Wagner J; Agostoni P; Arena R; Belardinelli R; Dumitrescu D; Hager A;
Myers J; Rauramaa R; Riley M; Takken T; Schmidt-Trucksass A.
American Heart Journal. 202:116-126, 2018 08.
Heart failure with reduced ejection fraction (HFrEF) is common in the
developed world and results in significant morbidity and mortality.
Accurate risk assessment methods and prognostic variables are therefore
needed to guide clinical decision making for medical therapy and surgical
interventions with the ultimate goal of decreasing risk and improving
health outcomes. The purpose of this review is to examine the role of
cardiopulmonary exercise testing (CPET) and its most commonly used
ventilatory gas exchange variables for the purpose of risk stratification
and management of HFrEF. We evaluated five widely studied gas exchange
variables from CPET in HFrEF patients based on nine previously used
systematic criteria for biomarkers. This paper provides clinicians with a
comprehensive and critical overview, class recommendations and evidence
levels. Although some CPET variables met more criteria than others,
evidence supporting the clinical assessment of variables beyond peak VO2
is well-established. A multi-variable approach also including the VE-VCO2
slope and EOV is therefore recommended.