To date, the role of CPET (cardiopulmonary exercise testing) for risk stratification in elderly patients with HF (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 HF ≥70 years of age [median age, 75 years; 23% had NYHA class III; and 59% had preserved ventricular systolic function (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 V̇E/V̇CO2 slope (slope of the minute ventilation/carbon dioxide production ratio) was 33.2 and 45% had an EVR (enhanced ventilatory response) to exercise (V̇E/V̇CO2 slope ≥34). During 19 months of 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 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 V̇E/V̇CO2 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.
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March 2009
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Research Article|
February 02 2009
Additive prognostic value of cardiopulmonary exercise testing in elderly patients with heart failure
Angela B. Scardovi;
*Department of Cardiology, St Spirito Hospital, 00143 Rome, Italy
Correspondence: Dr Angela B. Scardovi (email [email protected]).
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Renata De Maria;
Renata De Maria
†CNR Clinical Physiology Institute, 20162 Milan, Italy
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Andrea Celestini;
Andrea Celestini
*Department of Cardiology, St Spirito Hospital, 00143 Rome, Italy
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Silvia Perna;
Silvia Perna
‡Department of Cardiology, St Andrea Hospital, University of Medicine ‘La Sapienza’, 00189 Rome, Italy
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Claudio Coletta;
Claudio Coletta
*Department of Cardiology, St Spirito Hospital, 00143 Rome, Italy
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Mauro Feola;
Mauro Feola
§Department of Cardiology Department, St Croce e Carle Hospital, 12100 Cuneo, Italy
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Nadia Aspromonte;
Nadia Aspromonte
*Department of Cardiology, St Spirito Hospital, 00143 Rome, Italy
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Gian Luca Rosso;
Gian Luca Rosso
§Department of Cardiology Department, St Croce e Carle Hospital, 12100 Cuneo, Italy
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Alessandro Carunchio;
Alessandro Carunchio
*Department of Cardiology, St Spirito Hospital, 00143 Rome, Italy
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Alessandro Ferraironi;
Alessandro Ferraironi
*Department of Cardiology, St Spirito Hospital, 00143 Rome, Italy
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Alessandro Pimpinella;
Alessandro Pimpinella
*Department of Cardiology, St Spirito Hospital, 00143 Rome, Italy
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Roberto Ricci
Roberto Ricci
*Department of Cardiology, St Spirito Hospital, 00143 Rome, Italy
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Publisher: Portland Press Ltd
Received:
April 04 2008
Revision Received:
August 05 2008
Accepted:
August 12 2008
Accepted Manuscript online:
August 12 2008
Online ISSN: 1470-8736
Print ISSN: 0143-5221
© The Authors Journal compilation © 2009 Biochemical Society
2009
Clin Sci (Lond) (2009) 116 (5): 415–422.
Article history
Received:
April 04 2008
Revision Received:
August 05 2008
Accepted:
August 12 2008
Accepted Manuscript online:
August 12 2008
Citation
Angela B. Scardovi, Renata De Maria, Andrea Celestini, Silvia Perna, Claudio Coletta, Mauro Feola, Nadia Aspromonte, Gian Luca Rosso, Alessandro Carunchio, Alessandro Ferraironi, Alessandro Pimpinella, Roberto Ricci; Additive prognostic value of cardiopulmonary exercise testing in elderly patients with heart failure. Clin Sci (Lond) 1 March 2009; 116 (5): 415–422. doi: https://doi.org/10.1042/CS20080111
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