Prognostic characteristics of cardiopulmonary exercise testing in heart failure: Comparing American and European models

Ross Arena, Marco Guazzi, Jonathan Myers, Mary Ann Peberdy

Research output: Contribution to journalArticle

Abstract

BACKGROUND: Cardiopulmonary exercise testing (CPET) in the heart failure population is a standard of care in both American and European clinics, although the mode of exercise typically differs. The purpose of the present study was to compare the prognostic characteristics of peak oxygen consumption (VO2) and the minute ventilation-carbon dioxide production (VE/VCO2) slope between two independent heart failure groups. DESIGN AND METHODS: One hundred and two subjects underwent maximal exercise CPET using bicycle ergometry at San Paolo Hospital in Milan, Italy (SPH) and 105 subjects underwent treadmill CPET at Virginia Commonwealth University in Richmond, Virginia (VCU). Subjects were tracked for cardiac-related mortality for a 1-year period after CPET. RESULTS: There were 13 cardiac-related deaths over the 1-year tracking period in both groups. Optimal prognostic threshold values for peak VO2 were 12.9 ml O2/kg per min (sensitivity 81%, specificity 69%) in the SPH group and 12.0 ml O2/kg per min (sensitivity 74%, specificity 69%) in the VCU group. An optimal prognostic threshold value for the VE/VCO2 slope was 34.4 in the SPH (sensitivity 61%, specificity 85%) and 34.5 in the VCU (sensitivity 64%, specificity 93%) groups. DISCUSSION: The prognostic characteristics of peak VO2 and the VE/VCO2 slope were similar between the two centers. These results suggest that the mode of exercise does not greatly impact the prognostic utility of CPET responses in heart failure. They further suggest that prognostic guidelines for the application of CPET in heart failure may be applied globally, irrespective of differences in testing modality.

Original languageEnglish
Pages (from-to)562-567
Number of pages6
JournalEuropean Journal of Cardiovascular Prevention and Rehabilitation
Volume12
Issue number6
DOIs
Publication statusPublished - Dec 2005

Fingerprint

Heart Failure
Sensitivity and Specificity
Ergometry
Standard of Care
Carbon Dioxide
Oxygen Consumption
Italy
Ventilation
Guidelines
Mortality
Population

Keywords

  • Exercise mode
  • Expired gas analysis
  • Heart failure
  • Mortality
  • Prognosis

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Rehabilitation
  • Public Health, Environmental and Occupational Health

Cite this

Prognostic characteristics of cardiopulmonary exercise testing in heart failure : Comparing American and European models. / Arena, Ross; Guazzi, Marco; Myers, Jonathan; Ann Peberdy, Mary.

In: European Journal of Cardiovascular Prevention and Rehabilitation, Vol. 12, No. 6, 12.2005, p. 562-567.

Research output: Contribution to journalArticle

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abstract = "BACKGROUND: Cardiopulmonary exercise testing (CPET) in the heart failure population is a standard of care in both American and European clinics, although the mode of exercise typically differs. The purpose of the present study was to compare the prognostic characteristics of peak oxygen consumption (VO2) and the minute ventilation-carbon dioxide production (VE/VCO2) slope between two independent heart failure groups. DESIGN AND METHODS: One hundred and two subjects underwent maximal exercise CPET using bicycle ergometry at San Paolo Hospital in Milan, Italy (SPH) and 105 subjects underwent treadmill CPET at Virginia Commonwealth University in Richmond, Virginia (VCU). Subjects were tracked for cardiac-related mortality for a 1-year period after CPET. RESULTS: There were 13 cardiac-related deaths over the 1-year tracking period in both groups. Optimal prognostic threshold values for peak VO2 were 12.9 ml O2/kg per min (sensitivity 81{\%}, specificity 69{\%}) in the SPH group and 12.0 ml O2/kg per min (sensitivity 74{\%}, specificity 69{\%}) in the VCU group. An optimal prognostic threshold value for the VE/VCO2 slope was 34.4 in the SPH (sensitivity 61{\%}, specificity 85{\%}) and 34.5 in the VCU (sensitivity 64{\%}, specificity 93{\%}) groups. DISCUSSION: The prognostic characteristics of peak VO2 and the VE/VCO2 slope were similar between the two centers. These results suggest that the mode of exercise does not greatly impact the prognostic utility of CPET responses in heart failure. They further suggest that prognostic guidelines for the application of CPET in heart failure may be applied globally, irrespective of differences in testing modality.",
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