Sato T, Yoshihisa A, Kanno Y, Suzuki S, Yamaki T, Sugimoto K,
Kunii H, Nakazato K, Suzuki H, Saitoh SI, Ishida T, Takeishi Y
Eur J Prev Cardiol. 2017 Dec;24(18):1979-1987.
We aimed to determine the differences of impact of cardiopulmonary exercise
testing (CPX) parameters on prognosis of heart failure with reduced left
ventricular ejection fraction (HFrEF), preserved ejection fraction (HFpEF) and
mid-range ejection fraction (HFmrEF).
We compared clinical
characteristics and CPX parameters among the three groups, and the value of each
CPX parameter to predict adverse cardiac events (cardiac deaths and
re-hospitalizations for heart failure), cardiac deaths and all-cause deaths.
Of 1190 patients, 41.9% had HFrEF, 36.8% had HFpEF and 21.3% had HFmrEF.
The patients in HFrEF group had higher rates of adverse cardiac events, cardiac
death and all-cause death than those of HFpEF and HFmrEF groups. In HFrEF, the
independent predictors of adverse cardiac events were peak oxygen consumption and
oxygen uptake efficiency slope, predictors of cardiac death were peak oxygen
consumption and oxygen uptake efficiency slope, and the predictor of all-cause
death was peak oxygen consumption. In HFpEF, the predictor of adverse cardiac
events was peak oxygen consumption, predictors of cardiac deaths and all-cause
deaths were peak oxygen consumption and exertional oscillatory ventilation. In
HFmrEF, predictors of adverse cardiac events were peak oxygen consumption and
oxygen uptake efficiency slope, and the predictor of cardiac deaths and all-cause
deaths was peak oxygen consumption.
Peak oxygen consumption is the
strong predictor for adverse events in all groups. Oxygen uptake efficiency slope
predicts adverse prognosis in HFrEF, but not in HFpEF. In contrast, exertional
oscillatory ventilation is the predictor only in HFpEF. Thus, different CPX
parameters may be able to differentially predict prognosis in HFrEF and HFpEF.
Those for predicting prognosis in HFmrEF may be intermediate between HFrEF and