Abstract
The prognostic role of cardiopulmonary exercise test (CPET) in elderly women with chronic heart failure (HF) has not yet been clarified. We assessed the incremental value of CPET variables for risk stratification in female HF patients with preserved or reduced left ventricular ejection fraction (LVEF). We prospectively followed up 131 female HF outpatients aged 72 [interquartile range 62 - 77] years after a symptom limited CPET. 34% had ischemic heart disease and 14% permanent atrial fibrillation, 24% were in NYHA class III. LVEF was 50% [interquartile range 36 - 62], peak oxygen consumption was 11.3 [interquartile range 9.2 - 13.5] ml/kg/min; the slope of the regression line relating ventilation to CO2 output was 33.9 [interquartile range 30.3 - 44.9]; 40% of patients showed exercise oscillatory breathing during CPET. During a median follow-up of 18 months [interquartile range 8 - 54], overall 39 patients (29.7%) met the combined end-point of cardiovascular mortality or HF admission using a time-to-first event approach. Moderate to severe mitral regurgitation, slope, exercise oscillatory breathing were independently associated to cardiovascular mortality or HF admission. When CPET ventilatory variables were added to clinical and echocardiographic parameters, prediction of the combined point improved significantly (AUC 0.755 (95% CI 0.662 to 0.832) vs 0.634 (95% CI 0.536 to 0.725), p = 0.016). In conclusion, among elderly female HF patients the CPET derived parameters EOB and VE/VCO2 slope emerged as strong prognostic markers, with additive predictive value to clinical and echocardiographic parameters in patients with both reduced and preserved LVEF.
Highlights
The natural history of heart failure (HF) is different in women and men
We studied female patients with a clinical diagnosis of HF based on European Society of Cardiology [7] criteria who were consecutively evaluated at the cardiopulmonary exercise test (CPET) laboratory of our institution between 2006 and 2011
The sample size was adjusted since a multiple regression of the main variables of interest on the other covariates (VE/VO2 slope, atrial fibrillation, left ventricular ejection fraction (LVEF), NYHA class, watts achieved) is expected to have an R-Squared of 0.1130
Summary
HF which develops later in life, is more often attributable to hypertension and less frequent to coronary disease and is more often associated with preserved ventricular function than that in men [1]. The cardiopulmonary exercise test (CPET) provides simultaneous assessment of the performance of the heart, lungs, muscles and cellular respiration during physical exercise and is one of the most reliable tools to select candidates for heart transplantation. Beyond this established role for risk stratification in HF patients, the longterm prognostic value of CPET in women suffering from HF has not yet been deeply explored. Our study aimed to assess the prognostic value of ventilatory variables for a composite of cardiovascular mortality and HF admissions in a cohort of elderly women with HF and reduced or preserved systolic function
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