Prognostic value of cardiopulmonary exercise testing in heart failure with preserved ejection fraction. The Henry Ford HospITal CardioPulmonary EXercise Testing (FIT-CPX) project
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Background Although cardiopulmonary exercise (CPX) testing in patients with heart failure and reduced ejection fraction is well established, there are limited data on the value of CPX variables in patients with HF and preserved ejection fraction (HFpEF). We sought to determine the prognostic value of select CPX measures in patients with HFpEF.Methods This was a retrospective analysis of patients with HFpEF (ejection fraction ≥ 50%) who performed a CPX test between 1997 and 2010. Selected CPX variables included peak oxygen uptake (VO2), percent predicted maximum oxygen uptake (ppMVO2), minute ventilation to carbon dioxide production slope (VE/VCO2 slope) and exercise oscillatory ventilation (EOV). Separate Cox regression analyses were performed to assess the relationship between each CPX variable and a composite outcome of all-cause mortality or cardiac transplant.Results We identified 173 HFpEF patients (45% women, 58% non-white, age 54 ± 14 years) with complete CPX data. During a median follow-up of 5.2 years, there were 42 deaths and 5 cardiac transplants. The 1-, 3-, and 5-year cumulative event-free survival was 96%, 90%, and 82%, respectively. Based on the Wald statistic from the Cox regression analyses adjusted for age, sex, and β-blockade therapy, ppMVO2 was the strongest predictor of the end point (Wald χ(2) = 15.0, hazard ratio per 10%, P < .001), followed by peak VO2 (Wald χ(2) = 11.8, P = .001). VE/VCO2 slope (Wald χ(2)= 0.4, P = .54) and EOV (Wald χ(2) = 0.15, P = .70) had no significant association to the composite outcome.Conclusion These data support the prognostic utility of peak VO2 and ppMVO2 in patients with HFpEF. Additional studies are needed to define optimal cut points to identify low- and high-risk patients.
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A consequence of the HF-mediated decline in peak VO2 is decreased physical functional performance and greater risk for poor outcomes.
“A consequence of the HF-mediated decline in peak V˙o2 is decreased physical functional performance and greater risk for poor outcomes.186,187,189–193”
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- Authors
- Shafiq, A., Brawner, C. A., Aldred, H. A., Lewis, B., Williams, C. T., Tita, C., Schairer, J. R., Ehrman, J. K., Velez, M., Selektor, Y., Lanfear, D. E., & Keteyian, S. J.
- Affiliations
- University of Missouri–Kansas City (US)
- Henry Ford Hospital (US)
- Corresponding author
- Shafiq, Ali
- Venue
- American Heart Journal
- Publisher
- Elsevier BV
- Published
- 2016-04
- Volume
- 174
- Pages
- 167-172
- ISSN
- 0002-8703 (ISSN-L)
- PMC
- PMC4804356
- OpenAlex
- W2234877337
- Cited by
- 102
- References
- 29
- Citations by year
- 2026: 3 · 2025: 10 · 2024: 10 · 2023: 8 · 2022: 7 · 2021: 11 · 2020: 11 · 2019: 6 · 2018: 9 · 2017: 22 · 2016: 5
- FWCI
- 28.79
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- American Heart Journal (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Heart, Lung, and Blood Institute (R01HL103871, T32HL110837)
- Topics
- Health Sciences › Medicine › Complementary and alternative medicine › Cardiovascular and exercise physiology
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Heart Failure Treatment and Management
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Heart rate and cardiovascular health
- Keywords
- heart failure with preserved ejection fraction, cardiopulmonary exercise testing, prognostic value, peak oxygen uptake, VE/VCO2 slope, exercise oscillatory ventilation, all-cause mortality, heart transplantation, risk stratification
- MeSH terms
- Echocardiography, Exercise Test, Female, Follow-Up Studies, Cardiac Catheterization, Heart Failure, Humans, Male, Middle Aged, Prognosis, Retrospective Studies, Severity of Illness Index, Stroke Volume, Time Factors, United States, Reproducibility of Results, Survival Rate, Disease Progression, Disease-Free Survival, Myocardial Perfusion Imaging
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