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Peak exercise oxygen consumption (PkVO2) is used to estimate prognosis in patients with systolic heart failure (HF). Exercise parameters such as ventilatory threshold (VT), heart-rate recovery (HRR), and chronotropic response index (CRI) may add prognostic information in this population.
We studied 4381 patients (age 54 ± 12 years, 27% female) with systolic HF (ejection fraction 21.9 ± 8.8%, 40% ischemic etiology) who underwent cardiopulmonary stress testing and were followed for a median of 11.3 years. HRR was defined as peak exercise HR minus 2 minute recovery HR and coded abnormal if <12 beats/min. CRI was calculated as [peak HR-rest HR/(220-age -rest HR)] and coded abnormal if < 0.62 if on beta-blocker or <0.8 if no beta-blocker. After univariate analysis, a stepwise multiple logistic regression analysis was used to identify predictors of mortality. Age, gender, ejection fraction, and beta-blockers were included as potential predictors.
PkVO2 and VT were 17 ± 6 and 12 ± 4 ml/kg/min respectively. Abnormal values for HRR and CRI were present in 56% and 62% of patients respectively. In univariate analyses, there was a significant difference between patients who lived and died (p<0.001) for all variables studied. Stepwise multivariate logistic regression analyses are shown in table.
In patients with systolic HF undergoing stress testing, HRR adds prognostic information to PkVO2, while VT and CRI do not. This holds true for ischemic and non-ischemic HF etiology.
Oral Contributions South, Room 102
Sunday, March 10, 2013, 9:15 a.m.-9:30 a.m.
Session Title: Cardiac Transplantation and Mechanical Support
Abstract Category: 15. Heart Failure: Clinical
Presentation Number: 915-8
- 2013 American College of Cardiology Foundation