What question did this study set out to answer?

The study aims to evaluate the prognostic significance of CPET parameters in young heart failure patients with reduced exercise capacity.

March 29, 2026Open Access

Prognostic Value of Cardiopulmonary Exercise Testing Parameters in Young Heart Failure Patients with Moderately Reduced Exercise Capacity

Key Result

A VE/VCO2 slope over 31 optimally predicted one-year major adverse cardiovascular events, occurring in 39.8% of young heart failure patients with moderately reduced exercise capacity.

Key Points

The study aims to evaluate the prognostic significance of CPET parameters in young heart failure patients with reduced exercise capacity.
Retrospective observational design
Involved young heart failure patients under 50 years old
Measured ejection fraction and peak oxygen uptake
Used multivariate Cox regression analysis for risk factors
Analyzed receiver operating characteristic curve for cut-off values.
39.8% of patients experienced major adverse cardiovascular events within one year
Age, plasma brain natriuretic peptide, serum creatinine, and VE/VCO2 slope were linked to MACE
A VE/VCO2 slope >31 served as the optimal predictive cut-off for outcomes.

Structured PICO

Does the VE/VCO2 slope predict 1-year major adverse cardiovascular events in young heart failure patients with moderately reduced exercise capacity?

Population

113 young (<50 years) heart failure patients with reduced ejection fraction (LVEF <40%) and moderately reduced exercise capacity (peak VO2 >12 mL/kg/min), median age 43, 75.2% male, Japanese cohort. Key inclusion criteria: receiving beta-blocker for at least 6 months before CPET, BNP ≥35 pg/mL.

Intervention

Cardiopulmonary exercise testing (CPET) parameter assessment, specifically VE/VCO2 slope >31

Comparator

VE/VCO2 slope <31

Outcome

Occurrence of major adverse cardiovascular events (MACE), defined as death, admission for HF, admission for HF followed by LVAD implantation or HTx, fatal arrhythmia (VT/VF), and fatal arrhythmia followed by LVAD implantation or HTx within 1 year after CPETcomposite

In young heart failure patients with moderately reduced exercise capacity, a VE/VCO2 slope >31 is a strong independent predictor of 1-year MACE and may help identify patients needing early referral for advanced therapies like LVAD or heart transplantation.

Main Result

Absolute Event Rate: 0% vs 0%

Abstract

Background: Exercise capacity, evaluated using cardiopulmonary exercise testing (CPET), is an important prognostic factor in ambulatory heart failure (HF) patients.However, interpreting the results of CPET in young, ambulatory HF patients who tend to J o u r n a l P r e -p r o o f be optimistic about their prognosis is complicated.This study aimed to assess the clinical impact of CPET parameters in predicting the prognosis of young, ambulatory HF patients.Methods: This single-center retrospective observational study targeted young (12 mL/kg/min.The primary endpoint was occurrence of major adverse cardiovascular events (MACE), such as death, admission for HF, and fatal arrhythmia, within 1 year after CPET.Results: A total of 113 patients (median age, 43 35-47 years) were enrolled: of these, 45 (39.8%) experienced MACE (death, n = 2; admission for HF, n = 35; fatal arrhythmia, n = 8).Multivariate Cox regression analysis demonstrated age, plasma brain natriuretic peptide level, serum creatinine level, and ventilatory efficiency (VE/VCO2 slope) were associated with the occurrence of MACE within 1 year after CPET.Receiver operating characteristic curve analysis revealed a VE/VCO2 slope of 31 was the optimal cutoff value for predicting prognosis.Conclusions: Nearly 40% of young (12 mL/kg/min) experienced MACE within 1 year after CPET.Among these patients, those with a VE/VCO2 slope >31 may warrant earlier consideration for left ventricular assist devices or heart transplantation.

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