Cardiopulmonary exercise testing for prognosis in chronic heart failure: Continuous and independent prognostic value from VE/VCO2 slope and peak VO2

D. P. Francis, W. Shamim, L. Ceri Davies, M. F. Piepoli, P. Ponikowski, S. D. Anker, A. J S Coats

Research output: Contribution to journalArticle

Abstract

Background: Chronic heart failure carries a poor prognosis. Cardiopulmonary exercise testing is useful in predicting survival. We set out to establish the prognostic value of peak VO2 and VE/VCO2 slope across a range of threshold values. Method and Results: Three hundred and three consecutive patients with stable chronic heart failure underwent cardiopulmonary exercise testing between 1992 and 1996. Their age was 59 ± 11 years (mean ± SD), peak VO2 17.8 ± 6.6 ml.kg-1 min-1, VE/VCO2 slope 37 ± 12. At the end of follow-up in January 1999, 91 patients had died (after a median of 7 months, interquartile range 3-16 months). The median follow-up for the survivors was 47 months (interquartile range 37-57 months). The areas under the receiver-operating characteristic curves for predicting mortality at 2 years were 0.77 for both peak VO2 and VE/VCO2 slope. With peak VO2 and VE/VCO2 slope viewed as continuous variables in the Cox proportional-hazards model, they were both highly significant prognostic indicators, both in univariate analysis and bivariate analysis (P <0.001 for VE/VCO2 slope, P <0.003 for peak VO2). Conclusions: Lower peak VO2 implies poorer prognosis across a range of values from 10 to 20 ml.kg-1 min-1 without a unique threshold. Gradations of elevation of the VE/VCO2, slope also carry prognostic information over a wide range (30-55). The two parameters are comparable in terms of prognostic power, and contribute complementary prognostic information. (C) 2000 The European Society of Cardiology.

Original languageEnglish
Pages (from-to)154-161
Number of pages8
JournalEuropean Heart Journal
Volume21
Issue number2
Publication statusPublished - Jan 15 2000

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Heart Failure
Exercise
Proportional Hazards Models
ROC Curve
Survivors
Survival
Mortality

Keywords

  • Cardiopulmonary exercise testing
  • Chronic heart failure
  • Prognosis

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Francis, D. P., Shamim, W., Davies, L. C., Piepoli, M. F., Ponikowski, P., Anker, S. D., & Coats, A. J. S. (2000). Cardiopulmonary exercise testing for prognosis in chronic heart failure: Continuous and independent prognostic value from VE/VCO2 slope and peak VO2. European Heart Journal, 21(2), 154-161.

Cardiopulmonary exercise testing for prognosis in chronic heart failure : Continuous and independent prognostic value from VE/VCO2 slope and peak VO2. / Francis, D. P.; Shamim, W.; Davies, L. Ceri; Piepoli, M. F.; Ponikowski, P.; Anker, S. D.; Coats, A. J S.

In: European Heart Journal, Vol. 21, No. 2, 15.01.2000, p. 154-161.

Research output: Contribution to journalArticle

Francis, DP, Shamim, W, Davies, LC, Piepoli, MF, Ponikowski, P, Anker, SD & Coats, AJS 2000, 'Cardiopulmonary exercise testing for prognosis in chronic heart failure: Continuous and independent prognostic value from VE/VCO2 slope and peak VO2', European Heart Journal, vol. 21, no. 2, pp. 154-161.
Francis, D. P. ; Shamim, W. ; Davies, L. Ceri ; Piepoli, M. F. ; Ponikowski, P. ; Anker, S. D. ; Coats, A. J S. / Cardiopulmonary exercise testing for prognosis in chronic heart failure : Continuous and independent prognostic value from VE/VCO2 slope and peak VO2. In: European Heart Journal. 2000 ; Vol. 21, No. 2. pp. 154-161.
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AU - Ponikowski, P.

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AB - Background: Chronic heart failure carries a poor prognosis. Cardiopulmonary exercise testing is useful in predicting survival. We set out to establish the prognostic value of peak VO2 and VE/VCO2 slope across a range of threshold values. Method and Results: Three hundred and three consecutive patients with stable chronic heart failure underwent cardiopulmonary exercise testing between 1992 and 1996. Their age was 59 ± 11 years (mean ± SD), peak VO2 17.8 ± 6.6 ml.kg-1 min-1, VE/VCO2 slope 37 ± 12. At the end of follow-up in January 1999, 91 patients had died (after a median of 7 months, interquartile range 3-16 months). The median follow-up for the survivors was 47 months (interquartile range 37-57 months). The areas under the receiver-operating characteristic curves for predicting mortality at 2 years were 0.77 for both peak VO2 and VE/VCO2 slope. With peak VO2 and VE/VCO2 slope viewed as continuous variables in the Cox proportional-hazards model, they were both highly significant prognostic indicators, both in univariate analysis and bivariate analysis (P <0.001 for VE/VCO2 slope, P <0.003 for peak VO2). Conclusions: Lower peak VO2 implies poorer prognosis across a range of values from 10 to 20 ml.kg-1 min-1 without a unique threshold. Gradations of elevation of the VE/VCO2, slope also carry prognostic information over a wide range (30-55). The two parameters are comparable in terms of prognostic power, and contribute complementary prognostic information. (C) 2000 The European Society of Cardiology.

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