Variables Measured During Cardiopulmonary Exercise Testing as Predictors of Mortality in Chronic Systolic Heart Failure
| Autor: | Timothy R. McConnell, Marianne Vest, Mary Norine Walsh, Clinton A. Brawner, Gordon Blackburn, Jerome L. Fleg, Gregg C. Fonarow, Dan Bensimhon, Mahesh J. Patel, Paul Chase, William E. Kraus, Hf-Action Investigators, Ileana L. Piña, Gregory A. Ewald, Eric S. Leifer, Jonathan K. Ehrman, Lucy W. Piner, Christopher M. O'Connor, Steven J. Keteyian, Stuart D. Russell |
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| Rok vydání: | 2015 |
| Předmět: |
Male
Pediatrics Time Factors 030204 cardiovascular system & hematology Cardiorespiratory Medicine and Haematology Cardiovascular 0302 clinical medicine Cause of Death 030212 general & internal medicine Respiratory exchange ratio Cause of death Chronic systolic heart failure Cardiopulmonary exercise testing Stroke volume Middle Aged Prognosis Survival Rate Heart Disease Predictive value of tests Cardiology Public Health and Health Services Disease Progression Female Cardiology and Cardiovascular Medicine Adult medicine.medical_specialty Clinical Trials and Supportive Activities survival Article 03 medical and health sciences Oxygen Consumption Clinical Research Predictive Value of Tests Internal medicine medicine sex Humans HF-ACTION Investigators Survival rate peak Vo(2) 6.7 Physical Aged Heart Failure peak VO2 business.industry Evaluation of treatments and therapeutic interventions Stroke Volume medicine.disease respiratory exchange ratio United States Good Health and Well Being Cardiovascular System & Hematology Heart failure Exercise Test business Systolic Follow-Up Studies Heart Failure Systolic |
| Zdroj: | Journal of the American College of Cardiology, vol 67, iss 7 |
| ISSN: | 1558-3597 |
| Popis: | BackgroundData from a cardiopulmonary exercise (CPX) test are used to determine prognosis in patients with chronic heart failure (HF). However, few published studies have simultaneously compared the relative prognostic strength of multiple CPX variables.ObjectivesThe study sought to describe the strength of the association among variables measured during a CPX test and all-cause mortality in patients with HF with reduced ejection fraction (HFrEF), including the influence of sex and patient effort, as measured by respiratory exchange ratio (RER).MethodsAmong patients (n= 2,100, 29% women) enrolled in the HF-ACTION (HF-A Controlled Trial Investigating Outcomes of exercise traiNing) trial, 10 CPX test variables measured at baseline (e.g., peak oxygen uptake [Vo2], exercise duration, percent predicted peak Vo2 [%ppVo2], ventilatory efficiency) were examined.ResultsOver a median follow-up of 32 months, there were 357 deaths. All CPX variables, except RER, were related to all-cause mortality (all p< 0.0001). Both %ppVo2 and exercise duration were equally able to predict (Wald chi-square: ∼141) and discriminate (c-index: 0.69) mortality. Peak Vo2 (ml·kg(-1)·min(-1)) was the strongest predictor of mortality among men (Wald chi-square: 129) and exercise duration among women (Wald chi-square: 41). Multivariable analyses showed that %ppVo2, exercise duration, and peak Vo2 (ml·kg(-1)·min(-1)) were similarly able to predict and discriminate mortality. In men, a 10% 1-year mortality rate corresponded to a peak Vo2 of 10.9 ml·kg(-1)·min(-1) versus 5.3ml·kg(-1)·min(-1) in women.ConclusionsPeak Vo2, exercise duration, and % ppVo2 carried the strongest ability to predict and discriminate the likelihood of death in patients with HFrEF. The prognosis associated with a given peak Vo2 differed by sex. (Exercise Training Program to Improve Clinical Outcomes in Individuals With Congestive Heart Failure; NCT00047437). |
| Databáze: | OpenAIRE |
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