Ahn HB; Department of Cardiology, Seongnam, Gyeonggi-do, Republic of Korea.;
Park J; Choi HJ; Choi HM; Hwang IC; Yoon YE; Cho GY;
American journal of preventive cardiology [Am J Prev Cardiol] 2024 Dec 06; Vol. 21, pp. 100913.
Date of Electronic Publication: 2024 Dec 06 (Print Publication: 2025).
Background: Given the high prevalence of stage A or B heart failure (HF), comprehensive screening for new-onset HF is cost-prohibitive. Therefore, further risk stratification is warranted to identify at-risk patients. This study aimed to evaluate the prognostic utility of cardiopulmonary exercise test (CPET) with bicycle stress echocardiography (BSE) in patients with stage A or B HF.
Methods: Among 687 consecutive patients who underwent CPET-BSE, 410 with stage A or B HF were analyzed. The association between the CPET-BSE parameters and adverse cardiac events (hospitalization for HF or cardiac-related death) was analyzed using the Cox proportional hazard model under univariate and multivariate analyses.
Results: After a median 9 years of follow-up, 47 (11.5 %) of the 410 patients had events. In the univariable analysis, age, diuretics, BUN, creatinine, peak oxygen uptake (VO2), ventilatory efficiency (VE/VCO 2 ), time to VT and peak exercise, left atrial volume index, rest and exercise E/e’, and tricuspid regurgitation velocity demonstrated significant parameters. In multivariate analysis, VE/VCO 2 (hazard ratio [HR] 1.205, 95 % CI 1.095-1.327) and VO 2 at peak exercise (HR 1.164, 95 % CI 1.022-1.325), time to VT (HR 0.993, 95 % CI 0.989-0.997), and exercise E/e’ (HR 1.582, 95 % CI 1.199-2.087) were only independent predictors for events.
Conclusions: In patients with stage A or B HF, four parameters of CPET-BSE were good predictors of future development of HF or cardiac death. If patients are unable to perform complete exercise, the time to VT may serve as a sufficiently predictive parameter for clinical events.