Abstract 18836: Differences in Cardiopulmonary Exercise Test Data and Prognosis in Black and White Men with Heart Failure: the Henry Ford HospITal CardioPulmonary EXercise Testing (FIT-CPX) Project

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Matthew A Saval ◽  
Clinton A Brawner ◽  
Ali Shafiq ◽  
Heather E Aldred ◽  
Raakesh Hassan ◽  
...  
Keyword(s):  
Heart Failure ◽  
Ejection Fraction ◽  
Risk Stratification ◽  
Exercise Test ◽  
Black Male ◽  
Composite Endpoint ◽  
Cardiopulmonary Exercise Test ◽  
Cardiopulmonary Exercise ◽  
Black Patients ◽  
Male Patients

Introduction: Numerous metrics from the cardiopulmonary exercise test (CPX) are associated with outcomes among patients with heart failure with reduced ejection fraction (HFrEF). Among patients with HFrEF, mortality rates differ by race; however, the influence of race on the association between common measures obtained during CPX and mortality has not been fully described. Purpose: Retrospective analysis to describe the relationship between key CPX measures and the composite endpoint of mortality, left ventricular assist device (LVAD), or cardiac transplant (CT) in white and black men with HFrEF. Methods: Self-identified white and black male patients (n= 761; age= 55 ± 12 y; BMI= 30.6±6.6) with a CPX between 1997 and 2010 and confirmed HFrEF (ejection fraction [EF] ≤ 40%) were identified. Endpoint data was obtained through 2011. The association with the composite endpoint was evaluated separately for 7 key CPX measures with adjustment for age, hypertension, beta-blocker therapy, EF, and ischemic etiology using Cox regression stratified by race. Results: During a median follow-up of 3.5 y there were 195 (54%) and 193 (48%) events for white and black patients, respectively. All CPX variables were associated (p<0.05) with the composite endpoint in both white and black patients (Table). The greatest Wald statistic among white patients was % predicted peak oxygen uptake (ppVO 2 ) at 76.2, and among black patients it was ventilatory efficiency (V E -VCO 2 slope) at 90.8. Conclusion: Among white and black male patients, % predicted peak VO 2 and V E -VCO 2 slope, respectively, were most strongly associated with the combined end point of mortality, LVAD or CT. These data suggest that risk stratification using CPX variables may differ by race. Further research is needed to determine if race-specific methods of CPX-based risk stratification are needed.

scholarly journals Risk stratification in heart failure with mild reduced ejection fraction

2020 ◽  
Vol 27 (2_suppl) ◽  
pp. 59-64
Author(s):  
Damiano Magrì ◽  
Giovanna Gallo ◽  
Gianfranco Parati ◽  
Mariantonietta Cicoira ◽  
Michele Senni
Keyword(s):  
Heart Failure ◽  
Ejection Fraction ◽  
Oxygen Uptake ◽  
Risk Stratification ◽  
Exercise Test ◽  
Peak Oxygen Uptake ◽  
Cardiopulmonary Exercise Test ◽  
Recent Contribution ◽  
Reduced Ejection Fraction ◽  
Cardiopulmonary Exercise

Heart failure with mid-range ejection fraction represents a heterogeneous and relatively young heart failure category accounting for nearly 20–30% of the overall heart failure population. Due to its complex phenotype, a reliable clinical picture of heart failure with mid-range ejection fraction patients as well as a definite risk stratification are still relevant unsolved issues. In such a context, there is growing interest in a comprehensive functional assessment by means of a cardiopulmonary exercise test, yet considered a cornerstone in the clinical management of patients with heart failure and reduced ejection fraction. Indeed, the cardiopulmonary exercise test has also been found to be particularly useful in the heart failure with mid-range ejection fraction category, several cardiopulmonary exercise test-derived parameters being associated with a poor outcome. In particular, a recent contribution by the metabolic exercise combined with cardiac and kidney indexes research group showed an independent association between the peak oxygen uptake and pure cardiovascular mortality in a large cohort of recovered heart failure with mid-range ejection fraction patients. Contextually, the same study supplied an easy approach to identify a high-risk heart failure with mid-range ejection fraction subset by using a combination of peak oxygen uptake and ventilatory efficiency cut-off values, namely 55% of the maximum predicted and 31, respectively. Thus, looking at the above-mentioned promising results and waiting for specific trials, it is reasonable to consider cardiopulmonary exercise test assessment as part of the heart failure with mid-range ejection fraction work-up in order to identify those patients with an unfavourable functional profile who probably deserve a close clinical follow-up and, probably, more aggressive therapeutic strategies.

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 How Patients With Heart Failure Perform Daily Life Activities

2020 ◽  
Vol 13 (11) ◽  
Author(s):  
Massimo Mapelli ◽  
Elisabetta Salvioni ◽  
Alice Bonomi ◽  
Paola Gugliandolo ◽  
Fabiana De Martino ◽  
...  
Keyword(s):  
Heart Failure ◽  
Ejection Fraction ◽  
Oxygen Uptake ◽  
Exercise Test ◽  
Cardiopulmonary Exercise Test ◽  
Peak Oxygen Consumption ◽  
Borg Scale ◽  
Walking Test ◽  
Cardiopulmonary Exercise ◽  
Stable Conditions

Background: Cardiopulmonary exercise test and 6-minute walking test are frequently used tools to evaluate physical performance in heart failure (HF), but they do neither represent activities of daily living (ADLs) nor fully reproduce patients’ symptoms. We assessed differences in task oxygen uptake, both as absolute value and as percentage of peak oxygen consumption (peakVO 2 ), ventilation efficiency (VE/VCO 2 ratio), and dyspnea intensity (Borg scale) in HF and healthy subjects during standard ADLs and other common physical actions. Methods: Healthy and HF subjects (ejection fraction <45%, stable conditions) underwent cardiopulmonary exercise test. All of them, carrying a wearable metabolic cart, performed a 6-minute walking test, two 4-minute treadmill exercises (at 2 and 3 km/h), and ADLs: ADL1 (getting dressed), ADL2 (folding 8 towels), ADL3 (putting away 6 bottles), ADL4 (making a bed), ADL5 (sweeping the floor for 4 minutes), ADL6 (climbing 1 flight of stairs carrying a load). Results: Sixty patients with HF (age 65.2±12.1 years; ejection fraction 30.4±6.7%, peakVO 2 14.2±4.0 mL/[min·kg]) and 40 healthy volunteers (58.9±8.2 years, peakVO 2 28.1±7.4 mL/[min·kg]) were enrolled. For each exercise, patients showed higher VE/VCO 2 ratio, percentage of peakVO 2 , and Borg scale value than controls, while absolute values of task oxygen uptake and exercise duration were lower and higher, respectively, in all activities, except for treadmill (fixed execution time and intensity). Differently from Borg Scale data, metabolic values and exercise time length changed in parallel with HF severity, except for ADL duration in very short (ADL3) and composite (ADL1) activities. Borg scale values correlated with percentage of peakVO 2 . Conclusions: During ADLs, patients self-regulated activities in parallel with HF severity by decreasing intensity (VO 2 ) and prolonging the effort.

scholarly journals Diagnostic utility of sub-maximum cardiopulmonary exercise testing in the ambulatory setting for heart failure with preserved ejection fraction

2020 ◽  
Vol 10 (4) ◽  
pp. 204589402097227
Author(s):  
Hannah T. Oakland ◽  
Phillip Joseph ◽  
Ahmed Elassal ◽  
Marjorie Cullinan ◽  
Paul M. Heerdt ◽  
...  
Keyword(s):  
Heart Failure ◽  
Pulmonary Hypertension ◽  
Gas Exchange ◽  
Ejection Fraction ◽  
Exercise Test ◽  
Cardiopulmonary Exercise Test ◽  
Right Heart Catheterization ◽  
Heart Catheterization ◽  
Preserved Ejection Fraction ◽  
Cardiopulmonary Exercise

Pulmonary hypertension is commonly associated with heart failure with preserved ejection fraction. In heart failure with preserved ejection fraction, the elevated left-sided filling pressures result in isolated post-capillary pulmonary hypertension or combined pre- and post-capillary pulmonary hypertension. Although right heart catheterization is the gold standard for diagnosis, it is an invasive test with associated risks. The ability of sub-maximum cardiopulmonary exercise test as an adjunct diagnostic tool in pulmonary hypertension-associated heart failure with preserved ejection fraction is not known. Forty-six patients with heart failure with preserved ejection fraction and pulmonary hypertension (27 patients with combined pre- and post-capillary pulmonary hypertension and 19 patients with isolated post-capillary pulmonary hypertension) underwent sub-maximum cardiopulmonary exercise test followed by right heart catheterization. The study also included 18 age- and gender-matched control subjects. Several sub-maximum gas exchange parameters were examined to determine the ability of sub-maximum cardiopulmonary exercise test to distinguish between isolated post-capillary pulmonary hypertension and combined pre- and post-capillary pulmonary hypertension. Conventional echocardiogram measures did not distinguish between isolated post-capillary pulmonary hypertension and combined pre- and post-capillary pulmonary hypertension. Compared to isolated post-capillary pulmonary hypertension, combined pre- and post-capillary pulmonary hypertension had greater ventilatory equivalent for carbon dioxide (VE/VCO2) slope, reduced delta end-tidal CO2 change during exercise, reduced oxygen uptake efficiency slope, and reduced gas exchange determined pulmonary vascular capacitance. The latter was significantly associated with right heart catheterization determined pulmonary artery compliance ( r = 0.5; p = 0.0004). On univariate analysis, sub-maximum VE/VCO2, delta end-tidal carbon dioxide, and gas exchange determined pulmonary vascular capacitance emerged as independent predictors of the extrapolated maximum oxygen uptake (%predicted) (β-coefficient values of –7.32, 95% CI: –13.3 – (–1.32), p = 0.01; 8.01, 95% CI: 1.96–14.05, p = 0.01; 8.78, 95% CI: 2.26–15.29, p = 0.01, respectively). Sub-maximum gas exchange parameters obtained during cardiopulmonary exercise test in an ambulatory setting allows for discrimination between isolated post-capillary pulmonary hypertension and combined pre- and post-capillary pulmonary hypertension. Additionally, sub-maximum cardiopulmonary exercise test derived VE/VCO2, delta end-tidal carbon dioxide, and gas exchange determined pulmonary vascular capacitance influences aerobic capacity in heart failure with preserved ejection fraction.

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