TY - JOUR
T1 - Ventilatory response to exercise improves risk stratification in patients with chronic heart failure and intermediate functional capacity
AU - Corrà, Ugo
AU - Mezzani, Alessandro
AU - Bosimini, Enzo
AU - Scapellato, Francesco
AU - Imparato, Alessandro
AU - Giannuzzi, Pantaleo
PY - 2002
Y1 - 2002
N2 - Background. Peak oxygen consumption (Vo2) has an important prognostic role in chronic heart failure (CHF), but its discriminatory power is limited in patients with intermediate exercise capacity (peak Vo2 between 10-18 mL/kg/min). Thus, supplementary exertional indexes are greatly needed. Methods. Six hundred patients with CHF with left ventricular ejection fraction (LVEF) ≤40% who performed a symptom-limited cardiopulmonary exercise testing were screened and followed up for 780 ± 450 days. Results. Eighty-seven patients had major cardiac events (77 cardiac deaths and 10 urgent heart transplantations). Multivariate analysis revealed the rate of increase of minute ventilation per unit of increase of carbon dioxide production (VE/Vco2 slope) (χ2, 79.3, P <.0001), LVEF (χ2, 24.6, P <.0001), and peak Vo2 (χ2, 9.4, P <.0001) as independent and additional predictors of major cardiac events. VE/Vco2 slope was the strongest independent predictor of outcome (χ2, 20.9, P = .0001) in patients with intermediate peak Vo2 (n = 403), and the best cutoff value was 35 (χ2, 25.8; relative risk = 3.2, 95% CI 2.0-5.1, P <.0001). Total mortality rate was 30% in patients with VE/Vco2 slope ≥35 (n = 103, 26%) and 10% in those with VE/Vco2 slope 2 slope ≥35 had a similar total mortality rate to those with peak Vo2 ≤ 10 mL/kg/min (30% vs 37%, P not significant). Conclusions. A rational and pragmatic risk stratification process with symptom-limited cardiopulmonary exercise testing in CHF should include both peak Vo2 and VE/Vco2 slope, the latter index effectively predicting outcome in almost one fourth of patients with intermediate exercise capacity.
AB - Background. Peak oxygen consumption (Vo2) has an important prognostic role in chronic heart failure (CHF), but its discriminatory power is limited in patients with intermediate exercise capacity (peak Vo2 between 10-18 mL/kg/min). Thus, supplementary exertional indexes are greatly needed. Methods. Six hundred patients with CHF with left ventricular ejection fraction (LVEF) ≤40% who performed a symptom-limited cardiopulmonary exercise testing were screened and followed up for 780 ± 450 days. Results. Eighty-seven patients had major cardiac events (77 cardiac deaths and 10 urgent heart transplantations). Multivariate analysis revealed the rate of increase of minute ventilation per unit of increase of carbon dioxide production (VE/Vco2 slope) (χ2, 79.3, P <.0001), LVEF (χ2, 24.6, P <.0001), and peak Vo2 (χ2, 9.4, P <.0001) as independent and additional predictors of major cardiac events. VE/Vco2 slope was the strongest independent predictor of outcome (χ2, 20.9, P = .0001) in patients with intermediate peak Vo2 (n = 403), and the best cutoff value was 35 (χ2, 25.8; relative risk = 3.2, 95% CI 2.0-5.1, P <.0001). Total mortality rate was 30% in patients with VE/Vco2 slope ≥35 (n = 103, 26%) and 10% in those with VE/Vco2 slope 2 slope ≥35 had a similar total mortality rate to those with peak Vo2 ≤ 10 mL/kg/min (30% vs 37%, P not significant). Conclusions. A rational and pragmatic risk stratification process with symptom-limited cardiopulmonary exercise testing in CHF should include both peak Vo2 and VE/Vco2 slope, the latter index effectively predicting outcome in almost one fourth of patients with intermediate exercise capacity.
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U2 - 10.1067/mhj.2002.120772
DO - 10.1067/mhj.2002.120772
M3 - Article
C2 - 11868046
AN - SCOPUS:0036189288
VL - 143
SP - 418
EP - 426
JO - American Heart Journal
JF - American Heart Journal
SN - 0002-8703
IS - 3
ER -