TY - JOUR
T1 - Cardiopulmonary Exercise Testing in the Age of New Heart Failure Therapies
T2 - Still a Powerful Tool?
AU - Garcia Brás, Pedro
AU - Gonçalves, António Valentim
AU - Reis, João Ferreira
AU - Moreira, Rita Ilhão
AU - Pereira-da-Silva, Tiago
AU - Rio, Pedro
AU - Timóteo, Ana Teresa
AU - Silva, Sofia
AU - Soares, Rui M.
AU - Ferreira, Rui Cruz
PY - 2023/8
Y1 - 2023/8
N2 - Background: New therapies with prognostic benefits have been recently introduced in heart failure with reduced ejection fraction (HFrEF) management. The aim of this study was to evaluate the prognostic power of current listing criteria for heart transplantation (HT) in an HFrEF cohort submitted to cardiopulmonary exercise testing (CPET) between 2009 and 2014 (group A) and between 2015 and 2018 (group B). Methods: Consecutive patients with HFrEF who underwent CPET were followed-up for cardiac death and urgent HT. Results: CPET was performed in 487 patients. The composite endpoint occurred in 19.4% of group A vs. 7.4% of group B in a 36-month follow-up. Peak VO2 (pVO2) and VE/VCO2 slope were the strongest independent predictors of mortality. International Society for Heart and Lung Transplantation (ISHLT) thresholds of pVO2 ≤ 12 mL/kg/min (≤14 if intolerant to β-blockers) and VE/VCO2 slope > 35 presented a similar and lower Youden index, respectively, in group B compared to group A, and a lower positive predictive value. pVO2 ≤ 10 mL/kg/min and VE/VCO2 slope > 40 outperformed the traditional cut-offs. An ischemic etiology subanalysis showed similar results. Conclusion: ISHLT thresholds showed a lower overall prognostic effectiveness in a contemporary HFrEF population. Novel parameters may be needed to improve risk stratification.
AB - Background: New therapies with prognostic benefits have been recently introduced in heart failure with reduced ejection fraction (HFrEF) management. The aim of this study was to evaluate the prognostic power of current listing criteria for heart transplantation (HT) in an HFrEF cohort submitted to cardiopulmonary exercise testing (CPET) between 2009 and 2014 (group A) and between 2015 and 2018 (group B). Methods: Consecutive patients with HFrEF who underwent CPET were followed-up for cardiac death and urgent HT. Results: CPET was performed in 487 patients. The composite endpoint occurred in 19.4% of group A vs. 7.4% of group B in a 36-month follow-up. Peak VO2 (pVO2) and VE/VCO2 slope were the strongest independent predictors of mortality. International Society for Heart and Lung Transplantation (ISHLT) thresholds of pVO2 ≤ 12 mL/kg/min (≤14 if intolerant to β-blockers) and VE/VCO2 slope > 35 presented a similar and lower Youden index, respectively, in group B compared to group A, and a lower positive predictive value. pVO2 ≤ 10 mL/kg/min and VE/VCO2 slope > 40 outperformed the traditional cut-offs. An ischemic etiology subanalysis showed similar results. Conclusion: ISHLT thresholds showed a lower overall prognostic effectiveness in a contemporary HFrEF population. Novel parameters may be needed to improve risk stratification.
KW - cardiorespiratory exercise testing
KW - heart failure therapies
KW - heart failure with reduced ejection fraction
KW - heart transplantation
KW - peak oxygen consumption
KW - VE/VCO slope
UR - http://www.scopus.com/inward/record.url?scp=85168892233&partnerID=8YFLogxK
U2 - 10.3390/biomedicines11082208
DO - 10.3390/biomedicines11082208
M3 - Article
AN - SCOPUS:85168892233
SN - 2227-9059
VL - 11
JO - Biomedicines
JF - Biomedicines
IS - 8
M1 - 2208
ER -