Copyright © 2000 by the European Society of Cardiology.
Prognostic value of changes over time in exercise capacity and echocardiographic measurements in patients with chronic heart failure
a Department of Cardiac Medicine, National Heart and Lung Institute, London, U.K.
b State Medical and Pharmaceutical University ‘Nicolae Testemitanu’ Chisinau, Republic of Moldova
c Department of Cardiology, Royal Brompton & Harefield NHS Trust, London, U.K.
d Franz-Volhard-Klinik (Charité, Campus Berlin-Buch), Max-Debrück-Centrum, Berlin, Germany
revised May 18, 1999; accepted May 19, 1999
Abstract
Aims This study sought to examine the predictive values of changes over time in exercise capacity and echocardiographic measurements of ventricular dimensions or function in predicting mortality in patients with chronic heart failure.
Methods and Results Sixty-two patients with chronic heart failure (58 men, mean [±SD] age 60±10 years, mean peak oxygen consumption (VO2) 18·2± 5·9ml.kg–1.min–1, mean left ventricular ejection fraction 38·9±15·8%) who underwent both treadmill exercise testing and echocardiographic examination on two occasions, separated by 19±15 months were followed-up for a mean of 17 months (interquartile range 9–30 months). During the follow-up period, 19 patients (30%) died and three (4·8%) underwent heart transplantation. Of measurements taken at a single time-point (visit 2) exercise duration, peak VO2, ventilatory response to exercise (VE/VCO2), left atrial diameter and left ventricular ejection fraction were found, by Cox proportional-hazard analysis, to predict the outcome in these patients (all P<0·05). Of the changes in parameters between visit 1 to visit 2, only changes in peak VO2per year (P=0·026) predicted non-transplanted survival (independent of changes in left ventricular ejection fraction and VE/VCO2). In Kaplan–Meier survival analysis patients with increased peak VO2over time (n=28) showed a better prognosis at 2 years (cumulative survival 75% [95% confidence interval: 56–95%] than those with a decrease in peak VO2(n=34, cumulative survival 50% [95% confidence interval: 31–68%]).
Conclusions Although single estimates of peak VO2, VE/VCO2and left ventricular ejection fraction have significant prognostic importance in patients with chronic heart failure, when monitoring changes over time only peak VO2remains a significant predictor of outcome.
Key Words: chronic heart failure, prognosis, exercise capacity, haemodynamics
f1 Correspondence: Dr Viorel G. Florea, National Heart and Lung Institute, Dovehouse Street, London SW3 6LY, U.K.
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