A meta-analysis of the prognostic significance of cardiopulmonary exercise testing in patients with heart failure

Cahalin, Lawrence P.; Chase, Paul; Arena, Ross; Myers, Jonathan; Bensimhon, Daniel; Peberdy, Mary Ann; Ashley, Euan A.; West, Erin; Forman, Daniel E.; Pinkstaff, Sherry; Lavie, Carl J.; Guazzi, Marco

doi:10.1007/s10741-012-9332-0

Cited by 117 publications

(112 citation statements)

References 24 publications

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“…28 There was no association between EOV and peak oxygen uptake , which stands in contrast to studies of EOV in acquired heart failure where EOV has consistently been found to correspond to lower aerobic capacity. [6][7][8]20,29 A previous study reporting on EOV in a group of young (average age, 12.3 years) Japanese total cavopulmonary anastomosis patients reported a sample of Fontan patients with, on average, normal Ventilatory data from baseline cardiopulmonary exercise test. Data are presented as mean±SD.…”

Section: Discussionmentioning

confidence: 99%

Exercise Oscillatory Ventilation in Patients With Fontan Physiology

Nathan

Loukas

Moko

et al. 2015

Circ: Heart Failure

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Background— Exercise oscillatory ventilation (EOV) refers to regular oscillations in minute ventilation (V E ) during exercise. Its presence correlates with heart failure severity and worse prognosis in adults with acquired heart failure. We evaluated the prevalence and predictive value of EOV in patients with single ventricle Fontan physiology. Methods and Results— We performed a cross-sectional analysis and prospective survival analysis of patients who had undergone a Fontan procedure and subsequent cardiopulmonary exercise test. Data were reviewed for baseline characteristics and incident mortality, heart transplant, or nonelective cardiovascular hospitalization. EOV was defined as regular oscillations for >60% of exercise duration with amplitude >15% of average V E . Survival analysis was performed using Cox regression. Among 253 subjects, EOV was present in 37.5%. Patients with EOV were younger (18.8±9.0 versus 21.7±10.1 years; P =0.02). EOV was associated with higher New York Heart Association functional class ( P =0.02) and V E /V CO 2 slope (36.8±6.9 versus 33.7±5.7; P =0.0002), but not with peak V O 2 (59.7±14.3 versus 61.0±16.0% predicted; P =0.52) or noninvasive measures of cardiac function. The presence of EOV was associated with slightly lower mean cardiac index but other invasive hemodynamic variables were similar. During a median follow-up of 5.5 years, 22 patients underwent transplant or died (n=19 primary deaths, 3 transplants with 2 subsequent deaths). EOV was associated with increased risk of death or transplant (hazard ratio, 3.9; 95% confidence interval, 1.5–10.0; P =0.002) and also predicted the combined outcome of death, transplant, or nonelective cardiovascular hospitalization after adjusting for New York Heart Association functional class, peak V O 2 , and other covariates (multivariable hazard ratio, 2.0; 95% confidence interval, 1.2–3.6; P =0.01). Conclusions— EOV is common in the Fontan population and strongly predicts lower transplant-free survival.

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Section: Discussionmentioning

confidence: 99%

Exercise Oscillatory Ventilation in Patients With Fontan Physiology

Nathan

Loukas

Moko

et al. 2015

Circ: Heart Failure

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“…VO2peak is shown to be a strong predictor of survival in general populations (5,6), among patients with coronary artery disease (CAD) (7) and in patients with severe HF (8). Limited exercise capacity is the cardinal symptom in HF.…”

Section: Physical Capacity As a Prognostic Variablementioning

confidence: 99%

Peak oxygen uptake and self‐reported physical health are strong predictors of long‐term survival after heart transplantation

Yardley

Havik

Grov

et al. 2015

Clinical Transplantation

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Background Peak oxygen uptake (VO2peak) is known as the gold standard measure of cardiopulmonary fitness. We therefore hypothesized that measures of physical health would predict long‐term survival in heart transplant recipients (HTx). Methods This retrospective study investigated survival in two HTx populations; the cardiopulmonary exercise test (CPET) cohort comprised 178 HTx patients who completed a VO2peak test during their annual follow‐up (1990–2003), and the SF‐36 cohort comprised 133 patients who completed a quality of life questionnaire, SF‐36v1 (1998–2000). Results Mean (SD) age in the CPET cohort was 52 (12) yr and 54 (11) yr in the SF‐36 cohort. Mean observation time was, respectively, 11 and 10 yr. Mean (SD) VO2peak was 19.6 (5.3) mL/kg/min, and median (IR) physical function (PF) score was 90 (30). VO2peak and PF scores were both significant predictors in univariate Cox regression. Multiple Cox regression analyses adjusted for other potential predictors showed that VO2peak, age, and cardiac allograft vasculopathy (CAV) were the most important predictors in the CPET cohort, whereas age, PF score, smoking, and CAV were the most important predictors in the SF‐36 cohort. In Kaplan–Meier analysis, VO2peak and PF scores above the median value were related to significant longer survival time. Conclusion Peak oxygen uptake and self‐reported physical health are strong predictors for long‐term survival in HTx recipients. VO2peak is a crucial measurement and should be more frequently used after HTx.

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“…When performed by experienced personnel, cardiopulmonary exercise testing with simultaneous measurement of respiratory gases is an objective measure of functional limitation [7]. Studies in patients with hypertrophic cardiomyopathy have shown that cardiopulmonary exercise testing can aid differential diagnosis and predict clinical outcomes, in particular heart failure [8].…”

Section: Attributed To Confuciusmentioning

confidence: 99%

Evolving Story of Clinical Trials in Hypertrophic Cardiomyopathy

Elliott

2018

Circ: Heart Failure

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A meta-analysis of the prognostic significance of cardiopulmonary exercise testing in patients with heart failure

Cited by 117 publications

References 24 publications

Exercise Oscillatory Ventilation in Patients With Fontan Physiology

Exercise Oscillatory Ventilation in Patients With Fontan Physiology

Peak oxygen uptake and self‐reported physical health are strong predictors of long‐term survival after heart transplantation

Evolving Story of Clinical Trials in Hypertrophic Cardiomyopathy

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