Article

While patients with heart failure who achieve a peak oxygen uptake
(peak (Equation is included in full-text article.)O2) of 10 mL.kg.min or less are
often considered for intensive surveillance or intervention,
those achieving 14
mL.kg.min or more are generally considered to be at lower risk. Among patients in
the "intermediate" range of 10.1 to 13.9 mL.kg.min, optimally stratifying risk
remains a challenge. METHODS : Patients with heart failure (N = 1167) referred
for cardiopulmonary exercise testing were observed for 21 +/- 13 months. Patients
were classified into 3 groups of peak (Equation is included in full-text
article.)o2 (/=14 mL.kg.min). The ability of heart rate
recovery at 1 minute (HRR1) and the minute ventilation/carbon dioxide output
((Equation is included in full-text article.)E/(Equation is included in full-text
article.)co2) slope to complement peak (Equation is included in full-text
article.)o2 in predicting cardiovascular mortality were determined. RESULTS::
Peak (Equation is included in full-text article.)o2, HRR1 (<16 beats per minute),
and the (Equation is included in full-text article.)E/(Equation is included in
full-text article.)co2 slope (>34) were independent predictors of mortality
(hazard ratio 1.6, 95% CI: 1.2-2.29, P = .006; hazard ratio 1.7, 95% CI: 1.1-2.5,
P = .008; and hazard ratio 2.4, 95% CI: 1.6-3.4, P < .001, respectively).
Compared with those achieving a peak (Equation is included in full-text
article.)o2 >/= 14 mL.kg.min, patients within the intermediate range with either
an abnormal (Equation is included in full-text article.)E/(Equation is included
in full-text article.)co2 slope or HRR1 had a nearly 2-fold higher risk of
cardiac mortality. Those with both an abnormal HRR1 and (Equation is included in
full-text article.)E/(Equation is included in full-text article.)co2 slope had a
higher mortality risk than those with a peak (Equation is included in full-text
article.)o2 </= 10 mL.kg.min. Survival was not different between those with a
peak (Equation is included in full-text article.)o2 </= 10 mL.kg.min and those in
the intermediate range with either an abnormal HRR1 or (Equation is included in
full-text article.)E/(Equation is included in full-text article.)co2 slope.
CONCLUSIONS : HRR1 and the (Equation is included in full-text
article.)E/(Equation is included in full-text article.)co2 slope effectively
stratify patients with peak (Equation is included in full-text article.)o2 within
the intermediate range into distinct groups at high and low risk.

Langue : ANGLAIS