Role of cardiopulmonary exercise testing in clinical stratification in heart failure. A position paper from the Committee on Exercise Physiology and Training of the Heart Failure Association of the European Society of Cardiology |
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| Authors: | Ugo Corrà Pier Giuseppe Agostoni Stefan D. Anker Andrew J.S. Coats Maria G. Crespo Leiro Rudolph A. de Boer Veli‐Pekka Harjola Loreena Hill Mitja Lainscak Lars H. Lund Marco Metra Piotr Ponikowski Jillian Riley Petar M. Seferović Massimo F. Piepoli |
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| Affiliation: | 1. Cardiology Division, Istituti Clinici Scientifici Maugeri, Centro Medico di Riabilitazione di Veruno, Veruno, Novara, Italy;2. Cardiology Center of Monzino, IRCCS, Milan, Italy;3. and Cardiovascular Section, Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy;4. Division of Cardiology and Metabolism ‐ Heart Failure, Cachexia & Sarcopenia, Department of Cardiology (CVK) and Berlin‐Brandenburg Center for Regenerative Therapies (BCRT), at Charité University Medicine, Berlin;5. Department of Cardiology and Pneumology, University Medicine G?ttingen (UMG), G?ttingen, Germany;6. German Center for Cardiovascular Research (DZHK), Berlin, Germany;7. University of Warwick, Coventry, UK;8. Heart Failure and Heart Transplant Unit, Complejo Hospitalario Universitario A Coru?a (CHUAC), CIBERCV, La Coru?a, Spain;9. University Medical Center Groningen, Groningen, The Netherlands;10. Emergency Medicine, University of Helsinki, Department of Emergency Medicine and Services, Helsinki University Hospital, Helsinki, Finland;11. School of Nursing and Midwifery, Queen's University, Belfast, UK;12. Faculty of Medicine, University of Ljubljana;13. and Center for Heart Failure, General Hospital Murska Sobota, Slovenia;14. Department of Medicine, Karolinska Institutet;15. and Heart and Vascular Theme, Karolinska University Hospital, Stockholm, Sweden;16. University of Brescia, Italy;17. Wroclaw Medical University, Wroclaw, Poland;18. National Heart and Lung Institute, Imperial College, London, UK;19. Internal Medicine, University of Belgrade School of Medicine, Belgrade, Serbia;20. Heart Failure Unit, Cardiac Department, Guglielmo da Saliceto Hospital, Piacenza, ItalyCorresponding author. Heart Failure Unit, Guglielmo da Saliceto Hospital, Cantone del Cristo, 29121 Piacenza, Italy. Tel: +39 0523 303217, Fax: +39 0523 303220, Email: |
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| Abstract: | Traditionally, the main indication for cardiopulmonary exercise testing (CPET) in heart failure (HF) was for the selection of candidates to heart transplantation: CPET was mainly performed in middle‐aged male patients with HF and reduced left ventricular ejection fraction. Today, CPET is used in broader patients' populations, including women, elderly, patients with co‐morbidities, those with preserved ejection fraction, or left ventricular assistance device recipients, i.e. individuals with different responses to incremental exercise and markedly different prognosis. Moreover, the diagnostic and prognostic utility of symptom‐limited CPET parameters derived from submaximal tests is more and more considered, since many patients are unable to achieve maximal aerobic power. Repeated tests are also being used for risk stratification and evaluation of intervention, so that these data are now available. Finally, patients, physicians and healthcare decision makers are increasingly considering how treatments might impact morbidity and quality of life rather than focusing more exclusively on hard endpoints (such as mortality) as was often the case in the past. Innovative prognostic flowcharts, with CPET at their core, that help optimize risk stratification and the selection of management options in HF patients, have been developed. |
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| Keywords: | Exercise testing Prognosis Heart failure |
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