Prognostic factors of chronic heart failure in NYHA class II or III: value of invasive exercise haemodynamic data

Roul, G.; Moulichon, Marc Eric; Bareiss, P; Gries, P.; A, Koegler; Sacrez, J; Germain, P.; Mossard, J. M.; Sacrez, A

doi:10.1093/oxfordjournals.eurheartj.a060747

Cited by 78 publications

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“…Exercise duration and peak VO 2 was not able to discriminate survivors from nonsurvivors. This was followed by the study of Roul et al 16 who showed that hemodynamic data measured at rest were weak predictors but cardiac power output and stroke work index measured at peak exercise were very strong predictors. Chomsky et al 8 in 185 patients with CHF found that the CO response to exercise was the most powerful predictor of survival in this study population according to both univariate and multivariate analyses.…”

Section: Discussionmentioning

confidence: 93%

Peak Cardiac Power Output, Measured Noninvasively, Is a Powerful Predictor of Outcome in Chronic Heart Failure

Lang

Karlin

Haythe

et al. 2009

Circ: Heart Failure

115

101

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Background-The cardiac output (CO) response to exercise and other invasively derived hemodynamic variables has been variably described to provide better prognostication than peak VO 2 in patients with chronic heart failure. Using noninvasive measurements of CO during exercise, we compared the prognostic value of peak CO and cardiac power to peak VO 2 in chronic heart failure patients. Method and Results-One hundred seventy-one consecutive patients with chronic heart failure underwent symptom limited bicycle exercise with noninvasive estimation of CO using an inert gas rebreathing method. An accurate measure of peak CO was obtained in 148 patients (85% of patients; mean age, 53Ϯ14 years; 80% male; left ventricular ejection fraction, 24Ϯ12%; ischemic etiology, 34%). Peak cardiac power was derived from the product of the peak mean arterial blood pressure and CO divided by 451. End points consisted of death, urgent heart transplant, or left ventricular assist device implantation. Duration of follow-up averaged 337Ϯ252 days (median, 295 days). Univariate and multivariate analysis were performed. The variables analyzed included peak VO 2 , peak CO, peak cardiac power, VE/VCO 2 slope, and VO 2 at anaerobic threshold. Event-free survival for the entire cohort was 83% with 5 deaths, 4 left ventricular assist device implants, and 16 urgent transplants. Peak VO 2 was 12.9Ϯ4.5 mL/kg per min, and peak cardiac power was 1.7Ϯ0.9 W. Peak VO 2 , peak CO, peak cardiac power, VE/VCO 2 slope, and VO 2 at anaerobic threshold were predictive of outcome on univariate analysis. On multivariate analysis, peak cardiac power and peak CO were predictive of outcome with peak cardiac power being the most powerful independent predictor of outcome (Pϭ0.01). Conclusions-Peak cardiac power, measured noninvasively, is an independent predictor of outcome that can enhance the prognostic power of peak VO 2 in the evaluation of patients with heart failure. (Circ Heart Fail. 2009;2:33-38.)

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Section: Discussionmentioning

confidence: 93%

Peak Cardiac Power Output, Measured Noninvasively, Is a Powerful Predictor of Outcome in Chronic Heart Failure

Lang

Karlin

Haythe

et al. 2009

Circ: Heart Failure

115

101

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“…Resting and peak exercise cardiac power output has been shown to be a most powerful predictor of prognosis and mortality in patients with chronic heart failure and those with cardiogenic shock 32–36. Moreover, patients with a peak cardiac power output <2 W have a considerably higher mortality rate than those with a peak cardiac power output >2 W 34 36. Therefore, it is reasonable to suggest that patients with optimal HeartMate II LVAD support have a good long-term prognosis.…”

Section: Discussionmentioning

confidence: 99%

The impact of acute reduction of continuous-flow left ventricular assist device support on cardiac and exercise performance

Jakovljevic

George

Nunan

et al. 2010

Heart

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“…20,21 The higher the pulmonary vascular resistance, the more the ventilation -perfusion inequality is aggravated. In the present study, none of the subjects had hypoxia before or after exercise testing, but would have developed hypoxemia if they continued to exercise after exhibiting aggravated ventilation -perfusion inequality.…”

Section: Discussionmentioning

confidence: 99%

Excessive Ventilatory Response During Exercise in Patients With Non-Hypoxic Pulmonary Hypertension.

Mitani

Haraguchi

Takata

et al. 2002

Circ J

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e can evaluate exercise capacity by oxygen consumption (V • O2), carbon dioxide output (V • CO2) and minute ventilation (V • E), [1][2][3][4] and the slope of the linear regression line between V• CO2 and V • E (SLOPE) is a useful parameter for indicating exercise capacity in chronic heart failure patients. [5][6][7][8][9] Furthermore, SLOPE is an index of ventilatory -perfusion inequality. 6,9 Few studies have investigated the relationship between exercise capacity and SLOPE in patients with pulmonary hypertension (PH), so we examined the relationship between exercise capacity and SLOPE in patients with PH, and the differences in ventilatory response between them and patients with a stable old myocardial infarction (OMI). We also discuss the meaning of the exercise tolerance test in PH patients. MethodsPatient Population (Table 1) Patients With Pulmonary Hypertension Eight patients with PH in series were recruited. Their mean age was 57±5 years (range, 22-68 monary thromboembolism were diagnosed by the criteria and description from textbooks. 10,11 Two female patients had PPH; pulmonary scintigraphy demonstrated only shallow subpleural perfusion deficits and pulmonary angiography could not detect significant thrombosis. The other 6 patients (3 male, 3 female) had chronic pulmonary thromboembolism shown by thrombi in proximal pulmonary arteries on pulmonary angiograms.According to echocardiography, all the patients had a normal left ventricular ejection fraction and none had wall motion asynergy. There were no significant disorders of the aortic or mitral valves.All of the patients were clinically stable. They were all receiving diuretics, calcium channel blockers (nifedipine), warfarin and prostaglandin I2 derivative (beraprost), without any change in medication for several months prior to the exercise test. No patient was on diltiazem or verapamil.Patients With OMI Thirty-eight patients with stable OMI (male only) who were not current smokers, were recruited. Their mean age was 52±1 years (range, 38-59) and they were all clinically stable. They were receiving diuretics, digoxin, calcium blockers, or nitrates, and there were no changes in these medications for several months prior to exercise testing. Diltiazem, verapamil, or -blockers were not prescribed for those patients.In the present study, patients who had to cease the exercise test because of cyanosis, anginal pain or ischemic changes on the electrocardiogram (ECG) were excluded. Patients with atrial fibrillation or other various arrhythmias, clinical valvular disorders, severe anemia (hemoglobin <12 g/dl), orthopedic disorders, obesity (body mass index (BMI) The slope of the regression line between carbon dioxide output (V • CO2) and minute ventilation (V • E) (SLOPE) is useful for evaluating ventilation -perfusion inequality during exercise. A cardiopulmonary exercise test was carried out in 8 pulmonary hypertension (PH) patients without hypoxemia (group PH), 38 male patients with old myocardial infarction (group OMI), and 20 healthy men (group Ctrl). ...

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Prognostic factors of chronic heart failure in NYHA class II or III: value of invasive exercise haemodynamic data

Cited by 78 publications

References 0 publications

Peak Cardiac Power Output, Measured Noninvasively, Is a Powerful Predictor of Outcome in Chronic Heart Failure

Peak Cardiac Power Output, Measured Noninvasively, Is a Powerful Predictor of Outcome in Chronic Heart Failure

The impact of acute reduction of continuous-flow left ventricular assist device support on cardiac and exercise performance

Excessive Ventilatory Response During Exercise in Patients With Non-Hypoxic Pulmonary Hypertension.

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