The additive prognostic value of the cardiopulmonary exercise test in elderly patients with heart failure
Résumé
Objectives: The role of the cardiopulmonary exercise test (CPET) for risk stratification in elderly HF patients with depressed or preserved ventricular function has not yet been evaluated. We analysed whether CPET is useful in predicting outcome in this population. Methods and Results: 220 NYHA class I-III HF patients ≥ 70 years performed maximal CPET (peak expiratory exchange ratio > 1.00). Median age was 75 years, 23% had NYHA class III; 59% had preserved ventricular systolic function (ejection fraction ≥ 40%). Median peak oxygen uptake was 11.9 mL/Kg/min, median slope of the ventilation to CO2 production ratio (VE/VCO2 slope) was 33.2; 45% showed enhanced ventilatory response to exercise (EVR, VE/VCO2 slope ≥ 34). During 19-month follow-up, 94 patients (43%) met the combined end point of death and hospital admission for worsening HF, arrhythmias or acute coronary syndromes . By Cox multivariable analysis, a creatinine clearance < 50 ml/min (HR 1.657, 95% CI 1.055 to 2.602) and EVR (HR 1.965, 95% CI 1.195 to 3.231) were the best predictors of outcome, while ventricular function had no influence on prognosis Conclusions: In elderly HF patients, a steeper VE/VCO2 slope provides additional information for risk stratification across the spectrum of ventricular function and identifies a high risk population, commonly not considered in exercise test guidelines.
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