Indicators of functional capacity and HS are improved in patients with continuous-flow LVADs who attend CR. Future trials should examine the mechanisms responsible for these improvements, and if such improvements translate into improved clinical outcomes. (Cardiac Rehabilitation in Patients With Continuous Flow Left Ventricular Assist Devices:Rehab VAD Trial [RehabVAD]; NCT01584895).

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Background Although cardiopulmonary exercise (CPX) testing in patients with heart failure and reduced ejection fraction (HFrEF) is well established, there is limited data on the value of CPX variables in patients with HF and preserved EF (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 (EF ≥ 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 (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 (CTx). Results We identified 173 HFpEF patients (45% women; 58% non-white; age = 54±14 y) with complete CPX data. During a median follow-up of 5.2 y there were 42 deaths and 5 CTx. The 1, 3, and 5 y 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 beta-blockade therapy, ppMVO2 was the strongest predictor of the endpoint (Wald χ2 = 15.0, HR per 10% = p < 0.001), followed by peak VO2 (Wald χ2 = 11.8, p = 0.001). VE/VCO2 slope (Wald χ2 = 0.4, p = 0.54) and EOV (Wald χ2 = 0.15, p = 0.70) 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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