Article

While the medical management strategy for patients with heart
failure (HF) has dramatically changed, cardiopulmonary exercise testing (CPX)
procedures and the data obtained have remained relatively stable. We are unaware
of any previous investigation that has assessed differences in the prognostic
utility of CPX in HF according to time period, reflecting differences in the
clinical management of systolic HF. METHODS: Subjects (n = 381) underwent CPX
between April 1, 1993, and December 31, 2005, and the remaining 511 were tested
between January 1, 2006, and October 28, 2010. Peak oxygen uptake ((Equation is
included in full-text article.)O2) and the minute ventilation/carbon dioxide
production ((Equation is included in full-text article.)E/(Equation is included
in full-text article.)CO2) slope were ascertained for all tests. RESULTS: Both
the (Equation is included in full-text article.)E/(Equation is included in
full-text article.)CO2 slope and peak (Equation is included in full-text
article.)O2 were strong univariate predictors of adverse events in both
subgroups. In the multivariate analysis, the (Equation is included in full-text
article.)E/(Equation is included in full-text article.)CO2 slope was the
strongest predictive marker while peak (Equation is included in full-text
article.)O2 added predictive value and was retained in the regression for all
scenarios. In subjects undergoing CPX before 2006, a (Equation is included in
full-text article.)E/(Equation is included in full-text article.)CO2 slope 45 or
greater and a peak (Equation is included in full-text article.)O2 of less than 10
mL . kg . min generated a hazard ratio of 4.2 (95% CI: 1.9-9.1, P < .001) when
considering only mortality as an endpoint. In subjects undergoing CPX after 2006,
a (Equation is included in full-text article.)E/(Equation is included in
full-text article.)CO2 slope 45 or greater and a peak (Equation is included in
full-text article.)O2 of less than 10 mL . kg . min generated a hazard ratio of
8.2 (95% CI: 4.7-14.3, P < .001) when considering only mortality as an endpoint.
CONCLUSION: The results of this study indicate that CPX continues to be a
valuable clinical assessment in the present-day HF management.

Langue : ANGLAIS

Tiré à part : OUI