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European Heart Journal Advance Access published online on April 30, 2009
European Heart Journal, doi:10.1093/eurheartj/ehp138
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Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2009. For permissions please email: journals.permissions@oxfordjournals.org

Exercise haemodynamic variables rather than ventilatory efficiency indexes contribute to risk assessment in chronic heart failure patients treated with carvedilol

Ugo Corrà1,*, Alessandro Mezzani1, Andrea Giordano2, Enzo Bosimini3 and Pantaleo Giannuzzi1

1 Laboratory for the Analysis of Cardio-Respiratory Signals, Division of Cardiology, Salvatore Maugeri Foundation, IRCCS, Via per Revislate, 13, 28010 Veruno (NO), Italy
2 Bioengineering Department, Salvatore Maugeri Foundation, IRCCS, Via per Revislate 13, 28010 Veruno (NO), Italy
3 Division of Cardiology, Clinica Major, Salvatore Maugeri Foundation, IRCCS, Torino, Italy

Received 19 March 2008; revised 6 March 2009; accepted 13 March 2009 * Corresponding author. Tel: +39 0322 884711, Fax: +39 0322 830294, Email: ugo.corra{at}fsm

Aims: To evaluate the prognostic significance of traditional cardiopulmonary exercise testing (CPET) parameters in chronic heart failure (CHF) patients treated with beta-blockers.

Methods and results: A total of 631 CHF patients were followed for cardiovascular death over 3.8 ± 1.4 years; among them 79 (13%) died. All prognostic CPET parameters were related to outcome at univariate analysis, with haemodynamic-derived parameters [peak systolic blood pressure (SBP), peak circulatory power (CP) = peak oxygen consumption (pVO2) x peak SBP] and exertional oscillatory ventilation (EOV) reaching the highest {chi}2 (46.5, 40.9, and 22.6, respectively, all with P < 0.0001). Exertional oscillatory ventilation, although associated with high mortality rate (43 vs. 11%, P < 0.001), was detected in 42 (7%) patients. In non-EOV, again both peak SBP and peak CP reached the highest {chi}2 (30.6, and 21.6, respectively, all with P < 0.0001). Regarding CPET parameters, at multivariable analysis, peak SBP was the strongest risk index both in total and non-EOV populations, with 11% risk reduction every 5 mmHg increase.

Conclusion: All traditional CPET risk parameters were informative in beta-blockers CHF patients, but peak SBP, peak CP, and EOV were the most predictive. In this low-risk population, EOV, although underrepresented, considerably enhanced risk stratification, although other ventilatory efficiency indexes provided less impressive predictive content. In large majority of non-EOV patients, peak SBP improved risk evaluation beyond other CPET parameters.

Key Words: Prognosis • Heart failure • Exercise


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