Abstract 3103: A Cardiopulmonary Exercise Testing Score for Predicting Risk in Patients with Heart Failure

Background. Cardiopulmonary exercise test (CPX) responses, including markers of ventilatory inefficiency (eg. the VE/VCO 2 slope and oxygen uptake efficiency slope [OUES]), and hemodynamic responses, such as heart rate recovery (HRR) and chronotropic incompetence (CRI) predict outcomes in patients with heart failure (HF). However, multivariate risk models integrating the full range of CPX variables have not been fully explored. Methods: 710 HF patients (568 male/142 female, mean age 56±13 years, EF 33±14%) underwent CPX and were followed for major cardiac events (death, transplant, LVAD implantation) for a mean of 29± 25 months. The age-adjusted prognostic power of peak VO 2 , VE/VCO 2 slope, OUES (VO 2 = a log 10 VE + b), resting end-tidal CO 2 pressure (PetCO 2 ), HRR, and CRI were determined using Cox proportional hazards, optimal cutpoints were determined, the variables were weighted, and a multivariate score was derived. Results. There were 111 composite outcomes. Multivariately, only CRI was not a significant predictor of risk. The VE/VCO 2 slope (≥ 34) was the strongest predictor, and was attributed a relative weight of 7, with weighted scores for abnormal HRR (≤6 beats at 1 min), OUES (>1.4), PetCO2 (<33mmHg), and peak VO 2 (≤14 ml/kg/min) having scores of 5, 3, 3, and 2, respectively. A Kaplan-Meier curve illustrating the incremental scores is presented in the figure ; a score >15 was associated with an annual mortality rate of 26% and a relative risk of 15. Conclusion . A score using CPX responses provides a simple and integrated method that powerfully predicts outcomes in patients with HF.

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Comparison of Heart Rate Recovery After the Six-Minute Walk Test to Cardiopulmonary Exercise Testing in Patients With Heart Failure and Reduced and Preserved Ejection Fraction

The American Journal of Cardiology ◽

10.1016/j.amjcard.2012.05.002 ◽

2012 ◽

Vol 110 (3) ◽

pp. 467-468 ◽

Cited By ~ 6

Author(s):

Lawrence P. Cahalin ◽

Ross Arena ◽

Marco Guazzi

Keyword(s):

Heart Failure ◽

Heart Rate ◽

Heart Rate Recovery ◽

Cardiopulmonary Exercise Testing ◽

Preserved Ejection Fraction ◽

Walk Test ◽

Cardiopulmonary Exercise ◽

Six Minute Walk Test ◽

Patients With Heart Failure ◽

Minute Walk

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Abstract 3104: Heart Rate Recovery Predicts Major Cardiac Events in Patients with Heart Failure Receiving a Beta-Blocking Agent

Circulation ◽

10.1161/circ.116.suppl_16.ii_696 ◽

2007 ◽

Vol 116 (suppl_16) ◽

Author(s):

Ross Arena ◽

Jonathan Myers ◽

Mary Ann Peberdy ◽

Daniel Bensimhon ◽

Joshua Abella ◽

...

Keyword(s):

Heart Failure ◽

Heart Rate ◽

Prognostic Value ◽

Heart Rate Recovery ◽

Cardiopulmonary Exercise Testing ◽

Cardiac Events ◽

Chi Square ◽

Cardiopulmonary Exercise ◽

Beta Blocking ◽

Tracking Period

Introduction: Heart rate recovery (HRR) following a maximal exercise test has demonstrated prognostic value in several investigations. The analysis of HRR in the heart failure (HF) population is, however, limited, particularly in a cohort receiving a beta-blocking (BB) agent. Hypothesis: We assessed the hypothesis that HRR would maintain prognostic value in HF patients prescribed a BB agent. Methods: One hundred and fifty-one subjects with HF (79% male/21% female, 54% ischemic/ 46% non-ischemic, age: 54.3 ± 12.6 years, ejection fraction: 31.2 ± 15.3%), on a stable dose of a BB agent, underwent cardiopulmonary exercise testing to determine peak oxygen consumption (VO 2 ), the minute ventilation/carbon dioxide production (VE/VCO 2 ) slope, peak respiratory exchange ratio (RER), percent-predicted maximal heart rate achieved (PPMHR) and HRR at one minute. Subjects were tracked for major cardiac events following testing. Results: Mean values for peak VO 2 , the VE/VCO 2 slope, peak RER, PPMHR and HRR were 17.9 ± 6.8 mlO 2 ·kg −1 ·min −1 , 33.0 ± 8.7, 1.07 ± 0.14, 75.1 ± 14.9% and 16.4 ± 13.6 beats per minute, respectively. There were 25 major cardiac events (20 deaths, 2 transplants, 3 left ventricular assist device implantations; mean tracking period: 26.7 ± 23.2 months, annual event rate: 6.8%) during the tracking period. A HRR threshold of ≤/> 11 beats per minute was prognostically optimal (hazard ratio: 4.4, 95% confidence interval: 1.8 –10.6, 91.1% vs. 72.1% event free survival, p<0.001). Multivariate Cox regression analysis revealed the VE/VCO 2 slope was the strongest predictor of cardiac events (Chi-square: 13.7, p<0.001) while HRR added significant value and was retained (residual chi-square: 4.6, p = 0.03). Peak VO 2 did not add prognostic value and was removed from the regression (residual chi-square: 0.97, p = 0.33). Conclusions: In conclusion, these results indicate HRR maintains prognostic value in HF patients prescribed a BB agent. Furthermore, HRR added predictive value to the VE/VCO 2 slope, perhaps one of the strongest prognostic markers obtained from cardiopulmonary exercise testing. The clinical assessment of HRR may therefore be warranted in HF patients who are prescribed a BB agent.

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PETCO2 gradient: a novel prognostic parameter in cardiopulmonary exercise testing

European Heart Journal ◽

10.1093/ehjci/ehaa946.1077 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

I.D Poveda Pinedo ◽

I Marco Clement ◽

O Gonzalez ◽

I Ponz ◽

A.M Iniesta ◽

...

Keyword(s):

Exercise Testing ◽

Proportional Hazards ◽

Cardiopulmonary Exercise Testing ◽

Cox Proportional Hazards ◽

Prognostic Parameter ◽

Cardiopulmonary Exercise ◽

Proportional Hazards Regression ◽

Kaplan Meier ◽

Baseline Characteristics ◽

The Difference

Abstract Background Previous parameters such as peak VO2, VE/VCO2 slope and OUES have been described to be prognostic in heart failure (HF). The aim of this study was to identify further prognostic factors of cardiopulmonary exercise testing (CPET) in HF patients. Methods A retrospective analysis of HF patients who underwent CPET from January to November 2019 in a single centre was performed. PETCO2 gradient was defined by the difference between final PETCO2 and baseline PETCO2. HF events were defined as decompensated HF requiring hospital admission or IV diuretics, or decompensated HF resulting in death. Results A total of 64 HF patients were assessed by CPET, HF events occurred in 8 (12.5%) patients. Baseline characteristics are shown in table 1. Patients having HF events had a negative PETCO2 gradient while patients not having events showed a positive PETCO2 gradient (−1.5 [IQR −4.8, 2.3] vs 3 [IQR 1, 5] mmHg; p=0.004). A multivariate Cox proportional-hazards regression analysis revealed that PETCO2 gradient was an independent predictor of HF events (HR 0.74, 95% CI [0.61–0.89]; p=0.002). Kaplan-Meier curves showed a significantly higher incidence of HF events in patients having negative gradients, p=0.002 (figure 1). Conclusion PETCO2 gradient was demonstrated to be a prognostic parameter of CPET in HF patients in our study. Patients having negative gradients had worse outcomes by having more HF events. Time to first event, decompensated heart Funding Acknowledgement Type of funding source: None

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Predictors of hospitalizations for heart failure decompensation in patients with comorbid occupational chronic obstructive pulmonary disease

European Heart Journal ◽

10.1093/ehjci/ehaa946.0949 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

L.A Shpagina ◽

O.S Kotova ◽

I.S Shpagin ◽

G.V Kuznetsova ◽

N.V Kamneva ◽

...

Keyword(s):

Heart Failure ◽

Proportional Hazards ◽

Cox Proportional Hazards ◽

Chronic Obstructive ◽

Length Of Service ◽

Obstructive Pulmonary Disease ◽

Copd Patients ◽

Patients With Heart Failure ◽

Occupational Copd ◽

Heart Failure Decompensation

Abstract Background Heart failure decompensation requiring hospitalization is an important event, associated with mortality and investigating its predictors is topical problem. Chronic obstructive pulmonary disease (COPD) is a common comorbidity for heart failure. Both conditions share common molecular mechanisms such as systemic inflammation. COPD is heterogeneous and subpopulations with different inflammation patterns may interact with heart failure in different manner. Airway inflammation in occupational COPD may differs from COPD in tobacco smokers. Additionally cardiotoxicity of industrial chemicals influence heart failure features. Despite this biological plausibility, heart failure and occupational COPD comorbidity is not studied enough. Purpose To reveal predictors of hospitalizations for heart failure decompensation in patients with heart failure and occupational COPD comorbidity. Methods Occupational COPD patients (n=115) were investigated in a prospective cohort observational study. Comparison group – 115 tobacco smokers with COPD. Control group – 115 healthy persons. Controls were selected by propensity score matching, covariates were COPD duration, age and gender. Then COPD groups were stratified according to heart failure. Working conditions, echocardiography, spirometry, pulsoxymetry, 6-mitute walking test were done. Molecular markers of tissue damage – chemokine ligand 18 (CCL 18), lactate dehydrogenase, cardiac troponin T, N-terminal pro-B-type natriuretic peptide (NT pro-BNP), protein S100 beta, von Willebrand factor were measured in serum by ELISA. Follow up after initial assessment was 12 month. Predictors were determined by Cox proportional hazards regression with ROC analysis. Results Heart failure rate in occupational COPD patients were higher – 54.8% versus 36.5% in tobacco smokers with COPD, p<0.05. Heart failure with preserved ejection fraction was predominant – 40.9%. Prevalence of biventricular heart failure was 38.3%, isolated right heart failure – 13%, left heart failure – 2.6%. Cumulative hospitalization rate in occupational COPD with heart failure group was higher than in comparison group, 17.5% and 9.5% respectively, p=0.01. In Cox proportional hazards regression model predictors of hospitalizations for heart failure decompensation during 12 months in this group were length of service (HR 1.22, 95% CI: 1.03–2.5), aromatic hydrocarbons concentration at workplaces air (HR 1.4, 95% CI: 1.15–1.96), serum protein S100 beta (HR 1.10, 95% CI: 1.02–1.87), SaO2 (HR 1.2, 95% CI: 1.06–2.13). Area under the ROC curve was 0.82. Conclusion Length of service, aromatic hydrocarbons concentration at workplaces air, serum protein S100 beta, SaO2 are considered to be independent risk factors of heart failure decompensation required hospitalization in patients with heart failure and occupational COPD comorbidity. Funding Acknowledgement Type of funding source: None

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