Severely Impaired Cardiorespiratory Fitness in Patients With Recently Decompensated Systolic Heart Failure

Canada JM; Trankle CR; Buckley LF; Carbone S; Abouzaki NA; Kadariya D; Shah K; Cooke R;
Kontos MC; Patel J; Mankad P; Schatz A; Bhatnagar A; Arena R; Van Tassell BW; Abbate A

The American Journal Of Cardiology [Am J
Cardiol], ISSN: 1879-1913, 2017 Nov 15; Vol. 120 (10), pp. 1854-1857

Hospital admission for
decompensated heart failure marks a critical inflection point in a
patient’s health. Despite the improvement in signs or symptoms during
hospitalization, patients have a high likelihood of readmission,
reflecting a lack of resolution of the underlying condition.
Surprisingly, no studies have characterized the cardiorespiratory
fitness of such patients. Fifty-two patients (38 [73%] male, age 57 [52
to 65] years, left ventricular ejection fraction 31% [24 to 38])
underwent cardiopulmonary exercise testing 4 (1 to 10) days after
hospital discharge, when stable and without overt signs of volume
overload. Transthoracic Doppler echocardiography, measurement of
N-terminal pro-B-natriuretic peptide, and quality of life were also
assessed. Aerobic exercise capacity was severely reduced: peak oxygen
consumption (pVO2) was 14.1 (11.2 to 16.3) ml/kg/min. Ventilatory
inefficiency as indicated by the minute ventilation carbon dioxide
production relation (VE/VCO2 slope) >30 and oxygen uptake efficiency
slope <2.0 was noted in 41 (77%) and 39 (75%) patients, respectively.
Forty-five (87%) patients had 1 of 2 high-risk features
(pVO2 < 14 ml/kg/min or VE/VCO2 >30). Perceived functional capacity,
measured by the Duke Activity Status Index, was also severely reduced
and correlated with pVO2. N-terminal pro-B-natriuretic peptide levels
and early transmitral velocity/early mitral annulus velocity (E/e’)
ratio at echocardiography showed a modest correlation with lower pVO2.
In conclusion, patients with recently decompensated systolic heart
failure demonstrate severe impairment in cardiorespiratory fitness,
severely limiting quality of life.