Copyright © 2000 by the European Society of Cardiology.
Cardiopulmonary exercise testing for prognosis in chronic heart failure: continuous and independent prognostic value from VE/VCO2slope and peak VO2
a National Heart & Lung Institute, Imperial College of Science, Technology and Medicine, London, U.K.
b Department of Cardiology, Military Hospital, Wroclaw, Poland
c Franz-Volhard-Klinik at Max Delbrück Centrum, Charité, Campus Berlin-Buch, Berlin, Germany
revised July 9, 1999; accepted July 14, 1999
Abstract
Background Chronic heart failure carries a poor prognosis. Cardiopulmonary exercise testing is useful in predicting survival. We set out to establish the prognostic value of peak VO2and VE/VCO2slope across a range of threshold values.
Method and Results Three hundred and three consecutive patients with stable chronic heart failure underwent cardiopulmonary exercise testing between 1992 and 1996. Their age was 59±11 years (mean±SD), peak VO217·8± 6·6ml.kg–1min–1, VE/VCO2slope 37±12. At the end of follow-up in January 1999, 91 patients had died (after a median of 7 months, interquartile range 3–16 months). The median follow-up for the survivors was 47 months (interquartile range 37–57 months). The areas under the receiver-operating characteristic curves for predicting mortality at 2 years were 0·77 for both peak VO2and VE/VCO2slope. With peak VO2and VE/VCO2slope viewed as continuous variables in the Cox proportional-hazards model, they were both highly significant prognostic indicators, both in univariate analysis and bivariate analysis (P<0·001 for VE/VCO2slope, P<0·003 for peak VO2).
Conclusions Lower peak VO2implies poorer prognosis across a range of values from 10 to 20ml.kg–1min–1, without a unique threshold. Gradations of elevation of the VE/VCO2slope also carry prognostic information over a wide range (30–55). The two parameters are comparable in terms of prognostic power, and contribute complementary prognostic information.
Key Words: Cardiopulmonary exercise testing, prognosis, chronic heart failure
f1 Correspondence: Dr D. P. Francis, Heart Failure Unit, Royal Brompton Hospital, National Heart & Lung Institute, Imperial College of Science, Technology and Medicine, Sydney St, London SW3 6NP, U.K.
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