Cardiopulmonary exercise testing is a prognostic tool in heart failure with reduced
left ventricular ejection fraction (HFrEF). Prognosticating algorithms have been proposed,
but none has been validated. In 2017, a predictive algorithm, based on peak oxygen
consumption (VO2), ventilatory response to exercise (ventilation [VE] carbon dioxide production [VCO2],
the VE/VCO2 slope), exertional oscillatory ventilation (EOV), and peak respiratory exchange ratio,
was recommended, according treatment with β blockers: patients with HFrEF registered
in the metabolic exercise test data combined with cardiac and kidney indexes (MECKIs)
database were used to validated this algorithm. According to the inclusion/exclusion
criteria, 4,683 MECKI patients with HFrEF were enrolled. At 3 years follow-up, the
end point was cardiovascular death and urgent heart transplantation (cardiovascular
events [CV]). CV events occurred in 25% in patients without β blockers, whereas those
with β-blockers had 11% (p <0.0001). In patients without β blockers, 36%, 24%, and
7% CV events were observed in those with peak VO2 ≤10, with peak VO2 >10 <18, and
with peak VO2 ≥18 ml/kg/min (p = 0.0001), respectively; in MECKI patients with peak
VO2 ≤10 and patients with intermediate exercise capacity, a peak respiratory exchange
ratio (≥1.15) and VE/VCO2 slope (≥35) were diriment, respectively (p = 0.0001). EOV, when occurred, increased
risk. In MECKI patients on β blockers, 29%, 17%, and 8% CV events were noticed in
those with a peak VO2 ≤8, with peak VO2 = 8 to 12, and patients with peak VO2 ≥12 ml/kg/min,
respectively (p = 0.0000); when EOV was monitored an increment of risk was witnessed.
In conclusion, the outcome of this algorithm was confirmed with the MECKI cohort.
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Article Info
Publication History
Published online: July 30, 2022
Received in revised form:
June 13,
2022
Received:
May 2,
2022
Publication stage
In Press Journal Pre-ProofIdentification
Copyright
© 2022 Elsevier Inc. All rights reserved.
