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Non-terminating ventricular arrhythmias during exercise testing reflect poorer prognosis and advanced disease severity in heart failure regardless of ejection fraction

Session Poster Session 7

Speaker Associate Professor Dejana Popovic

Congress : ESC Congress 2019

  • Topic : heart failure
  • Sub-topic : Chronic Heart Failure - Epidemiology, Prognosis, Outcome
  • Session type : Poster Session
  • FP Number : P6327

Authors : D Popovic (Belgrade,RS), M Guazzi (San Donato Milanese,IT), R Arena (Chicago,US)

Authors:
D Popovic1 , M Guazzi2 , R Arena3 , 1Clinical Center of Serbia, Institute for Cardiovascular Disease - Belgrade - Serbia , 2IRCCS Policlinico San Donato - San Donato Milanese - Italy , 3University of Illinois at Chicago - Chicago - United States of America ,

Citation:

Introduction: Electrocardiography is an integral component of cardiopulmonary exercise testing (CPET), a standard of care in patients with heart failure (HF). We hypothetized that ventricular arrhythmias during CPET that do not meet test-termination criteria (NTVA) set forth by current guidelines may help in phenotyping disease severity and prognosis in HF with either reduced (rEF), and mid-range (mrEF)/preserved (pEF) left ventricular (LV) ejection fraction.

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.

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