The prognostic utility of cardiopulmonary exercise testing stands the test of time in patients with heart failure

Ross Arena, Marco Guazzi, Jonathan Myers, Paul Chase, Daniel Bensimhon, Lawrence P. Cahalin, Mary Ann Peberdy, Euan Ashley, Erin West, Daniel E. Forman

Research output: Contribution to journalArticle


INTRODUCTION: While the medical management strategy for patients with heart failure (HF) has dramatically changed, cardiopulmonary exercise testing (CPX) procedures and the data obtained have remained relatively stable. We are unaware of any previous investigation that has assessed differences in the prognostic utility of CPX in HF according to time period, reflecting differences in the clinical management of systolic HF. METHODS: Subjects (n = 381) underwent CPX between April 1, 1993, and December 31, 2005, and the remaining 511 were tested between January 1, 2006, and October 28, 2010. Peak oxygen uptake (VO 2) and the minute ventilation/carbon dioxide production (VE/VCO 2) slope were ascertained for all tests. RESULTS: Both the VE/VCO 2 slope and peak VO 2 were strong univariate predictors of adverse events in both subgroups. In the multivariate analysis, the VE/VCO 2 slope was the strongest predictive marker while peak VO 2 added predictive value and was retained in the regression for all scenarios. In subjects undergoing CPX before 2006, a VE/VCO 2 slope 45 or greater and a peak VO 2 of less than 10 mL · kg -1 · min -1 generate d a hazard ratio of 4.2 (95% CI: 1.9-9.1, P <.001) when considering only mortality as an endpoint. In subjects undergoing CPX after 2006, a VE/VCO 2 slope 45 or greater and a peak VO 2 of less than 10 mL · kg -1 · min -1 generated a hazard ratio of 8.2 (95% CI: 4.7-14.3, P <.001) when considering only mortality as an endpoint. CONCLUSION: The results of this study indicate that CPX continues to be a valuable clinical assessment in the present-day HF management.

Original languageEnglish
Pages (from-to)198-202
Number of pages5
JournalJournal of Cardiopulmonary Rehabilitation and Prevention
Issue number4
Publication statusPublished - Jul 2012



  • Expired gas
  • Heart disease
  • Survival
  • Ventilation

ASJC Scopus subject areas

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

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