Valore prognostico del test cardiopolmonare nello scompenso cardiaco dal 1991 al 2002: Dalla revisione della letteratura ad un nuovo di stratificazione prognostica

Identification of individual at high risk in chronic heart failure (CHF) is a medical art of growing concern, reflecting an increasing confidence on effective pharmacological therapies as well as on innovative surgical and device-related treatments. Cardiopulmonary exercise stress testing, when properly performed, providing objectivity in the measurements of peak functional capacity, has become an important clinical tool to define severity of disease and to predict outcome in CHF patients due to left ventricular systolic dysfunction. The value of peak oxygen consumption rests in the fact that this measurement integrates elements of cardiac adaptations, skeletal muscle, pulmonary, and endothelial dysfunction more than other traditional prognostic indicators in CHF. Over the past 11 years, from 1991 to 2002, several studies have been published confirming that peak oxygen consumption is a strong univariate and multivariate predictor of outcome, whereas, exercise-related ventilatory abnormalities have recently gained attention, stimulating scientific debate and an innovative perspective. This review, throughout a critical examination of previous experiences, will focus on the clinical application and interpretation of cardiopulmonary exercise stress testing with specific mention to prognosis, defining a proficient outline for the individual patient.