Variables Measured During Cardiopulmonary Exercise Testing as Predictors of Mortality in Chronic Systolic Heart Failure

被引:155
作者
Keteyian, Steven J. [1 ]
Patel, Mahesh [2 ]
Kraus, William E. [2 ]
Brawner, Clinton A. [1 ]
McConnell, Timothy R. [3 ]
Pina, Ileana L. [4 ]
Leifer, Eric S. [5 ]
Fleg, Jerome L. [5 ]
Blackburn, Gordon [6 ]
Fonarow, Gregg C. [7 ]
Chase, Paul J. [8 ]
Piner, Lucy [2 ]
Vest, Marianne [9 ]
O'Connor, Christopher M. [2 ]
Ehrman, Jonathan K. [1 ]
Walsh, Mary N. [10 ]
Ewald, Gregory [11 ]
Bensimhon, Dan [2 ]
Russell, Stuart D. [12 ]
机构
[1] Henry Ford Hosp, Div Cardiovasc Med, 6525 Second Ave, Detroit, MI 48202 USA
[2] Duke Univ, Sch Med, Div Cardiol, Durham, NC USA
[3] Bloomsburg Univ, Dept Exercise Sci, Bloomsburg, PA USA
[4] Montefiore Med Ctr, Albert Einstein Coll Med, 111 E 210th St, Bronx, NY 10467 USA
[5] NHLBI, Div Cardiovasc Sci, Bldg 10, Bethesda, MD 20892 USA
[6] Cleveland Clin, Dept Cardiovasc Med, Cleveland, OH 44106 USA
[7] Ronald Regan UCLA Med Ctr, Ahmanson UCLA Cardiomyopathy Ctr, Los Angeles, CA USA
[8] Cone Hlth, Div Cardiol, Greensboro, NC USA
[9] Univ Hosp Case Med Ctr, Cleveland, OH USA
[10] St Vincent Heart Ctr Indiana, Indianapolis, IN USA
[11] Washington Univ, Sch Med, Div Cardiol, St Louis, MO USA
[12] Johns Hopkins Univ Hosp, Div Cardiol, Baltimore, MD 21287 USA
基金
美国国家卫生研究院;
关键词
peak VO2; respiratory exchange ratio; sex; survival; PEAK OXYGEN-CONSUMPTION; TRIAL INVESTIGATING OUTCOMES; HF-ACTION; CARDIAC TRANSPLANTATION; VENTILATORY EFFICIENCY; CLASSIFICATION-SYSTEM; AMBULATORY PATIENTS; PROGNOSTIC VALUE; GUIDELINES; MODEL;
D O I
10.1016/j.jacc.2015.11.050
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
BACKGROUND Data 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. OBJECTIVES The 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). METHODS Among 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 [% ppVO(2)], ventilatory efficiency) were examined. RESULTS Over 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 % ppVO(2) and exercise duration were equally able to predict (Wald chi-square: similar to 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 % ppVO(2), 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 5.3 ml.kg(-1).min(-1) in women. CONCLUSIONS Peak VO2, exercise duration, and % ppVO(2) 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) (C) 2016 by the American College of Cardiology Foundation.
引用
收藏
页码:780 / 789
页数:10
相关论文
共 33 条
  • [1] Development and prospective validation of a clinical index to predict survival in ambulatory patients referred for cardiac transplant evaluation
    Aaronson, KD
    Schwartz, JS
    Chen, TM
    Wong, KL
    Goin, JE
    Mancini, DM
    [J]. CIRCULATION, 1997, 95 (12) : 2660 - 2667
  • [2] Metabolic exercise test data combined with cardiac and kidney indexes, the MECKI score: A multiparametric approach to heart failure prognosis
    Agostoni, Piergiuseppe
    Corra, Ugo
    Cattadori, Gaia
    Veglia, Fabrizio
    La Gioia, Rocco
    Scardovi, Angela B.
    Emdin, Michele
    Metra, Marco
    Sinagra, Gianfranco
    Limongelli, Giuseppe
    Raimondo, Rossella
    Re, Federica
    Guazzi, Marco
    Belardinelli, Romualdo
    Parati, Gianfranco
    Magri, Damiano
    Fiorentini, Cesare
    Mezzani, Alessandro
    Salvioni, Elisabetta
    Scrutinio, Domenico
    Ricci, Renato
    Bettari, Luca
    Di Lenarda, Andrea
    Pastormerlo, Luigi E.
    Pacileo, Giuseppe
    Vaninetti, Raffaella
    Apostolo, Anna
    Iorio, AnnaMaria
    Paolillo, Stefania
    Palermo, Pietro
    Contini, Mauro
    Confalonieri, Marco
    Giannuzzi, Pantaleo
    Passantino, Andrea
    Dei Cas, Livio
    Piepoli, Massimo F.
    Passino, Claudio
    [J]. INTERNATIONAL JOURNAL OF CARDIOLOGY, 2013, 167 (06) : 2710 - 2718
  • [3] American College of Sports Medicine, 2014, ACSMS GUID EX TEST P, P125
  • [4] Development of a ventilatory classification system in patients with heart failure
    Arena, Ross
    Myers, Jonathan
    Abella, Joshua
    Peberdy, Mary Ann
    Bensimhon, Daniel
    Chase, Paul
    Guazzi, Marco
    [J]. CIRCULATION, 2007, 115 (18) : 2410 - 2417
  • [5] Revisiting Cardiopulmonary Exercise Testing Applications in Heart Failure: Aligning Evidence with Clinical Practice
    Arena, Ross
    Guazzi, Marco
    Cahalin, Lawrence P.
    Myers, Jonathan
    [J]. EXERCISE AND SPORT SCIENCES REVIEWS, 2014, 42 (04): : 153 - 160
  • [6] Determining the Preferred Percent-Predicted Equation for Peak Oxygen Consumption in Patients With Heart Failure
    Arena, Ross
    Myers, Jonathan
    Abella, Joshua
    Pinkstaff, Sherry
    Brubaker, Peter
    Moore, Brian
    Kitzman, Dalane
    Peberdy, Mary Ann
    Bensimhon, Daniel
    Chase, Paul
    Forman, Daniel
    West, Erin
    Guazzi, Marco
    [J]. CIRCULATION-HEART FAILURE, 2009, 2 (02) : 113 - 120
  • [7] Clinician's Guide to Cardiopulmonary Exercise Testing in Adults A Scientific Statement From the American Heart Association
    Balady, Gary J.
    Arena, Ross
    Sietsema, Kathy
    Myers, Jonathan
    Coke, Lola
    Fletcher, Gerald F.
    Forman, Daniel
    Franklin, Barry
    Guazzi, Marco
    Gulati, Martha
    Keteyian, Steven J.
    Lavie, Carl J.
    Macko, Richard
    Mancini, Donna
    Milani, Richard V.
    [J]. CIRCULATION, 2010, 122 (02) : 191 - 225
  • [8] Reproducibility of peak oxygen uptake and other cardiopulmonary exercise testing parameters in patients with heart failure (from the Heart Failure and A Controlled Trial Investigating Outcomes of exercise traiNing)
    Bensimhon, Daniel R.
    Leifer, Eric S.
    Ellis, Stephen J.
    Fleg, Jerome L.
    Keteyian, Steven J.
    Pina, Ileana L.
    Kitzman, Dalane W.
    McKelvie, Robert S.
    Kraus, William E.
    Forman, Daniel E.
    Kao, Andrew J.
    Whellan, David J.
    O'Connor, Christopher M.
    Russell, Stuart D.
    [J]. AMERICAN JOURNAL OF CARDIOLOGY, 2008, 102 (06) : 712 - 717
  • [9] Comprehensive Analysis of Cardiopulmonary Exercise Testing and Mortality in Patients With Systolic Heart Failure: The Henry Ford Hospital Cardiopulmonary Exercise Testing (FIT-CPX) Project
    Brawner, Clinton A.
    Shafiq, Ali
    Aldred, Heather A.
    Ehrman, Jonathan K.
    Leifer, Eric S.
    Selektor, Yelena
    Tita, Cristina
    Velez, Mauricio
    Williams, Celeste T.
    Schairer, John R.
    Lanfear, David E.
    Keteyian, Steven J.
    [J]. JOURNAL OF CARDIAC FAILURE, 2015, 21 (09) : 710 - 718
  • [10] Four-Variable Risk Model in Men and Women With Heart Failure
    Chyu, Jennifer
    Fonarow, Gregg C.
    Tseng, Chi Hong
    Horwich, Tamara B.
    [J]. CIRCULATION-HEART FAILURE, 2014, 7 (01) : 88 - 95