Prognostic usefulness of the functional aerobic reserve in patients with heart failure

Paul Chase, Ross Arena, Marco Guazzi, Jonathan Myers, Mary Ann Peberdy, Daniel Bensimhon

Research output: Contribution to journalArticle

Abstract

Background: Peak oxygen consumption derived from cardiopulmonary exercise (CPX) testing provides important prognostic information in patients with heart failure (HF). The oxygen consumption at the ventilatory threshold (VT) has also been shown to be prognostic. However, the VT cannot always be detected in patients with HF. Other variables such as the difference between peak oxygen consumption and oxygen consumption at the VT (termed the functional aerobic reserve [FAR]) may also provide prognostic information. The purpose of this study was to determine the prognostic value of an undetectable VT and FAR. Methods: Eight hundred seventy-four patients with chronic, systolic HF (70% male, age 54 ± 14 years, ejection fraction 29% ± 12%) underwent CPX and were tracked for 2 years for major events (death, transplant, and left ventricular assist device implantation). Results: Patients were divided into 2 subgroups based on whether VT could be detected or not. There were 141 major events during the 2-year follow-up. Kaplan-Meier analysis for the 2 VT subgroups demonstrated worse prognoses for patients with a nondetectable VT versus those with a detectable VT (P <.001). Based on receiver operating characteristic curve analysis (FAR = 0 mlO2 kg-1 min-1 for patients with undetectable VT), the optimal cut-point for FAR was ≤/>3 mlO2 kg-1 min-1 (sensitivity/specificity 69%/60%). Cox regression analysis identified the FAR as a significant univariate predictor of risk and was retained in multivariate analysis. Conclusion: In conclusion, these data reveal that an undetectable VT and the FAR during CPX testing can provide useful prognostic information in patients with HF.

Original languageEnglish
Pages (from-to)922-927
Number of pages6
JournalAmerican Heart Journal
Volume160
Issue number5
DOIs
Publication statusPublished - Nov 2010

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Heart Failure
Oxygen Consumption
Exercise
Systolic Heart Failure
Heart-Assist Devices
Kaplan-Meier Estimate
Multivariate Analysis
Regression Analysis
Transplants
Sensitivity and Specificity

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Prognostic usefulness of the functional aerobic reserve in patients with heart failure. / Chase, Paul; Arena, Ross; Guazzi, Marco; Myers, Jonathan; Peberdy, Mary Ann; Bensimhon, Daniel.

In: American Heart Journal, Vol. 160, No. 5, 11.2010, p. 922-927.

Research output: Contribution to journalArticle

Chase, Paul ; Arena, Ross ; Guazzi, Marco ; Myers, Jonathan ; Peberdy, Mary Ann ; Bensimhon, Daniel. / Prognostic usefulness of the functional aerobic reserve in patients with heart failure. In: American Heart Journal. 2010 ; Vol. 160, No. 5. pp. 922-927.
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abstract = "Background: Peak oxygen consumption derived from cardiopulmonary exercise (CPX) testing provides important prognostic information in patients with heart failure (HF). The oxygen consumption at the ventilatory threshold (VT) has also been shown to be prognostic. However, the VT cannot always be detected in patients with HF. Other variables such as the difference between peak oxygen consumption and oxygen consumption at the VT (termed the functional aerobic reserve [FAR]) may also provide prognostic information. The purpose of this study was to determine the prognostic value of an undetectable VT and FAR. Methods: Eight hundred seventy-four patients with chronic, systolic HF (70{\%} male, age 54 ± 14 years, ejection fraction 29{\%} ± 12{\%}) underwent CPX and were tracked for 2 years for major events (death, transplant, and left ventricular assist device implantation). Results: Patients were divided into 2 subgroups based on whether VT could be detected or not. There were 141 major events during the 2-year follow-up. Kaplan-Meier analysis for the 2 VT subgroups demonstrated worse prognoses for patients with a nondetectable VT versus those with a detectable VT (P <.001). Based on receiver operating characteristic curve analysis (FAR = 0 mlO2 kg-1 min-1 for patients with undetectable VT), the optimal cut-point for FAR was ≤/>3 mlO2 kg-1 min-1 (sensitivity/specificity 69{\%}/60{\%}). Cox regression analysis identified the FAR as a significant univariate predictor of risk and was retained in multivariate analysis. Conclusion: In conclusion, these data reveal that an undetectable VT and the FAR during CPX testing can provide useful prognostic information in patients with HF.",
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