Morimoto, Junko; Department of Cardiovascular Medicine, Arida City Hospital, Wakayama 6490316, Japan.
Taruya, Akira;Satogami, Keisuke;Taniguchi, Motoki;+10 more

International journal of cardiology,2025 Dec 30

• Background: Cardiopulmonary exercise testing combined with stress echocardiography (CPET-SE) allows the non-invasive assessment of cardiac function and oxygen metabolism during exercise. However, their prognostic value in older patients with heart failure (HF) remains unclear. This study aimed to determine whether left ventricular diastolic function at the anaerobic threshold (AT) predicts 1-year composite outcomes, defined as cardiovascular death or worsening HF, in older patients with HF.
• Methods: In this study, 104 older patients with HF who underwent CPET-SE were prospectively enrolled. Of the initial cohort, 15 patients (14 %) were excluded due to inability to obtain e’ measurements, and one patient for loss of follow-up. Ultimately, 88 patients were included in the analysis. Patients were divided into event and non-event groups based on 1-year outcomes. Diastolic function was evaluated by measuring e’ at rest and immediately after reaching the AT (e’ _AT ), and values were compared between groups.
• Results: No adverse events related to the CPET-SE were observed. Only 10.2 % of the patients reached the target heart rate. During the follow-up, 26 patients (29.6 %) experienced composite events. Multivariate analysis revealed that e’ _AT , along with the presence or absence of atrial fibrillation, remained as a prognostic factor of the composite outcomes. An e’ _AT cutoff <6.0 cm/s demonstrated 89 % sensitivity and 84 % specificity for predicting events.
• Conclusions: An e’ _AT value of <6.0 cm/s derived by CPET-SE is a feasible and robust prognostic marker in older patients with HF. CPET-SE may be an adjunct tool for risk stratification, complementing conventional biomarkers, echocardiography, and CPET parameters.