Exertional oscillatory ventilation strongly predicted cardiovascular death (43% vs 11%, P<0.001), while peak systolic blood pressure provided an 11% risk reduction for every 5 mmHg increase.
Cohort (n=631)
Do cardiopulmonary exercise testing parameters predict cardiovascular death in chronic heart failure patients treated with carvedilol?
In chronic heart failure patients treated with beta-blockers, exercise hemodynamic variables like peak systolic blood pressure are stronger predictors of cardiovascular death than ventilatory efficiency indexes.
Absolute Event Rate: 43% vs 11%
p-value: p=<0.001
AIMS: To evaluate the prognostic significance of traditional cardiopulmonary exercise testing (CPET) parameters in chronic heart failure (CHF) patients treated with beta-blockers. METHODS AND RESULTS: A total of 631 CHF patients were followed for cardiovascular death over 3.8 +/- 1.4 years; among them 79 (13%) died. All prognostic CPET parameters were related to outcome at univariate analysis, with haemodynamic-derived parameters peak systolic blood pressure (SBP), peak circulatory power (CP) = peak oxygen consumption (pVO2) x peak SBP and exertional oscillatory ventilation (EOV) reaching the highest chi2 (46.5, 40.9, and 22.6, respectively, all with P < 0.0001). Exertional oscillatory ventilation, although associated with high mortality rate (43 vs. 11%, P < 0.001), was detected in 42 (7%) patients. In non-EOV, again both peak SBP and peak CP reached the highest chi2 (30.6, and 21.6, respectively, all with P < 0.0001). Regarding CPET parameters, at multivariable analysis, peak SBP was the strongest risk index both in total and non-EOV populations, with 11% risk reduction every 5 mmHg increase. CONCLUSION: All traditional CPET risk parameters were informative in beta-blockers CHF patients, but peak SBP, peak CP, and EOV were the most predictive. In this low-risk population, EOV, although underrepresented, considerably enhanced risk stratification, although other ventilatory efficiency indexes provided less impressive predictive content. In large majority of non-EOV patients, peak SBP improved risk evaluation beyond other CPET parameters.
Corrà et al. (2009) conducted a cohort in chronic heart failure (n=631). Cardiopulmonary exercise testing (CPET) was evaluated on cardiovascular death (p=<0.001). Exertional oscillatory ventilation strongly predicted cardiovascular death (43% vs 11%, P<0.001), while peak systolic blood pressure provided an 11% risk reduction for every 5 mmHg increase.