Cardiopulmonary exercise testing as prognostic indicators: Comparisons among heart failure patients with reduced, mid-range and preserved ejection fraction

Abstract

Aims We aimed to determine the differences of impact of cardiopulmonary exercise testing (CPX) parameters on prognosis of heart failure with reduced left ventricular ejection fraction (HFrEF), preserved ejection fraction (HFpEF) and mid-range ejection fraction (HFmrEF). Methods We compared clinical characteristics and CPX parameters among the three groups, and the value of each CPX parameter to predict adverse cardiac events (cardiac deaths and re-hospitalizations for heart failure), cardiac deaths and all-cause deaths. Results Of 1190 patients, 41.9% had HFrEF, 36.8% had HFpEF and 21.3% had HFmrEF. The patients in HFrEF group had higher rates of adverse cardiac events, cardiac death and all-cause death than those of HFpEF and HFmrEF groups. In HFrEF, the independent predictors of adverse cardiac events were peak oxygen consumption and oxygen uptake efficiency slope, predictors of cardiac death were peak oxygen consumption and oxygen uptake efficiency slope, and the predictor of all-cause death was peak oxygen consumption. In HFpEF, the predictor of adverse cardiac events was peak oxygen consumption, predictors of cardiac deaths and all-cause deaths were peak oxygen consumption and exertional oscillatory ventilation. In HFmrEF, predictors of adverse cardiac events were peak oxygen consumption and oxygen uptake efficiency slope, and the predictor of cardiac deaths and all-cause deaths was peak oxygen consumption. Conclusion Peak oxygen consumption is the strong predictor for adverse events in all groups. Oxygen uptake efficiency slope predicts adverse prognosis in HFrEF, but not in HFpEF. In contrast, exertional oscillatory ventilation is the predictor only in HFpEF. Thus, different CPX parameters may be able to differentially predict prognosis in HFrEF and HFpEF. Those for predicting prognosis in HFmrEF may be intermediate between HFrEF and HFpEF.

Clinical characteristics of hospitalized heart failure patients with preserved, mid‐range, and reduced ejection fractions in Japan

“…23,24 Age and the proportion of women were the highest in the HFpEF group, followed by those in the HFmrEF and HFrEF groups; these results are comparable with reports from the USA and Europe. 23,24 Age and the proportion of women were the highest in the HFpEF group, followed by those in the HFmrEF and HFrEF groups; these results are comparable with reports from the USA and Europe.…”

“…23,24 Age and the proportion of women were the highest in the HFpEF group, followed by those in the HFmrEF and HFrEF groups; these results are comparable with reports from the USA and Europe. 23,24 However, the Chronic Heart Failure Analysis and Registry in the Tohoku District (CHART)-2 reported that coronary artery disease was found in nearly 50% of HF patients. In general, coronary artery disease is a major type of underlying heart disease in HF patients in the USA and Europe (~50%).…”

“…2 However, our results showed that only 30% of HF patients had coronary artery disease. 23,24 Japanese patients with HFmrEF have a relatively high proportion of underlying coronary artery disease, and there is a possibility that the LVEF may improve with the subsequent treatment of ischaemia (including revascularization). 23,24 However, the Chronic Heart Failure Analysis and Registry in the Tohoku District (CHART)-2 reported that coronary artery disease was found in nearly 50% of HF patients.…”

Haemodynamic and metabolic phenotyping of hypertensive patients with and without heart failure by combining cardiopulmonary and echocardiographic stress test

“…CPET and ESE provide several parameters with a well‐known prognostic value in HF individually, also when systolic function (i.e. LVEF) is preserved . The aim should be to interrupt the slippery slope towards HFpEF, which is a more complex and heterogeneous disease than HFrEF .…”

Editor’s presentation

“…CPET parameters in HFmrEF patients were intermediate between heart failure with preserved ejection fraction (HFpEF) and HFrEF, probably because the pathophysiology of HFmrEF overlaps with that of both HFpEF and HFrEF. 17 …”