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European Heart Journal 2002 23(10):806-814; doi:10.1053/euhj.2001.2966
Copyright © 2002 by the European Society of Cardiology.
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A non-invasively determined surrogate of cardiac power (‘circulatory power’) at peak exercise is a powerful prognostic factor in chronic heart failure

A. Cohen-Solalf1, J.Y. Tabet, D. Logeart, P. Bourgoin, M. Tokmakova and M. Dahan

Service de Cardiologie, Hôpital Beaujon, 92110, Clichy, France

revised August 7, 2001; accepted August 15, 2001

Abstract

Objectives This study was designed to assess the prognostic value of a new variable derived from a cardiopulmonary exercise test, the circulatory power, a surrogate of cardiac power, at peak exercise, in patients with chronic heart failure.

Background Peak exercise cardiac power and stroke work are invasive parameters with recently proven prognostic value. It is unclear whether these variables have better prognostic value than peak oxygen uptake (VO2).

Methods The study population comprised 175 patients with chronic heart failure (ejection fraction <45%) who underwent a cardiopulmonary exercise test. Circulatory power and circulatory stroke work were defined as the product of systolic arterial pressure and VO2 and oxygen pulse, respectively. Prognostic value was assessed by survival curves (Kaplan–Meier method) and uni- and multivariate Cox analyses.

Results With a mean follow-up of 25±10 months, ejection fraction, heart rate, systolic arterial pressure, peak VO2, VCO2, the anaerobic threshold, minute ventilation, the ventilatory equivalents of oxygen and carbon dioxide, the half times of VO2 and VCO2 recoveries, and the circulatory stroke work and power predicted outcome. Multivariate analysis demonstrated that the peak circulatory power (chi-square=19·9,P <0·001) (but not peak circulatory stroke work) was the only variable predictive of prognosis.

Conclusion The prognostic value of cardiopulmonary exercise tests in heart failure patients can be improved by assessing a new variable, the circulatory power—a surrogate of cardiac power—at peak exercise.

Key Words: Peak oxygen consumption, exercise, chronic heart failure, recovery, circulatory power, prognosis

f1 Correspondence: Pr Alain Cohen-Solal, Service de Cardiologie, Hôpital Beaujon, 100 Boulevard du General Leclerc, 92110 Clichy, France.

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