Variables Measured During Cardiopulmonary Exercise Testing as Predictors of Mortality in Chronic Systolic Heart Failure
Open accessAbstract
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 [%ppVo2], 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 %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 5.3 ml·kg(-1)·min(-1) in women.Conclusions Peak 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).
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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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References 37 · Cited by 221
Research works printed but not linked: 3
- [15]American College of Sports Medicine Chapter 5 Clinical Exercise Testing, in ACSM’s Guidelines for Exercise Testing and Prescription 9 Philadelphia, PA Lippincott, Williams & Wilkens 2014 125
- [19]The International Society for Heart & Lung Transplantation Registries, heart/lung registries, quarterly data report Survival rates for transplants perfomed between April 1, 2010 and March 31, 2014 Available at: http://www.ishlt.org/registries/quarterlyDataReportResults.asp?organ=HR&rptType=recip_p_surv&continent=4 Accessed July 3, 2015
- [26]Guazzi M Adams V Conraads V EACPR/AHA Scientific Statement. Clinical recommendations for cardiopulmonary exercise testing data assessment in specific patient populations Circulation 2012 126 2261 74 22952317 PMC4777325
- Authors
- Keteyian, S. J., Patel, M., Kraus, W. E., Brawner, C. A., McConnell, T. R., Piña, I. L., Leifer, E. S., Fleg, J. L., Blackburn, G., Fonarow, G. C., Chase, P. J., Piner, L., Vest, M., O’Connor, C. M., Ehrman, J. K., Walsh, M. N., Ewald, G., Bensimhon, D., & Russell, S. D.
- Affiliations
- Henry Ford Health (US)
- Duke University (US)
- Bloomsburg University (US)
- Albert Einstein College of Medicine (US)
- National Heart, Lung, and Blood Institute (US)
- Cleveland Clinic (US)
- University of California, Los Angeles (US)
- Cone Health (US)
- University Hospitals Cleveland Medical Center (US)
- St Vincent Hospital (US)
- Washington University in St. Louis (US)
- Johns Hopkins University (US)
- Corresponding author
- Keteyian, Steven J.
- ORCID
- Venue
- Journal of the American College of Cardiology
- Publisher
- Elsevier BV
- Published
- 2016-02
- Volume
- 67
- Issue
- 7
- Pages
- 780-789
- ISSN
- 0735-1097 (ISSN-L)
- PMC
- PMC4761107
- OpenAlex
- W2279897032
- Cited by
- 221
- References
- 37
- Citations by year
- 2026: 14 · 2025: 20 · 2024: 20 · 2023: 27 · 2022: 25 · 2021: 22 · 2020: 20 · 2019: 20 · 2018: 19 · 2017: 25 · 2016: 9
- FWCI
- 50.08
- Type
- journal article
- Language
- en
- Update notices
- erratum (2016-04-26)
- Open access
- bronze
- doi.org
- Licence
- Locations
- Journal of the American College of Cardiology (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- eScholarship (California Digital Library) (submittedVersion)
- Funders
- National Heart, Lung, and Blood Institute (U01HL064250)
- 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 › Cardiac Health and Mental Health
- Keywords
- chronic systolic heart failure, heart failure with reduced ejection fraction, cardiopulmonary exercise testing, all-cause mortality, peak oxygen uptake, exercise duration, sex differences in prognosis, respiratory exchange ratio, prognostic factors, HF-ACTION trial
- MeSH terms
- Adult, Aged, Cause of Death, Exercise Test, Female, Follow-Up Studies, Humans, Male, Middle Aged, Oxygen Consumption, Predictive Value of Tests, Prognosis, Stroke Volume, Time Factors, United States, Survival Rate, Disease Progression, Heart Failure, Systolic
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