Author + information
- Received August 3, 1994
- Revision received November 4, 1994
- Accepted November 7, 1994
- Published online April 1, 1995.
- Thomas G. Di Salvo, MD*,
- Michael Mathier, MD,
- Marc J. Semigran, MD and
- G. William Dec, MD, FACC
- ↵*Address for correspondence: Dr. Thomas G. Di Salvo, Massachusetts General Hospital Heart Failure Center, Bulfinch 211, Massachusetts General Hospital, Boston, Massachusetts 02114.
Objectives. This study was undertaken to determine which exercise and radionuclide ventriculographic variables predict prognosis in advanced heart failure.
Background. Although cardiopulmonary exercise testing is frequently used to predict prognosis in patients with advanced heart failure, little is known about the prognostic significance of ventriculographic variables.
Methods. The results of maximal symptom-limited cardiopulmonary exercise testing and first-pass radionuclide ventriculography in patients with advanced heart failure referred for evalution for cardiac transplantation were analyzed.
Results. Sixty-seven patients with advanced heart failure (mean [±SD]; age 51 ± 10 years, New York Heart Association functional classes III (58%) and IV (18%); mean left ventricular ejection fraction 0.22 ± 0.07) underwent simultaneous upright bicycle ergometric cardiopulmonary exercise testing and first-pass rest/exercise radionuclide ventriculography. Mean peak oxygen consumption (Vo2) was 11.8 ± 4.2 ml/kg per min, and mean peak age-and gender-adjusted percent predicted oxygen consumption (%Vo2) was 38 ± 11.9%. Univariate predictors of overall survival included right ventricular ejection fraction ≥0.35 at rest and ≥0.35 at exercise and %Vo2≥45% (all p < 0.05). In a multivariate proportional hazards survival model, right ventricular ejection fraction ≥0.35 at exercise (p < 0.01) and %Vo2≥45% (p = 0.01) were selected as independent predictors of overall survival. Univariate predictors of event-free survival included right ventricular ejection fraction ≥0.35 at rest (p = 0.01) and ≥0.35 at exercise (p < 0.01), functional class II (p < 0.05) and %Vo2≥45% (p = 0.05). Right ventricular ejection fraction ≥0.35 at exercise (p = 0.01) was the only independent predictor of event-free survival in a multivariate proportional hazards model. Cardiac index at rest, Vo2, left ventricular ejection fraction at rest, and exercise-related increase or decrease >0.05 in left or right ventricular ejection fraction were not predictive of overall or event-free survival in any univariate or multivariate analysis.
Conclusions. 1) Right ventricular ejection fraction ≥0.35 at rest and exercise is a more potent predictor of survival in advanced heart failure than Vo2or %Vo2; 2) %Vo2rather than Vo2predicts survival in advanced heart failure; 3) neither %Vo2nor Vo2predicts survival to the combined end point of death or admission for inotropic or mechanical support in patients with advanced heart failure.
- Received August 3, 1994.
- Revision received November 4, 1994.
- Accepted November 7, 1994.
- North American Society of Pacing and Electrophysiology; American College of Cardiology; American Heart Association, Inc.; and European Society of Cardiology.