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Different prognostic predictors in cardiopulmonary exercise testing according to the aetiology of systolic heart failure
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1Hospital de Santa Cruz, Cardiology - Lisbon - Portugal
European Journal of Heart Failure
Introduction: The Cardiopulmonary Exercise Testing (CPET) has an important role in the risk stratification and prognostic evaluation of patients with Heart Failure and reduced Ejection Fraction (HFrEF). Several variables in CPET have been validated as independent predictors for a worse prognosis, but, their impact according to the aetiology of the HFrEF has not been established.
Purpose: To evaluate the prognostic value of CPET variables in patients with HFrEF according to the aetiology – Ischemic Vs Nonischemic HF.
Methods: Of all the patients submitted to CPET in our laboratory between 2009 and 2015, those with HFrEF (EF <40%), NYHA functional class II-III and optimal medical therapy were selected. The following variables of the CPET were studied: Peak VO2, VE/VCO2 slope, exercise oscillatory ventilation, PetCO2 at rest and during exercise, exercise blood pressure response to effort, electrocardiogram changes, heart rate recovery at 1 min and patient reason for test termination. During a mean 44 month follow-up, the independent predictors for the composite endpoint of hospitalization for decompensated heart failure, need for heart transplant and death of any cause, in both groups of patients, were determined using a Cox Regression.
Results: A total of 123 patients were included in the study (average age of 55±11 years; 80% of male gender), 57% with ischemic HFrEF, with the ramped protocol test being the most commonly used (65% of the cases). Patients with ischemic HFrEF were mostly male, and had a higher mean age. The composite endpoint occurred in 35% of the total sample. In patients with ischemic HFrEF the sole predictor for the composite endpoint was the Peak VO2 (HR 0.79, IC95% [0.69,0.91]; p<0.01), while in those with nonischemic HFrEF the predictors were the Peak VO2 (HR 0.84, IC95% [0.71,0.99]; p=0.04) and the VE/VCO2 slope (HR 1.09, IC95% [1.04,1.14]; p<0.01).
Conclusions: Of the CPET variables studied, the Peak VO2 was an independent predictor for the composite endpoint in both groups, with the VE/VCO2 slope having also been a predictor in the nonischemic HFrEF patients, probably reflecting a lower ventilatory efficiency as a result of the longer chronicity of the cardiac dysfunction.
ESC 365 is supported by Bayer, Boehringer Ingelheim and Lilly Alliance, Bristol-Myers Squibb and Pfizer Alliance, Novartis Pharma AG and Vifor Pharma in the form of educational grants. The sponsors were not involved in the development of this platform and had no influence on its content.
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