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European Heart Journal 1997 18(12):1921-1930;
Copyright © 1997 by the European Society of Cardiology.
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© 1997 The European Society of Cardiology

Physiological parameters during the initial stages of cardiopulmonary exercise testing in patients with chronic heart failure

Their value in the assessment of clinical severity and prognosis

R. J. M. de Vries*, D. J. van Veldhuisen*,, P. H. J. M. Dunselman{dagger}, N. van der Veer* and H. J. G. M. Crijns*

*Department of Cardiology, University Hospital Groningen Groningen
{dagger}Ignatius Hospital Breda, The Netherlands

Received 9 April 1997; accepted 16 April 1997.

Correspondence: D. J. van Veldhuisen, MD, Department of Cardiology/Thoraxcenter, University Hospital Groningen, Hanzeplein 1, PO Box 30.001, 9713 EZ Groningen, The Netherlands

Abstract

AIMS: To analyse the relationship between initial exercise parameters and peak oxygen consumption and prognosis in 96 patients with congestive heart failure.

METHODS AND RESULTS: Comparison of responses during the initial 6 min of cardiopulmonary exercise testing (Naughton modified protocol) in patients stratified to the Weber classification, and analysis of their predictive value with respect to peak oxygen uptake and prognosis. All patients had a left ventricular ejection fraction <0·45 and a valid cardiopulmonary exercise test, during which they remained in sinus rhythm. Significant differences in several parameters were seen in the initial stages, including oxygen pulse (P<0·04) and ventilation equivalent for oxygen (P<0·004). These parameters remained as independent predictors of peak oxygen uptake in the algorithm derived from baseline and initial stage variables. In a multivariate Cox proportional hazards model, the predicted peak oxygen uptake (P<0·003) was an independent predictor of mortality.

CONCLUSION: In patients with congestive heart failure, the initial 6 min parameters of a cardiopulmonary exercise test have additional value in the assessment of clinical severity and prognosis. This may be of clinical relevance since a limited incremental exercise protocol may be more objective than more traditional 6 min walking tests and less demanding.

Key Words: Cardiopulmonary exercise • prognosis • heart failure • peak oxygen uptake


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