Cardiopulmonary Exercise Testing In Heart Failure Research Articles

Statement on cardiopulmonary exercise testing in chronic heart failure due to left ventricular dysfunction: recommendations for performance and interpretation Part I: Definition of cardiopulmonary exercise testing parameters for appropriate use in chronic heart failure

Cardiopulmonary exercise testing (CPET) provides a global assessment of the integrated response to exercise involving the pulmonary, cardiovascular, haematopoietic, neuropsychological, and skeletal muscle systems. This information cannot be obtained through investigation of the individual organ systems in isolation. The non-invasive, dynamic physiological overview permits the evaluation of both submaximal and peak exercise responses, providing the physician with relevant information for clinical decision making. The use of CPET in management of the chronic heart failure patient is increasing with the understanding that resting pulmonary and cardiac function testing cannot reliably predict exercise performance and functional capacity and that, furthermore, overall health status and prognosis are predicted better by indices of exercise tolerance than by resting measurements. Our aim is to produce a statement which provides recommendations on the interpretation and clinical application of CPET in heart failure, based on contemporary scientific knowledge and technical advances: the focus is on clinical indications, issues of standardization, and interpretative strategies for CPET.

Prognostic characteristics of cardiopulmonary exercise testing in heart failure: comparing American and European models

Cardiopulmonary exercise testing (CPET) in the heart failure population is a standard of care in both American and European clinics, although the mode of exercise typically differs. The purpose of the present study was to compare the prognostic characteristics of peak oxygen consumption (VO2) and the minute ventilation-carbon dioxide production (VE/VCO2) slope between two independent heart failure groups. One hundred and two subjects underwent maximal exercise CPET using bicycle ergometry at San Paolo Hospital in Milan, Italy (SPH) and 105 subjects underwent treadmill CPET at Virginia Commonwealth University in Richmond, Virginia (VCU). Subjects were tracked for cardiac-related mortality for a 1-year period after CPET. There were 13 cardiac-related deaths over the 1-year tracking period in both groups. Optimal prognostic threshold values for peak VO2 were 12.9 ml O2/kg per min (sensitivity 81%, specificity 69%) in the SPH group and 12.0 ml O2/kg per min (sensitivity 74%, specificity 69%) in the VCU group. An optimal prognostic threshold value for the VE/VCO2 slope was 34.4 in the SPH (sensitivity 61%, specificity 85%) and 34.5 in the VCU (sensitivity 64%, specificity 93%) groups. The prognostic characteristics of peak VO2 and the VE/VCO2 slope were similar between the two centers. These results suggest that the mode of exercise does not greatly impact the prognostic utility of CPET responses in heart failure. They further suggest that prognostic guidelines for the application of CPET in heart failure may be applied globally, irrespective of differences in testing modality.

Peak VO 2 and VE/VCO 2 slope in patients with heart failure: a prognostic comparison

Background Exercise testing with ventilatory expired gas analysis has proven to be a valuable tool for assessing patients with heart failure (HF). Peak oxygen consumption (peak VO 2) continues to be considered the gold standard for assessing prognosis in HF. The minute ventilation − carbon dioxide production relationship (VE/VCO 2 slope) has recently demonstrated prognostic significance in patients with HF, and in some studies, it has outperformed peak VO 2. Methods Two hundred thirteen subjects, in whom HF was diagnosed, underwent exercise testing between April 1, 1993, and October 19, 2001. The ability of peak VO 2 and VE/VCO 2 slope to predict cardiac-related mortality and hospitalization was examined. Results Peak VO 2 and VE/VCO 2 slope were demonstrated with univariate Cox regression analysis both to be significant predictors of cardiac-related mortality and hospitalization ( P <.01). Multivariate analysis revealed that peak VO 2 added additional value to the VE/VCO 2 slope in predicting cardiac-related hospitalization, but not cardiac mortality. The VE/VCO 2 slope was demonstrated with receiver operating characteristic curve analysis to be significantly better than peak VO 2 in predicting cardiac-related mortality ( P <.05). Although area under the receiver operating characteristic curve for the VE/VCO 2 slope was greater than peak VO 2 in predicting cardiac-related hospitalization (0.77 vs 0.73), the difference was not statistically significant ( P = .14). Conclusions These results add to the present body of knowledge supporting the use of cardiopulmonary exercise testing in HF. Consideration should be given to revising clinical guidelines to reflect the prognostic importance of the VE/VCO 2 slope in addition to peak VO 2.

Peak VO2 and VE/VCO2 slope in patients with heart failure: a prognostic comparison

Exercise testing with ventilatory expired gas analysis has proven to be a valuable tool for assessing patients with heart failure (HF). Peak oxygen consumption (peak VO 2 ) continues to be considered the gold standard for assessing prognosis in HF. The minute ventilation − carbon dioxide production relationship (VE/VCO 2 slope) has recently demonstrated prognostic significance in patients with HF, and in some studies, it has outperformed peak VO 2 . Two hundred thirteen subjects, in whom HF was diagnosed, underwent exercise testing between April 1, 1993, and October 19, 2001. The ability of peak VO 2 and VE/VCO 2 slope to predict cardiac-related mortality and hospitalization was examined. Peak VO 2 and VE/VCO 2 slope were demonstrated with univariate Cox regression analysis both to be significant predictors of cardiac-related mortality and hospitalization ( P <.01). Multivariate analysis revealed that peak VO 2 added additional value to the VE/VCO 2 slope in predicting cardiac-related hospitalization, but not cardiac mortality. The VE/VCO 2 slope was demonstrated with receiver operating characteristic curve analysis to be significantly better than peak VO 2 in predicting cardiac-related mortality ( P <.05). Although area under the receiver operating characteristic curve for the VE/VCO 2 slope was greater than peak VO 2 in predicting cardiac-related hospitalization (0.77 vs 0.73), the difference was not statistically significant ( P = .14). These results add to the present body of knowledge supporting the use of cardiopulmonary exercise testing in HF. Consideration should be given to revising clinical guidelines to reflect the prognostic importance of the VE/VCO 2 slope in addition to peak VO 2 .