Predictive Value of Cardiopulmonary Exercise Testing Parameters in Ambulatory Advanced Heart Failure
This study sought to determine cardiopulmonary exercise (CPX) predictors of the combined outcome of durable mechanical circulatory support (MCS), transplantation, or death at 1 year among patients with ambulatory advanced heart failure (HF). Optimal CPX predictors of outcomes in contemporary ambulat...
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| Vydáno v: | JACC. Heart failure Ročník 9; číslo 3; s. 226 |
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| Hlavní autoři: | , , , , , , , , , , , , , , , , |
| Médium: | Journal Article |
| Jazyk: | angličtina |
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United States
01.03.2021
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| ISSN: | 2213-1787, 2213-1787 |
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| Abstract | This study sought to determine cardiopulmonary exercise (CPX) predictors of the combined outcome of durable mechanical circulatory support (MCS), transplantation, or death at 1 year among patients with ambulatory advanced heart failure (HF).
Optimal CPX predictors of outcomes in contemporary ambulatory advanced HF patients are unclear.
REVIVAL (Registry Evaluation of Vital Information for ventricular assist devices [VADs] in Ambulatory Life) enrolled 400 systolic HF patients, INTERMACS (Interagency Registry for Mechanically Assisted Circulatory Support) profiles 4-7. CPX was performed by 273 subjects 2 ± 1 months after study enrollment. Discriminative power of maximal (peak oxygen consumption [peak VO
]; VO
pulse, circulatory power [CP]; peak systolic blood pressure • peak VO
], peak end-tidal pressure CO
[PEtCO
], and peak Borg scale score) and submaximal CPX parameters (ventilatory efficiency [VE/VCO
slope]; VO
at anaerobic threshold [VO
AT]; and oxygen uptake efficiency slope [OUES]) to predict the composite outcome were assessed by univariate and multivariate Cox regression and Harrell's concordance statistic.
At 1 year, there were 39 events (6 transplants, 15 deaths, 18 MCS implantations). Peak VO
, VO
AT, OUES, peak PEtCO
, and CP were higher in the no-event group (all p < 0.001), whereas VE/VCO
slope was lower (p < 0.0001); respiratory exchange ratio was not different. CP (hazard ratio [HR]: 0.89; p = 0.001), VE/VCO
slope (HR: 1.05; p = 0.001), and peak Borg scale score (HR: 1.20; p = 0.005) were significant predictors on multivariate analysis (model C-statistic: 0.80).
Among patients with ambulatory advanced HF, the strongest maximal and submaximal CPX predictor of MCS implantation, transplantation, or death at 1 year were CP and VE/VCO
respectively. The patient-reported measure of exercise effort (Borg scale score) contributed substantially to the prediction of outcomes, a surprising and novel finding that warrants further investigation. (Registry Evaluation of Vital Information for VADs in Ambulatory Life [REVIVAL]; NCT01369407). |
|---|---|
| AbstractList | This study sought to determine cardiopulmonary exercise (CPX) predictors of the combined outcome of durable mechanical circulatory support (MCS), transplantation, or death at 1 year among patients with ambulatory advanced heart failure (HF).
Optimal CPX predictors of outcomes in contemporary ambulatory advanced HF patients are unclear.
REVIVAL (Registry Evaluation of Vital Information for ventricular assist devices [VADs] in Ambulatory Life) enrolled 400 systolic HF patients, INTERMACS (Interagency Registry for Mechanically Assisted Circulatory Support) profiles 4-7. CPX was performed by 273 subjects 2 ± 1 months after study enrollment. Discriminative power of maximal (peak oxygen consumption [peak VO
]; VO
pulse, circulatory power [CP]; peak systolic blood pressure • peak VO
], peak end-tidal pressure CO
[PEtCO
], and peak Borg scale score) and submaximal CPX parameters (ventilatory efficiency [VE/VCO
slope]; VO
at anaerobic threshold [VO
AT]; and oxygen uptake efficiency slope [OUES]) to predict the composite outcome were assessed by univariate and multivariate Cox regression and Harrell's concordance statistic.
At 1 year, there were 39 events (6 transplants, 15 deaths, 18 MCS implantations). Peak VO
, VO
AT, OUES, peak PEtCO
, and CP were higher in the no-event group (all p < 0.001), whereas VE/VCO
slope was lower (p < 0.0001); respiratory exchange ratio was not different. CP (hazard ratio [HR]: 0.89; p = 0.001), VE/VCO
slope (HR: 1.05; p = 0.001), and peak Borg scale score (HR: 1.20; p = 0.005) were significant predictors on multivariate analysis (model C-statistic: 0.80).
Among patients with ambulatory advanced HF, the strongest maximal and submaximal CPX predictor of MCS implantation, transplantation, or death at 1 year were CP and VE/VCO
respectively. The patient-reported measure of exercise effort (Borg scale score) contributed substantially to the prediction of outcomes, a surprising and novel finding that warrants further investigation. (Registry Evaluation of Vital Information for VADs in Ambulatory Life [REVIVAL]; NCT01369407). This study sought to determine cardiopulmonary exercise (CPX) predictors of the combined outcome of durable mechanical circulatory support (MCS), transplantation, or death at 1 year among patients with ambulatory advanced heart failure (HF).OBJECTIVESThis study sought to determine cardiopulmonary exercise (CPX) predictors of the combined outcome of durable mechanical circulatory support (MCS), transplantation, or death at 1 year among patients with ambulatory advanced heart failure (HF).Optimal CPX predictors of outcomes in contemporary ambulatory advanced HF patients are unclear.BACKGROUNDOptimal CPX predictors of outcomes in contemporary ambulatory advanced HF patients are unclear.REVIVAL (Registry Evaluation of Vital Information for ventricular assist devices [VADs] in Ambulatory Life) enrolled 400 systolic HF patients, INTERMACS (Interagency Registry for Mechanically Assisted Circulatory Support) profiles 4-7. CPX was performed by 273 subjects 2 ± 1 months after study enrollment. Discriminative power of maximal (peak oxygen consumption [peak VO2]; VO2 pulse, circulatory power [CP]; peak systolic blood pressure • peak VO2], peak end-tidal pressure CO2 [PEtCO2], and peak Borg scale score) and submaximal CPX parameters (ventilatory efficiency [VE/VCO2 slope]; VO2 at anaerobic threshold [VO2AT]; and oxygen uptake efficiency slope [OUES]) to predict the composite outcome were assessed by univariate and multivariate Cox regression and Harrell's concordance statistic.METHODSREVIVAL (Registry Evaluation of Vital Information for ventricular assist devices [VADs] in Ambulatory Life) enrolled 400 systolic HF patients, INTERMACS (Interagency Registry for Mechanically Assisted Circulatory Support) profiles 4-7. CPX was performed by 273 subjects 2 ± 1 months after study enrollment. Discriminative power of maximal (peak oxygen consumption [peak VO2]; VO2 pulse, circulatory power [CP]; peak systolic blood pressure • peak VO2], peak end-tidal pressure CO2 [PEtCO2], and peak Borg scale score) and submaximal CPX parameters (ventilatory efficiency [VE/VCO2 slope]; VO2 at anaerobic threshold [VO2AT]; and oxygen uptake efficiency slope [OUES]) to predict the composite outcome were assessed by univariate and multivariate Cox regression and Harrell's concordance statistic.At 1 year, there were 39 events (6 transplants, 15 deaths, 18 MCS implantations). Peak VO2, VO2AT, OUES, peak PEtCO2, and CP were higher in the no-event group (all p < 0.001), whereas VE/VCO2 slope was lower (p < 0.0001); respiratory exchange ratio was not different. CP (hazard ratio [HR]: 0.89; p = 0.001), VE/VCO2 slope (HR: 1.05; p = 0.001), and peak Borg scale score (HR: 1.20; p = 0.005) were significant predictors on multivariate analysis (model C-statistic: 0.80).RESULTSAt 1 year, there were 39 events (6 transplants, 15 deaths, 18 MCS implantations). Peak VO2, VO2AT, OUES, peak PEtCO2, and CP were higher in the no-event group (all p < 0.001), whereas VE/VCO2 slope was lower (p < 0.0001); respiratory exchange ratio was not different. CP (hazard ratio [HR]: 0.89; p = 0.001), VE/VCO2 slope (HR: 1.05; p = 0.001), and peak Borg scale score (HR: 1.20; p = 0.005) were significant predictors on multivariate analysis (model C-statistic: 0.80).Among patients with ambulatory advanced HF, the strongest maximal and submaximal CPX predictor of MCS implantation, transplantation, or death at 1 year were CP and VE/VCO2, respectively. The patient-reported measure of exercise effort (Borg scale score) contributed substantially to the prediction of outcomes, a surprising and novel finding that warrants further investigation. (Registry Evaluation of Vital Information for VADs in Ambulatory Life [REVIVAL]; NCT01369407).CONCLUSIONSAmong patients with ambulatory advanced HF, the strongest maximal and submaximal CPX predictor of MCS implantation, transplantation, or death at 1 year were CP and VE/VCO2, respectively. The patient-reported measure of exercise effort (Borg scale score) contributed substantially to the prediction of outcomes, a surprising and novel finding that warrants further investigation. (Registry Evaluation of Vital Information for VADs in Ambulatory Life [REVIVAL]; NCT01369407). |
| Author | Baldwin, J Timothy Richards, Blair Stewart, Garrick C Khalatbari, Shokoufeh Mancini, Donna M Jeffries, Neal Thibodeau, Jennifer T Taddei-Peters, Wendy C Shah, Keyur B Lanfear, David E Spino, Cathie Mann, Douglas L Aaronson, Keith D Palardy, Maryse Lala, Anuradha McNamara, Dennis M Ambardekar, Amrut V |
| Author_xml | – sequence: 1 givenname: Anuradha surname: Lala fullname: Lala, Anuradha organization: Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA; Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, New York, USA – sequence: 2 givenname: Keyur B surname: Shah fullname: Shah, Keyur B organization: Department of Medicine, Division of Cardiology, Virginia Commonwealth University, Richmond, Virginia, USA – sequence: 3 givenname: David E surname: Lanfear fullname: Lanfear, David E organization: Heart and Vascular Institute, Henry Ford Hospital, Detroit, Michigan, USA – sequence: 4 givenname: Jennifer T surname: Thibodeau fullname: Thibodeau, Jennifer T organization: Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA – sequence: 5 givenname: Maryse surname: Palardy fullname: Palardy, Maryse organization: Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, Michigan, USA – sequence: 6 givenname: Amrut V surname: Ambardekar fullname: Ambardekar, Amrut V organization: University of Colorado, Boulder, Colorado, USA – sequence: 7 givenname: Dennis M surname: McNamara fullname: McNamara, Dennis M organization: Department of Medicine, Division of Cardiology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA – sequence: 8 givenname: Wendy C surname: Taddei-Peters fullname: Taddei-Peters, Wendy C organization: Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, Maryland, USA – sequence: 9 givenname: J Timothy surname: Baldwin fullname: Baldwin, J Timothy organization: Michigan State University, East Lansing, Michigan, USA – sequence: 10 givenname: Neal surname: Jeffries fullname: Jeffries, Neal organization: Center for Devices and Radiological Health, Food and Drug Administration, Silver Spring, Maryland, USA – sequence: 11 givenname: Shokoufeh surname: Khalatbari fullname: Khalatbari, Shokoufeh organization: Michigan Institute for Clinical and Health Research, University of Michigan, Ann Arbor, Michigan, USA – sequence: 12 givenname: Cathie surname: Spino fullname: Spino, Cathie organization: Department of Biostatistics, University of Michigan, Ann Arbor, Michigan, USA – sequence: 13 givenname: Blair surname: Richards fullname: Richards, Blair organization: Michigan Institute for Clinical and Health Research, University of Michigan, Ann Arbor, Michigan, USA – sequence: 14 givenname: Douglas L surname: Mann fullname: Mann, Douglas L organization: Cardiovascular Division, Washington University School of Medicine, Washington University School of Medicine, St. Louis, Missouri, USA – sequence: 15 givenname: Garrick C surname: Stewart fullname: Stewart, Garrick C organization: Cardiovascular Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA – sequence: 16 givenname: Keith D surname: Aaronson fullname: Aaronson, Keith D organization: Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, Michigan, USA – sequence: 17 givenname: Donna M surname: Mancini fullname: Mancini, Donna M email: donna.mancini@mountsinai.org organization: Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA; Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, New York, USA. Electronic address: donna.mancini@mountsinai.org |
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| Keywords | predictors mechanical circulatory support cardiac transplant ambulatory heart failure cardiopulmonary exercise stress test |
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| Title | Predictive Value of Cardiopulmonary Exercise Testing Parameters in Ambulatory Advanced Heart Failure |
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