Congestive Heart FailureVentilatory response to exercise improves risk stratification in patients with chronic heart failure and intermediate functional capacity*
Section snippets
Study population
The study cohort consisted of 600 patients with CHF caused by ischemic or idiopathic dilated cardiomyopathy referred for CPX as part of functional evaluation, between July 1995 and March 2000. All patients had a history of an unequivocal clinical episode of heart failure and were on stable medical treatment for at least 1 month at the time of the study. Eligibility criteria were (1) echocardiographic left ventricular ejection fraction (LVEF) ≤40%, (2) ability to perform a CPX until exhaustion
Results
The study population included 530 men and 70 women: mean age was 58 ± 7 years. The etiology of heart failure was idiopathic dilated cardiomyopathy in 180 patients (30%) and coronary artery disease in 420 (70%). Despite optimal medical treatment, the majority of patients were in New York Heart Association (NYHA) functional class II-III (n = 475), whereas fewer than one fourth (n = 125) did not complain of symptomatic limitation at the time of CPX. Mean peak VO2, VE/VCO2 slope, and
Study findings
Our data indicate that an abnormally high VE/VCO2 slope, a low LVEF, and a low peak VO2 are powerful and independent predictors of major cardiac events in patients with CHF. Although a peak VO2 value of 13 mL/kg/min significantly discriminates survivors from nonsurvivors in our population, we confirm that functional capacity is strongly correlated with mortality among patients achieving a peak VO2 ≤10 mL/kg/min and distinctly predicts a very good prognosis in those with a peak VO2 ≥18
Acknowledgements
We thank Alfio Agazzone, Elena Bonanomi, and Barbara Temporelli for technical support; Fabio Comazzi for statistical analysis; and Rosemary Allpress for her careful revision of the English manuscript.
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Reprint requests: Ugo Corrà, MD, Divisione di Cardiologia, Fondazione “S. Maugeri,” Via per Revislate, 13, 28010 Veruno (NO), Italy.E-mail: [email protected]