Key result
Lower Vo2peak, higher VE/Vco2 slope, and larger LV/RV dimensions are linked to major events, unlike LVEF.
Why the study?
Accurate prognostic stratification in chronic HFrEF remains challenging, and identifying which CPET and echocardiographic parameters best correlate with cardiac events in patients evaluated for heart transplantation was needed.
Do CPET and echocardiographic parameters predict cardiac events in HFrEF patients evaluated for heart transplantation?
Observational (n=170)
Do CPET and echocardiographic parameters predict cardiac events in HFrEF patients evaluated for heart transplantation?
p-value: p=<0.005
In HFrEF patients evaluated for heart transplantation, CPET parameters (Vo2peak, VE/VCO2 slope) and biventricular remodeling dimensions are better prognostic markers for cardiac events than LVEF.
May refine risk stratification beyond LVEF in HFrEF transplant candidates; leaves open prospective validation.
Accurate prognostic stratification in patients with chronic heart failure and reduced ejection fraction (HFrEF) remains a significant clinical challenge. Many different parameters, including left ventricular (LV) and right ventricular (RV) function and cardiopulmonary exercise testing (CPET) parameters, are available in the literature. LV ejection fraction (LVEF) is the most used parameter in clinical practice. This study aimed to analyze CPET and echocardiographic data in patients under evaluation for heart transplantation (HTx) to identify the parameter that best correlates with cardiac events. Methods and Results. Echocardiography and CPET were performed in patients with HFrEF under evaluation for HTx. The population comprised 170 patients (mean age: 55 ± 9 years; 88% male; non-ischemic etiology: 63%). LVEF was 30.4 ± 7.6%, peak oxygen uptake (Vo2peak) was 17.08 ± 4.6 mL/Kg/min; minute ventilation (VE)/carbon dioxide production (Vco2) slope was 34.8 ± 8.7. During a follow-up of 4 ± 1 years, 37 hospitalizations, 4 deaths, 14 HTx, and 5 LV assist device implantation occurred. Patients who experienced major events had a lower Vo2peak (p < 0.005), higher VE/Vco2 slope (p < 0.005), greater LV end-systolic diameter (p < 0.005), and RV end-diastolic diameter (p < 0.005) than patients without events. Conversely, LVEF did not differ between these two groups. VE/Vco2 slope and RV dimensions significantly correlated with hard cardiac events (p = 0.019 and p = 0.008, respectively). Conclusions. In patients with HFrEF, parameters quantifying the system reserve (i.e., Vo2peak and VE/Vco2 slope) and those demonstrating advanced biventricular remodeling may help stratify the risk of cardiac events. Conversely, LVEF showed a limited prognostic value in this setting.
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Pagliaro et al. (2025) conducted an observational in Heart failure with reduced ejection fraction (HFrEF) (n=170). Cardiopulmonary exercise testing (CPET) and echocardiographic parameters was evaluated on Major events (hospitalizations, deaths, HTx, and LV assist device implantation) (p=<0.005). Lower Vo2peak, higher VE/Vco2 slope, and greater LV/RV dimensions were significantly associated with major cardiac events (p<0.005), whereas LVEF showed limited prognostic value.
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