Patients with heart failure in the "intermediate Range" of peak oxygen uptake: Additive value of heart rate recovery and the minute ventilation/carbon dioxide output slope in predicting mortality

Luiz Eduardo Ritt, Ricardo Brandão Oliveira, Jonathan Myers, Ross Arena, Mary Ann Peberdy, Daniel Bensimhon, Paul Chase, Daniel Forman, Marco Guazzi

Research output: Contribution to journalArticlepeer-review

Abstract

PURPOSE: While patients with heart failure who achieve a peak oxygen uptake (peak (Equation is included in full-text article.)VO 2) of 10 mL•kg -1•min -1 or less are often considered for intensive surveillance or intervention, those achieving 14 mL•kg -1•min -1 or more are generally considered to be at lower risk. Among patients in the "intermediate" range of 10.1 to 13.9 mL•kg -1•min -1, optimally stratifying risk remains a challenge. METHODS: Patients with heart failure (N = 1167) referred for cardiopulmonary exercise testing were observed for 21 ± 13 months. Patients were classified into 3 groups of peak (Equation is included in full-text article.)Vo 2 (≤10, 10.1-13.9, and ≥14 mL•kg -1•min -1). The ability of heart rate recovery at 1 minute (HRR1) and the minute ventilation/carbon dioxide output ((Equation is included in full-text article.)E/(Equation is included in full-text article.)co 2) slope to complement peak (Equation is included in full-text article.)Vo 2 in predicting cardiovascular mortality were determined. RESULTS: Peak (Equation is included in full-text article.)Vo 2, HRR 1 (2 slope (>34) were independent predictors of mortality (hazard ratio 1.6, 95% CI: 1.2-2.29, P = .006; hazard ratio 1.7, 95% CI: 1.1-2.5, P = .008; and hazard ratio 2.4, 95% CI: 1.6-3.4, P <.001, respectively). Compared with those achieving a peak (Equation is included in full-text article.)Vo 2 ≥ 14 mL•kg -1•min -1, patients within the intermediate range with either an abnormal (Equation is included in full-text article.)E/(Equation is included in full-text article.)co 2 slope or HRR1 had a nearly 2-fold higher risk of cardiac mortality. Those with both an abnormal HRR1 and (Equation is included in full-text article.)E/(Equation is included in full-text article.)co 2 slope had a higher mortality risk than those with a peak (Equation is included in full-text article.)Vo 2 ≤ 10 mL•kg -1•min -1. Survival was not different between those with a peak (Equation is included in full-text article.)Vo 2 ≤ 10 mL•kg -1•min -1 and those in the intermediate range with either an abnormal HRR1 or (Equation is included in full-text article.)E/(Equation is included in full-text article.)co 2 slope. CONCLUSIONS: HRR1 and the (Equation is included in full-text article.)E/(Equation is included in full-text article.)co 2 slope effectively stratify patients with peak (Equation is included in full-text article.)Vo 2 within the intermediate range into distinct groups at high and low risk.

Original languageEnglish
Pages (from-to)141-146
Number of pages6
JournalJournal of Cardiopulmonary Rehabilitation and Prevention
Volume32
Issue number3
DOIs
Publication statusPublished - May 2012

Keywords

  • cardiopulmonary exercise test
  • heart failure
  • mortality

ASJC Scopus subject areas

  • Rehabilitation
  • Cardiology and Cardiovascular Medicine
  • Pulmonary and Respiratory Medicine

Fingerprint Dive into the research topics of 'Patients with heart failure in the "intermediate Range" of peak oxygen uptake: Additive value of heart rate recovery and the minute ventilation/carbon dioxide output slope in predicting mortality'. Together they form a unique fingerprint.

Cite this