Ventilatory power was the strongest predictor of major cardiac events compared to traditional exercise testing parameters in patients with systolic heart failure (P<0.001).
Cohort (n=875)
Does ventilatory power provide greater prognostic discrimination than traditional cardiopulmonary exercise testing parameters for major cardiac events in patients with systolic heart failure?
Ventilatory power, a novel index combining VE/Vco2 slope with systolic blood pressure, provides superior prognostic discrimination compared to traditional cardiopulmonary exercise testing parameters in patients with systolic heart failure.
p-value: p=<0.001
BACKGROUND: Minute ventilation/CO(2) production (VE/Vco(2)) slope is an index determined by cardiopulmonary exercise testing, which incorporates pertinent cardiac, pulmonary, and skeletal muscle physiology into a substantive composite assessment. The VE/Vco(2) slope has many applications, including utility as a well-validated prognostic gauge for patients with heart failure (HF). In this study, we combine VE/Vco(2) slope with systolic blood pressure, creating a novel index that we labeled ventilatory power. Ventilatory power links the combined physiology inherent in the VE/Vco(2) slope to peripheral pressure, adding an additional dimension pertinent to HF assessment. Whereas the related concept of circulatory power links peak oxygen consumption with peak systolic blood pressure as a prognostic index, we hypothesized that ventilatory power would provide greater prognostic discrimination than VE/Vco2 slope, peak oxygen consumption, and circulatory power for patients with systolic HF. METHODS AND RESULTS: Patients with systolic HF (left ventricular ejection fraction ≤35%) underwent symptom-limited cardiopulmonary exercise testing as part of routine management and were followed for up to 4 years for major cardiac events (mortality, left ventricular assist device implantation, and heart transplantation). Eight hundred seventy-five patients with HF (left ventricular ejection fraction, 26±9%; mean age, 55±14) were studied. Cardiopulmonary exercise testing indices peak oxygen consumption, VE/Vco(2) slope, circulatory power, and ventilatory power were all predictive of cardiac events (P<0.001). Multivariate analysis demonstrated that ventilatory power was the strongest indicator of prognosis. CONCLUSIONS: Although circulatory power and traditional cardiopulmonary exercise testing parameters can be used to predict prognosis among patients with HF, ventilatory power provides relatively greater prognostic discrimination and may constitute a relatively more useful composite tool.
Forman et al. (Fri,) conducted a cohort in Systolic heart failure (n=875). Ventilatory power vs. Circulatory power and traditional cardiopulmonary exercise testing parameters was evaluated on Major cardiac events (mortality, left ventricular assist device implantation, and heart transplantation) (p=<0.001). Ventilatory power was the strongest predictor of major cardiac events compared to traditional exercise testing parameters in patients with systolic heart failure (P<0.001).