Prognostic Value of Oxygen Kinetics During Recovery From Cardiopulmonary Exercise Testing in Patients With Chronic Heart Failure

Abstract Background Peak oxygen uptake ( V ˙ O2 peak) is a well-established prognostic marker in chronic heart failure (CHF). Cardiopulmonary exercise testing (CPET) provides physiological parameters other than V ˙ O2 peak that might have prognostic value. We aimed at determining whether exercise re...

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Bibliographic Details
Published in:Canadian journal of cardiology 2015-10, Vol.31 (10), p.1259-1265
Main Authors: Fortin, Marc, MD, Turgeon, Pierre-Yves, Nadreau, Éric, MSc, Grégoire, Pierre, Maltais, Louis-Gabriel, Sénéchal, Mario, MD, Provencher, Steeve, MD, MSc, Maltais, François, MD
Format: Article
Language:English
Subjects:
Canada - epidemiology
Cardiovascular
Chronic Disease
Exercise Test - adverse effects
Exercise Test - methods
Female
Heart Failure - diagnosis
Heart Failure - metabolism
Heart Failure - mortality
Heart Failure - therapy
Heart Transplantation - methods
Heart-Assist Devices - statistics & numerical data
Humans
Male
Middle Aged
Oxygen - metabolism
Oxygen - pharmacokinetics
Oxygen Consumption - physiology
Predictive Value of Tests
Preoperative Care - methods
Prognosis
Recovery of Function - physiology
Retrospective Studies
Survival Analysis
Time Factors
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Summary:Abstract Background Peak oxygen uptake ( V ˙ O2 peak) is a well-established prognostic marker in chronic heart failure (CHF). Cardiopulmonary exercise testing (CPET) provides physiological parameters other than V ˙ O2 peak that might have prognostic value. We aimed at determining whether exercise recovery data kinetics have prognostic implications over V ˙ O2 peak and Heart Failure Survival Score. Methods Exercise data from 200 consecutive CHF patients evaluated for possible heart transplantation and received CPET at our institution between 2004 and 2011 were analyzed. The rate of recovery of oxygen uptake ( V ˙ O2 ) at 2 minutes after exercise ( V ˙ O2 -REC2 ) was calculated using the difference between V ˙ O2 peak and V ˙ O2 at minute 2 of recovery and expressed as a percentage of V ˙ O2 peak. The composite primary end point was the time from CPET to the first event including death, heart transplant, or mechanical heart implantation. Results Mean follow-up period was 1271 ± 61 days during which there were 108 first events including 35 deaths, 66 heart transplants, and 7 mechanical heart implantations. The strongest prognostic factors in the univariate analysis were V ˙ O2 -REC2 , V ˙ O2 peak, V ˙ O2 efficiency slope, and ventilation to carbon dioxide excretion ratio slope (all P < 0.0001). Multivariate analysis showed that V ˙ O2 -REC2 ( P < 0.0001), ventilation to carbon dioxide excretion ratio slope ( P  = 0.0022), use of angiotensin-converting enzyme inhibitors or angiotensin receptor blockers ( P  = 0.0042), presence of a defibrillator ( P  = 0.0127), and mean arterial pressure ( P  = 0.0151) were independent predictors of event-free survival time. Conclusions V ˙ O2 -REC2 was the strongest prognostic marker of death, heart transplantation, and mechanical heart implantation in severe CHF. This finding should be confirmed prospectively.
ISSN:0828-282X
1916-7075
DOI:10.1016/j.cjca.2015.02.015