.6, whereas a score

Original languageEnglish
Pages (from-to)1177-1183
Number of pages7
JournalAmerican Heart Journal
Issue number6
Publication statusPublished - Dec 2008

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine


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