Additive prognostic value of cardiopulmonary exercise testing in elderly patients with heart failure

作者：Scardovi Angela B^*; De Maria Renata; Celestini Andrea; Perna Silvia; Coletta Claudio; Feola Mauro; Aspromonte Nadia; Rosso Gian Luca; Carunchio Alessandro; Ferraironi Alessandro; Pimpinella Alessandro; Ricci Roberto

来源：Clinical Science, 2009, 116(5-6): 415-422.

DOI：10.1042/CS20080111

• cardiopulmonary exercise testing
• creatinine clearance
• elderly
• heart failure
• preserved left ventricular ejection fraction
• risk stratification

To date, the role of CPET (cardiopulmonary exercise testing) for risk stratification in elderly patients with HIF (heart failure) with depressed or preserved ventricular function has not been evaluated. In the present study, we analysed whether CPET is useful in predicting outcome in this population. A total of 220 NYHA (New York Heart Association) class I-III patients with HIP >= 70 years of age [median age, 75 years; 23% had NYHA class III; and 59% had preserved ventricular systolic left ventricular ejection fraction >= 40%)] performed maximal CPET (peak expiratory exchange ratio > 1.00). Median peak oxygen uptake was 11.9 ml . kg(-1) of body weight . min(-1), median VE/VCO(2) slope (slope of the minute ventilation/carbon dioxide production ratio) was 33.2 and 45% had an EVR (enhanced ventilatory response) to exercise (VE/VCO(2) slope >= 34). During 19 months of follow-up, 94 patients (43%) met the combined end point of death and hospital admission for worsening HE arrhythmias or acute coronary syndromes. By Cox multivariable analysis, a creatinine clearance of < 50 ml/min {HR (hazard ratio), 1.657 [95% CI (confidence interval), 1.055-2.602]} and EVR [HR, 1.965 (95 % CI, 1.195-3.231)] were the best predictors of outcome, while ventricular function had no influence on prognosis. In conclusion, in elderly patients with HF, a steeper VE/VCO(2) slope provides additional information for risk stratification across the spectrum of ventricular function and identifies a high-risk population, commonly not considered in exercise testing guidelines.

• 出版日期2009-3