Abstract
Purpose Diminished exercise capacity is a key symptom in heart failure (HF), varying directly with disease severity. Exercise capacity can be objectively measured by oxygen uptake (VO2). Low peak VO2 is widely recognized as a predictor of poor prognosis, and is currently used to determine need for heart transplant (HTx). VE/VCO2 slope and oxygen uptake efficiency slope (OUES) have also been identified as prognostic markers. Unlike peak VO2, these variables can be calculated from sub-maximal exercise, critical in HF patients who may be unable to achieve maximal effort. Objective: To determine which exercise variable(s) obtained during cardiopulmonary exercise testing adds the most prognostic value to recognized clinical predictors of prognosis in HF. Methods and Materials This was a retrospective cohort study of 517 HF patients seen at Toronto General Hospital. The endpoints were a composite outcome (ventricular assistance device (VAD) implantation, HTx, and death) and hospital admissions due to HF. Cox proportional hazards modeling was used to determine the additional prognostic value of peak VO2, OUES and VE/VCO2 slope. Results During a mean follow up of 2.7 years, there were 118 outcomes (52 deaths, 47 HTx, 19 VAD). After adjusting for age, NYHA class, ejection fraction, BMI, creatinine, and brain natriuretic peptide (BNP); VO2peak, OUES, and VE/VCO2 slope were found to be independent predictors associated with the composite outcome (p Conclusions The study showed that peak VO2, OUES, and VE/VCO2 slope are independent predictors of HF prognosis. However, no single exercise variable was found to be superior to the others.
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