Abstract 17154: Cardiopulmonary Exercise Testing and Prognosis in HFpEF: the Henry Ford HospITal CardioPulmonary EXercise Testing (FIT-CPX) Project

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Clinton A Brawner ◽  
Ali Shafiq ◽  
Heather A Aldred ◽  
Raakesh Hassan ◽  
Stephanie Vasko ◽  
...  
Keyword(s):  
Exercise Testing ◽  
Cox Regression ◽  
Cardiopulmonary Exercise Testing ◽  
Composite Endpoint ◽  
Left Ventricular ◽  
Cardiac Transplant ◽  
Reduced Ejection Fraction ◽  
Cardiopulmonary Exercise ◽  
Prognostic Utility

The prognostic utility of cardiopulmonary exercise testing (CPX) in patients with heart failure and reduced ejection fraction (HFrEF) has received much attention. However, there are limited data on the value of CPX in patients with HF and preserved EF (HFpEF). Purpose: Among patients with HFpEF, describe the association between select CPX measures and prognosis for the composite endpoint of mortality, left ventricular assist device (LVAD), or cardiac transplant (CT). Methods: Patients with a CPX between 1997 and 2010 and confirmed HFrEF (EF ≤ 40%; n= 1,201) or HFpEF (EF ≥ 50%; n= 192) were identified. Patients with HFpEF (n= 189, age= 54 ± 14 y, 43% female, EF = 56 ± 5%) were matched (propensity score) to patients with HFrEF (n= 189, age= 54 ± 13 y, 43% female, EF = 22 ± 9%) based on age, gender, history of coronary artery disease, and body mass index. Endpoint data was obtained through 2011. The association between select CPX measures and the endpoint was assessed using Cox regression with adjustment for age, gender, EF, and beta-blocker therapy. Results: There were 53 events (28%; median follow-up = 5.1 y) among the HFpEF group and 88 events (47%; median follow-up = 3.6 y) among the HFrEF group. Results from the Cox regression analyses are shown in the Table. Percent predicted peak VO 2 was one of the best predictors of the endpoint in both HFpEF and HFrEF with similar hazard ratios. Although significantly related to the endpoint among HFrEF, V E -VCO 2 slope and peak P ET CO 2 were not significant among HFpEF. Conclusions: These data support the use of % predicted peak VO 2 to risk stratify patients with HFpEF and suggest that the prognostic utility of some CPX measures developed in HFrEF may not be relevant in HFpEF. Additional research is needed to define the association between CPX measures and prognosis specifically for patients with HFpEF.

Abstract 14036: An Algorithm to Guide Prognosis Based on the Combination of Peak VO 2 and V E -VCO 2 slope in Patients with HFrEF: The Henry Ford HospITal CardioPulmonary EXercise Testing (FIT-CPX) Project

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Clinton A Brawner ◽  
Ali Shafiq ◽  
Heather A Aldred ◽  
Raakesh Hassan ◽  
Stephanie Vasko ◽  
...  
Keyword(s):  
Ejection Fraction ◽  
Cox Regression ◽  
Prognostic Significance ◽  
Cardiopulmonary Exercise Testing ◽  
Composite Endpoint ◽  
Left Ventricular ◽  
Cardiac Transplant ◽  
Cardiopulmonary Exercise ◽  
Increased Risk ◽  
Event Rates

Many studies have reported the prognostic significance of peak oxygen consumption (VO 2 ) and V E -VCO 2 slope in patients with heart failure (HF). However, there are limited data stratifying risk based on a combination of these measures and how to best use them. Purpose: Describe 1 and 3-y event rates for the composite endpoint of mortality, left ventricular assist device (LVAD), or cardiac transplant (CT) based on the combined evaluation of peak VO 2 and V E -VCO 2 slope in patients with HF with reduced ejection fraction (≤ 40%; HFrEF). Methods: Patients (n= 1,116; 33% female; age= 54 ± 13 y) with a cardiopulmonary exercise test between 1997 and 2010 and confirmed HFrEF were identified. Endpoint data was obtained through 2011. Patients were grouped based on peak VO 2 (< 12, 12 to18, and > 18 mL/kg/min) and (V E -VCO 2 slope ≥ 34 or < 34). Cumulative events were identified from life tables. Cox regression with adjustment for age, gender, ejection fraction, and beta-blocker therapy was used to calculate the hazard ratio for V E -VCO 2 slope ≥ 34 within each peak VO 2 group. Results: The 1 and 3-y event rates are shown in the Table. Among patients with a peak VO 2 < 12, 1 and 3-y events were 23% and 44%, respectively. Within this group, V E -VCO 2 slope ≥ 34 represented more than twice the risk at both 1 y (HR 2.42, 95% CI 1.09, 5.38) and 3 y (HR 2.32, 95% CI 1.33, 4.05). Among patients with a peak VO 2 12 to 18, 1 and 3-y events were 14% and 30%, respectively. Within this group, a V E -VCO 2 slope ≥ 34 was associated with increased risk at both 1 y (HR 1.80, 95% CI 1.13, 2.87) and 3 y (HR 1.80, 95% CI 1.30, 2.50). Among patients with peak VO 2 > 18, 1 and 3-y events were 2% and 10%, respectively, and V E -VCO 2 slope was not statistically associated with increased risk. Conclusion: Among patients with a peak VO 2 ≤ 18, V E -VCO 2 slope ≥ 34 further refines the risk for a composite endpoint of mortality, LVAD, or CT at both 1 and 3 y.

The role of cardiopulmonary exercise testing in a contemporary heart failure population

2021 ◽  
Vol 28 (Supplement_1) ◽  
Author(s):  
P Garcia Bras ◽  
A Valentim Goncalves ◽  
J Reis ◽  
T Pereira Da Silva ◽  
R Ilhao Moreira ◽  
...  
Keyword(s):  
Heart Failure ◽  
Risk Stratification ◽  
Exercise Testing ◽  
Predictive Power ◽  
Cardiopulmonary Exercise Testing ◽  
Composite Endpoint ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Discriminative Power ◽  
Cardiopulmonary Exercise

Abstract Funding Acknowledgements Type of funding sources: None. Introduction Cardiopulmonary exercise testing (CPET) is used for risk stratification in patients with chronic heart failure (CHF). However, there is a lack of information regarding CPET prognostic power in patients under new HF therapies such as sacubitril/valsartan, Mitraclip, IV iron or SGLT2 inhibitors. The aim of this study was to evaluate the prognostic value of CPET parameters in a contemporary subset of patients with optimal medical and device therapy for CHF. Methods Retrospective evaluation of patients with CHF submitted to CPET in a tertiary center. Patients were followed up for 24 months for the composite endpoint of cardiac death, urgent heart transplantation or left ventricular assist device. CPET parameters, including peak oxygen consumption (pVO2) and VE/VCO2 slope, were analysed and their predictive power was measured. HF events were stratified according to cut-off values defined by the International Society for Heart and Lung Transplantation (ISHLT) guidelines: pVO2 of ≤12 mL/Kg/min and VE/VCO2 slope of &gt;35. Results CPET was performed in 204 patients, from 2014 to 2018. Mean age was 59 ± 13 years, 83% male, with a mean left ventricular ejection fraction of 33 ± 8%, and a mean Heart Failure Survival Score of 8.6 ± 1.3. The discriminative power of CPET parameters is displayed in the Table. In patients with pVO2 ≤12 mL/Kg/min, the composite endpoint occurred in 18% of patients. A pVO2 value of ≤12 mL/Kg/min had a positive predictive power of 18% while pVO2 &gt;12 had a negative predictive power of 93%. Regarding VE/VCO2 slope &gt;35, the composite endpoint occurred in 13% of patients. A VE/VCO2 slope value of &gt;35 had a positive predictive power of 13% while VE/VCO2 slope &lt;35 had a negative predictive power or 94%. Conclusion Using ISHLT guideline cut-off values for advanced HF therapies patient selection, there was a reduced number of HF events (&lt;20%) at 24 months in patients under optimal CHF therapy. While pVO2 and VE/VCO2 slope are still valuable parameters in risk stratification, redefining cut-off values may be necessary in a modern HF population. Discriminative power of CPET parameters Parameters HR; 95% CI AUC p-value Peak VO2 0.824 (0.728-0.934) 0.781 0.001 Percent of predicted pVO2 0.942 (0.907-0.978) 0.774 0.002 VE/VCO2 slope 1.068 (1.031-1.106) 0.756 0.008 Cardiorespiratory optimal point 1.118 (1.053-1.188) 0.746 0.004 PETCO2 maximum exercise 0.854 (0.768-0.950) 0.775 0.003 Ventilatory Power 0.358 (0.176-0.728) 0.796 0.002 HR Hazard ratio, AUC: Area under the curve, PETCO2: end-tidal CO2 pressure

Abstract 14681: Uber Analysis of Cardiopulmonary Exercise Test Variables and Mortality in Patients with Heart Failure: the Henry Ford HospITal CardioPulmonary EXercise Testing (FIT-CPX) Project

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Ali Shafiq ◽  
Clinton A Brawner ◽  
Heather E Aldred ◽  
Raakesh Hassan ◽  
Stepahanie Vasko ◽  
...  
Keyword(s):  
Heart Failure ◽  
Ejection Fraction ◽  
Exercise Test ◽  
Cox Regression ◽  
Composite Endpoint ◽  
Cardiopulmonary Exercise Test ◽  
Left Ventricular ◽  
Cardiac Transplant ◽  
Cardiopulmonary Exercise ◽  
Patients With Heart Failure

Introduction: Numerous metrics derived from the cardiopulmonary exercise test (CPX) are associated with outcomes among patients with heart failure with reduced ejection fraction (HFrEF). However few studies have examined the independent prognostic value of all variables assessed simultaneously. Purpose: Retrospective analysis to describe the relationship between all CPX measures and the composite outcome of mortality, left ventricular assist device (LVAD), or cardiac transplant (CT). Methods: Patients (n= 1,201; 33% female; age= 55 ± 13 y) with a CPX between 1997 and 2010 and confirmed HFrEF (ejection fraction [EF] < 40%) were identified. Death data through 2011 was obtained from the National Death Index. The association with the composite endpoint was evaluated separately for 30 CPX measures with adjustment for age, gender, EF, and beta-blocker therapy using Cox regression. Forward stepwise Cox regression was performed to identify which of the CPX variables contribute the most to outcome prediction. Results: During a median follow-up of 3.75 years there were 576 (48%) events. When tested separately, nearly all CPX variables (except heart rate reserve/metabolic reserve and peak respiratory exchange ratio) were associated (p<0.05) with the composite endpoint. The top 5 predictors are shown in the Table. Stepwise Cox regression revealed that only % predicted peak oxygen uptake (VO 2 , Wald= 76.1), ventilatory power (peak systolic blood pressure/V E -VCO 2 slope, Wald= 58.0), and EF (Wald= 27.0) independently predicted outcomes. Conclusion: When considering all variables measured during a CPX test, % predicted peak VO 2 was the variable with the strongest independent association to outcomes in this cohort of patients with HFrEF. The % predicted peak VO 2 may represent a key variable in determining when to consider a patient for an LVAD or CT.

scholarly journals The Fitter the Better? Cardiopulmonary Exercise Testing Can Predict Pulmonary Exacerbations in Cystic Fibrosis

Children ◽  
2021 ◽  
Vol 8 (6) ◽  
pp. 527
Author(s):  
Asterios Kampouras ◽  
Elpis Hatziagorou ◽  
Thomas Kalantzis ◽  
Vasiliki Avramidou ◽  
Kalliopi Kontouli ◽  
...  
Keyword(s):  
Cystic Fibrosis ◽  
Exercise Testing ◽  
Cox Regression ◽  
Cardiopulmonary Exercise Testing ◽  
Peak Exercise ◽  
Cox Regression Analysis ◽  
Cardiopulmonary Exercise ◽  
Pulmonary Exacerbations

Background: The role of cardiopulmonary exercise testing (CPET) in the assessment of prognosis in CF (cystic fibrosis) is crucial. However, as the overall survival of the disease becomes better, the need for examinations that can predict pulmonary exacerbations (PEx) and subsequent deterioration becomes evident. Methods: Data from a 10-year follow up with CPET and spirometry of CF patients were used to evaluate whether CPET-derived parameters can be used as prognostic indexes for pulmonary exacerbations in patients with CF. Pulmonary exacerbations were recorded. We used a survival analysis through Cox Regression to assess the prognostic role of CPET parameters for PeX. CPET parameters and other variables such as sputum culture, age, and spirometry measurements were tested via multivariate cox models. Results: During a 10-year period (2009–2019), 78 CF patients underwent CPET. Cox regression analysis revealed that VO2peak% (peak Oxygen Uptake predicted %) predicted (hazard ratio (HR), 0.988 (0.975, 1.000) p = 0.042) and PetCO2 (end-tidal CO2 at peak exercise) (HR 0.948 (0.913, 0.984) p = 0.005), while VE/VO2 and (respiratory equivalent for oxygen at peak exercise) (HR 1.032 (1.003, 1.062) p = 0.033) were significant predictors of pulmonary exacerbations in the short term after the CPET. Additionally, patients with VO2peak% predicted <60% had 4.5-times higher relative risk of having a PEx than those with higher exercise capacity. Conclusions: CPET can provide valuable information regarding upcoming pulmonary exacerbation in CF. Patients with VO2peak <60% are at great risk of subsequent deterioration. Regular follow up of CF patients with exercise testing can highlight their clinical image and direct therapeutic interventions.

Risk stratification in hf with mid-range LVEF: the role of cardiopulmonary exercise testing

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
B.M.L Rocha ◽  
G.J Lopes Da Cunha ◽  
P.M.D Lopes ◽  
P.N Freitas ◽  
F Gama ◽  
...  
Keyword(s):  
Risk Stratification ◽  
Exercise Testing ◽  
Primary Endpoint ◽  
Prognostic Significance ◽  
Cardiopulmonary Exercise Testing ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction ◽  
Cardiopulmonary Exercise

Abstract Background Cardiopulmonary exercise testing (CPET) is recommended in the evaluation of selected patients with Heart Failure (HF). Notwithstanding, its prognostic significance has mainly been ascertained in those with left ventricular ejection fraction (LVEF) &lt;40% (i.e., HFrEF). The main goal of our study was to assess the role of CPET in risk stratification of HF with mid-range (40–49%) LVEF (i.e., HFmrEF) compared to HFrEF. Methods We conducted a single-center retrospective study of consecutive patients with HF and LVEF &lt;50% who underwent CPET from 2003–2018. The primary composite endpoint of death, heart transplant or HF hospitalization was assessed. Results Overall, 404 HF patients (mean age 57±11 years, 78.2% male, 55.4% ischemic HF) were included, of whom 321 (79.5%) had HFrEF and 83 (20.5%) HFmrEF. Compared to the former, those with HFmrEF had a significantly higher mean peak oxygen uptake (pVO2) (20.2±6.1 vs 16.1±5.0 mL/kg/min; p&lt;0.001), lower median minute ventilation/carbon dioxide production (VE/VCO2) [35.0 (IQR: 29.1–41.2) vs 39.0 (IQR: 32.0–47.0); p=0.002) and fewer patients with exercise oscillatory ventilation (EOV) (22.0 vs 46.3%; p&lt;0.001). Over a median follow-up of 28.7 (IQR: 13.0–92.3) months, 117 (28.9%) patients died, 53 (13.1%) underwent heart transplantation, and 134 (33.2%) had at least one HF hospitalization. In both HFmrEF and HFrEF, pVO2 &lt;12 mL/kg/min, VE/VCO2 &gt;35 and EOV identified patients at higher risk for events (all p&lt;0.05). In Cox regression multivariate analysis, pVO2 was predictive of the primary endpoint in both HFmrEF and HFrEF (HR per +1 mL/kg/min: 0.81; CI: 0.72–0.92; p=0.001; and HR per +1 mL/kg/min: 0.92; CI: 0.87–0.97; p=0.004), as was EOV (HR: 4.79; CI: 1.41–16.39; p=0.012; and HR: 2.15; CI: 1.51–3.07; p&lt;0.001). VE/VCO2, on the other hand, was predictive of events in HFrEF but not in HFmrEF (HR per unit: 1.03; CI: 1.02–1.05; p&lt;0.001; and HR per unit: 0.99; CI: 0.95–1.03; p=0.512, respectively). ROC curve analysis demonstrated that a pVO2 &gt;16.7 and &gt;15.8 mL/kg/min more accurately identified patients at lower risk for the primary endpoint (NPV: 91.2 and 60.5% for HFmrEF and HFrEF, respectively; both p&lt;0.001). Conclusions CPET is a useful tool in HFmrEF. Both pVO2 and EOV independently predicted the primary endpoint in HFmrEF and HFrEF, contrasting with VE/VCO2, which remained predictive only in latter group. Our findings strengthen the prognostic role of CPET in HF with either reduced or mid-range LVEF. Funding Acknowledgement Type of funding source: None

scholarly journals Impairments in Blood Pressure Regulation and Cardiac Baroreceptor Sensitivity Among Patients With Heart Failure Supported With Continuous-Flow Left Ventricular Assist Devices

2021 ◽  
Vol 14 (1) ◽  
Author(s):  
Christine Sailer ◽  
Hannah Edelmann ◽  
Cullen Buchanan ◽  
Pedro Giro ◽  
Matthew Babcock ◽  
...  
Keyword(s):  
Heart Failure ◽  
Heart Rate ◽  
Exercise Testing ◽  
Cardiopulmonary Exercise Testing ◽  
Left Ventricular ◽  
Advanced Heart Failure ◽  
Ventricular Assist Devices ◽  
Left Ventricular Assist Devices ◽  
Baroreceptor Sensitivity ◽  
Cardiopulmonary Exercise

Background: Continuous-flow (CF) left ventricular assist devices (LVADs) improve outcomes for patients with advanced heart failure (HF). However, the lack of a physiological pulse predisposes to side-effects including uncontrolled blood pressure (BP), and there are little data regarding the impact of CF-LVADs on BP regulation. Methods: Twelve patients (10 males, 60±11 years) with advanced heart failure completed hemodynamic assessment 2.7±4.1 months before, and 4.3±1.3 months following CF-LVAD implantation. Heart rate and systolic BP via arterial catheterization were monitored during Valsalva maneuver, spontaneous breathing, and a 0.05 Hz repetitive squat-stand maneuver to characterize cardiac baroreceptor sensitivity. Plasma norepinephrine levels were assessed during head-up tilt at supine, 30 o and 60 o . Heart rate and BP were monitored during cardiopulmonary exercise testing. Results: Cardiac baroreceptor sensitivity, determined by Valsalva as well as Fourier transformation and transfer function gain of Heart rate and systolic BP during spontaneous breathing and squat-stand maneuver, was impaired before and following LVAD implantation. Norepinephrine levels were markedly elevated pre-LVAD and improved—but remained elevated post-LVAD (supine norepinephrine pre-LVAD versus post-LVAD: 654±437 versus 323±164 pg/mL). BP increased during cardiopulmonary exercise testing post-LVAD, but the magnitude of change was modest and comparable to the changes observed during the pre-LVAD cardiopulmonary exercise testing. Conclusions: Among patients with advanced heart failure with reduced ejection fraction, CF-LVAD implantation is associated with modest improvements in autonomic tone, but persistent reductions in cardiac baroreceptor sensitivity. Exercise-induced increases in BP are blunted. These findings shed new light on mechanisms for adverse events such as stroke, and persistent reductions in functional capacity, among patients supported by CF-LVADs. Registration: URL: https://www.clinicaltrials.gov ; Unique identifier: NCT03078972.

Abstract 17232: Cardiopulmonary Exercise Testing in Diabetic Chronic Heart Failure Patients With Microalbuminuria

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Thida tabucanon ◽  
Timothy Engelman ◽  
Sanjeeb S Bhattacharya ◽  
J Emanuel Finet ◽  
Wai Hong W Tang
Keyword(s):  
Oxygen Consumption ◽  
Exercise Testing ◽  
Beta Blocker ◽  
Multivariable Analysis ◽  
Cardiopulmonary Exercise Testing ◽  
Left Ventricular ◽  
Peak Oxygen Consumption ◽  
Left Ventricular Ejection ◽  
Cardiopulmonary Exercise ◽  
History Of

Introduction: Microalbuminuria can be a presentation of microvascular complication in diabetes mellitus (DM). Hypothesis: Microalbuminuria is associated with impaired exercise performance in chronic HF with DM patients. Methods: We retrospectively analyzed a cardiopulmonary exercise testing (CPET) database in 255 chronic HF patients with DM that had urine microalbumin test between December 2012 and September 2019. Demographic data and CPET parameters were compared between the patients who had and had not microalbuminuria which was defined by microalbumin/creatinine ratio ≥ 30 mg/g. Peak oxygen consumption (peak VO 2 ) ≤ 14 ml/kg/min and ≤ 12 ml/kg/min if had history of beta-blocker uses were classified as low peak VO 2 and used in multivariable analysis. Results: There were a total 92 patients (36.1%) that had microalbuminuria. Mean age was not significant different between the patients with and without microalbuminuria (57.7 vs 59.4 years, p = 0.26). The patients with microalbuminuria had lower body mass index (BMI; 30.8 vs. 32.7 kg/m 2 , p = 0.014) and had more history of beta-blocker (BB) uses (81.5% vs. 69.3%, p = 0.038), no significant different in other medication uses. Left ventricular ejection fraction (LVEF) was significant lower in patients with microalbuminuria (35.8% vs. 41.5%, p = 0.028). The patients with microalbuminuria had significant higher prevalence of low peak VO 2 (45.7% vs. 30.1%, p = 0.015) and lower peak stroke work (VO 2 /HR; 11.5 vs. 12.8 ml/ beat, p = 0.008). No significant different in ventricular efficiency slope (VE/VCO 2 ; 37.1 vs. 35.4, p = 0.094), Multivariable analysis showed that proteinuria was independently associated with low peak VO 2 after adjusted for age, sex, BMI LVEF, history of BB uses, VE/VCO 2 and HR at peak VO 2 , (odds ratio = 3.83, p < 0.001). Conclusions: Microalbuminuria was independently associated with low peak oxygen consumption in chronic HF with DM patients.

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