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Comparison of Peak Exercise Oxygen Consumption and the Heart Failure Survival Score for Predicting Prognosis in Women Versus Men

Published:December 16, 2006DOI:https://doi.org/10.1016/j.amjcard.2006.08.046
      The Heart Failure Survival Score (HFSS) and peak exercise oxygen consumption (VO2) predict survival in ambulatory patients with heart failure and are used for selection for cardiac transplantation. However, the populations tested have predominately been men. To investigate if peak VO2 and the HFSS predict prognosis in women, we derived HFSS and measured peak VO2 in 274 women referred for cardiac transplantation and in 278 men matched by referral year. Seven HFSS parameters were obtained, including presence of coronary artery disease, left ventricular ejection fraction, heart rate, mean arterial blood pressure, peak VO2, presence of intraventricular conduction defects, and serum sodium. Subjects were divided into high-, medium-, and low-risk strata for HFSS and VO2 based on previous cutpoints. Survival curves were derived using Kaplan-Meier analysis and compared by log-rank analysis. Follow-up averaged 929 days. For women, 1-year event-free survival in the low- (>14), medium- (10.1 to 14), and high-risk (<10 ml/kg/min) VO2 strata was 93%, 84%, and 80%, respectively. For the HFSS, 1-year event-free survival in the low- (≥8.10), medium- (7.20 to 8.09), and high-risk (≤7.19) strata was 90%, 87%, and 67%, respectively. Survival curves for VO2 (p <0.01) and HFSS (p <0.001) demonstrated significant differences. In both genders, the low-risk groups for HFSS and VO2 can safely have transplantation deferred. Women had better survival than men for a given peak VO2. The HFSS was consistent between genders. In conclusion, peak VO2 and the HFSS are excellent parameters to predict survival in women with congestive heart failure. THE HFSS is more consistent than the peak VO2 between the genders.
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      References

        • Mancini D.M.
        • Eisen H.
        • Kussmaul W.
        • Mull R.
        • Edmunds Jr, L.H.
        • Wilson J.R.
        Value of peak exercise oxygen consumption for optimal timing of cardiac transplantation in ambulatory patients with heart failure.
        Circulation. 1991; 83: 778-786
        • Aaronson K.D.
        • Schwartz J.S.
        • Chen T.M.
        • Wong K.L.
        • Goin J.E.
        • Mancini D.M.
        Development and prospective validation of a clinical index to predict survival in ambulatory patients referred for cardiac transplant evaluation.
        Circulation. 1997; 95: 2660-2667
        • Aaronson K.D.
        • Mancini D.M.
        Is percentage of predicted maximal exercise oxygen consumption a better predictor of survival than peak exercise oxygen consumption for patients with severe heart failure?.
        J Heart Lung Transplant. 1995; 14: 981-989
        • Mancini D.
        • Katz S.
        • Donchez L.
        • Aaronson K.
        Coupling of hemodynamic measurements with oxygen consumption during exercise does not improve risk stratification in patients with heart failure.
        Circulation. 1996; 94: 2492-2496
        • Hunt S.A.
        • Abraham W.T.
        • Chin M.H.
        • Feldman A.M.
        • Francis G.S.
        • Ganiats T.G.
        • Jessup M.
        • Konstam M.A.
        • Mancini D.M.
        • Michl K.
        • et al.
        • American College of Cardiology, American Heart Association Task Force on Practice Guidelines, American College of Chest Physicians, International Society for Heart and Lung Transplantation, Heart Rhythm Society
        ACC/AHA 2005 guideline update for the diagnosis and management of chronic heart failure in the adult: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Update the 2001 Guidelines for the Evaluation and Management of Heart Failure): developed in collaboration with the American College of Chest Physicians and the International Society for Heart and Lung Transplantation: endorsed by the Heart Rhythm Society.
        Circulation. 2005; 112: e154-e235
        • Swedberg K.
        • Cleland J.
        • Dargie H.
        • Drexler H.
        • Follath F.
        • Komajda M.
        • Tavazzi L.
        • Smiseth O.A.
        • Gavazzi A.
        • Haverich A.
        • et al.
        • European Society of Heart Failure
        Guidelines for the diagnosis and treatment of chronic heart failure: executive summary (update 2005).
        Eur Heart J. 2005; 26: 1115-1140
        • Lund L.H.
        • Aaronson K.D.
        • Mancini D.M.
        Predicting survival in ambulatory patients with severe heart failure on beta-blocker therapy.
        Am J Cardiol. 2003; 92: 1350-1354
        • Bobbio M.
        • Dogliani S.
        • Giacomarra G.
        Superiority of the heart failure survival score to peak exercise oxygen consumption in the prediction of outcomes in an independent population referred for heart transplant evaluation.
        Ital Heart J. 2004; 5: 899-905
        • Koelling T.M.
        • Joseph S.
        • Aaronson K.D.
        Heart failure survival score continues to predict clinical outcomes in patients with heart failure receiving beta-blockers.
        J Heart Lung Transplant. 2004; 23: 1414-1422
        • Elmariah S.
        • Goldberg L.
        • Allan M.
        • Kao A.
        Effects of gender on peak oxygen consumption and the timing of cardiac transplanation.
        J Am Coll Cardiol. 2006; 47: 2237-2242
        • Lund L.
        • Mancini D.
        Heart failure in women.
        Med Clin North Am. 2004; 88: 1321-1345
        • Levy W.
        • Mozaffarian D.
        • Linker D.
        • Sutradhar S.
        • Anker S.
        • Cropp A.
        • Anand I.
        • Maggiono A.
        • Burton P.
        • Sullivan M.
        • et al.
        The Seattle Heart Failure model: the prediction of survival in heart failure.
        Circulation. 2006; 113: 1424-1433