Methods: 319 patients with HF (199 HFrEF; 80 HFmrEF; 41 HFpEF) underwent CPET. Tricuspid annular plane systolic excursion (TAPSE) and pulmonary artery systolic pressure (PASP) were measured by echocardiography. B-type natriuretic peptide (BNP) at rest and peak exercise were also determined. The patients were tracked for the primary [cardiac death] and secondary composite outcome [all-cause death, heart transplantation/left ventricular assist device implantation, hospitalization for cardiac reasons].
Results: 47 (15%) of the patients demonstrated NTVA during CPET, regardless of coronary artery disease prevalence. Patients without arrhythmias had a significantly higher LVEF (p<0.05), TAPSE/PASP ratio (p<0.001), peak oxygen consumption (p<0.01), lower resting and peak BNP (p<0.001) and the minute ventilation/carbon dioxide production slope (p<0.001) compared to those with NTVA. 71 patients died during the tracking period, 54 for cardiac reasons. NTVA during CPX were a significant predictor of primary and secondary outcome in all patients with HF (HR: 5.3, 3.7; 95% CI: 3.1–9.1, 2.4-5.5, p<0.001, respectively) as well as in subgroups categorized according to reduced, middle range and preserved LVEF (p<0.001).
Conclusion: These results indicate that exercise-induced ventricular arrhythmias not reaching criteria for test termination are nonetheless indicative of an advanced disease severity phenotype and worse prognosis.