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A meta-analysis of the prognostic significance of cardiopulmonary exercise testing in patients with heart failure |
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| Authors: | Lawrence P. Cahalin Paul Chase Ross Arena Jonathan Myers Daniel Bensimhon Mary Ann Peberdy Euan Ashley Erin West Daniel E. Forman Sherry Pinkstaff Carl J. Lavie Marco Guazzi |
| Affiliation: | 1. Department of Physical Therapy, Leonard M. Miller School of Medicine, University of Miami, 5915 Ponce de Leon Blvd., 5th Floor, Coral Gables, FL, 33146-2435, USA 2. Lebauer Cardiovascular Research Foundation, Greensboro, NC, USA 3. Physical Therapy Program, Department of Orthopaedics and Department of Internal Medicine, Division of Cardiology, University of New Mexico, Albuquerque, NM, USA 4. Division of Cardiology, VA Palo Alto Healthcare System, Palo Alto, CA, USA 5. Department of Internal Medicine, Virginia Commonwealth University, Richmond, VA, USA 6. Cardiovascular Medicine, Stanford University, Palo Alto, CA, USA 7. Division of Cardiovascular Medicine, Brigham and Women’s Hospital, Boston, MA, USA 8. Physical Therapy Program, Brooks College of Health, University of North Florida, Jacksonville, FL, USA 10. Pennington Biomedical Research Center, Louisiana State University System, Baton Rouge, LA, USA 9. Department of Cardiovascular Diseases, John Ochsner Heart and Vascular Institute, Ochsner Clinical School, The University of Queensland School of Medicine, New Orleans, LA, USA 11. Cardiology, I.R.C.C.S. Policlinico San Donato, University of Milano, San Donato Milanese, Italy |
| Abstract: | The objective of the study is to assess the role of cardiopulmonary exercise testing (CPX) variables, including peak oxygen consumption (VO2), which is the most recognized CPX variable, the minute ventilation/carbon dioxide production (VE/VCO2) slope, the oxygen uptake efficiency slope (OUES), and exercise oscillatory ventilation (EOV) in a current meta-analysis investigating the prognostic value of a broader list of CPX-derived variables for major adverse cardiovascular events in patients with HF. A search for relevant CPX articles was performed using standard meta-analysis methods. Of the initial 890 articles found, 30 met our inclusion criteria and were included in the final analysis. The total subject populations included were as follows: peak VO2 (7,319), VE/VCO2 slope (5,044), EOV (1,617), and OUES (584). Peak VO2, the VE/VCO2 slope and EOV were all highly significant prognostic markers (diagnostic odds ratios ≥ 4.10). The OUES also demonstrated promise as a prognostic marker (diagnostic odds ratio = 8.08) but only in a limited number of studies (n = 2). No other independent variables (including age, ejection fraction, and beta-blockade) had a significant effect on the meta-analysis results for peak VO2 and the VE/VCO2 slope. CPX is an important component in the prognostic assessment of patients with HF. The results of this meta-analysis strongly confirm this and support a multivariate approach to the application of CPX in this patient population. |
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