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European Journal of Heart Failure 2008 10(1):85-88; doi:10.1016/j.ejheart.2007.10.010
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© 2008 European Society of Cardiology

Combining the ventilatory response to exercise and peak oxygen consumption is no better than peak oxygen consumption alone in predicting mortality in chronic heart failure

Lee Inglea, Klaus K. Wittec,*, John G.F. Clelandb and Andrew L. Clarkb

a Carnegie Research Institute, Leeds Metropolitan University Leeds, UK
b Academic Department of Cardiology, University of Hull Hull, UK
c Department of Cardiology, Leeds General Infirmary Leeds, UK

* Corresponding author. Leeds General Infirmary, Great George Street, Leeds, LS1 3EX, United Kingdom. Tel.: +44 113 2787206. E-mail address: klauswitte{at}hotmail.com (K. K. Witte).


  Abstract

Background: A low peak oxygen uptake (pVO2) and steep VE/VCO2 slope are independently associated with a worse prognosis in patients with chronic heart failure (CHF). We wished to confirm whether combining these variables as a ratio would lead to a more accurate predictor of prognosis than using either alone.

Methods: 388 CHF patients completed a treadmill-based cardiopulmonary exercise test (CPET) to volitional exhaustion using a modified Bruce protocol.

Results: 212 CHF patients completed the CPET with a peak RER ≥1.0. Of these, 48 patients died and one was transplanted during follow-up. In surviving patients, the median follow-up period was 42 months (IQR 34–49 months). The ratio VE/VCO2 slope/pVO2 was calculated for each individual and its ability to predict outcome compared with other variables. The Cox multivariable survival analysis showed that pVO2 was the strongest independent predictor of mortality in CHF patients.

Conclusion: Our study shows that the composite variable VE/VCO2 slope/pVO2 is a less effective prognosticator than pVO2 alone in patients with CHF.

Key Words: Exercise testing • Cardiopulmonary exercise testing • Prognosis

Received June 28, 2007; Revised September 21, 2007; Accepted October 18, 2007


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