TY - JOUR
T1 - Predictive Value of Cardiopulmonary Exercise Testing Parameters in Ambulatory Advanced Heart Failure
AU - REVIVAL Investigators
AU - Lala, Anuradha
AU - Shah, Keyur B.
AU - Lanfear, David E.
AU - Thibodeau, Jennifer T.
AU - Palardy, Maryse
AU - Ambardekar, Amrut V.
AU - McNamara, Dennis M.
AU - Taddei-Peters, Wendy C.
AU - Baldwin, J. Timothy
AU - Jeffries, Neal
AU - Khalatbari, Shokoufeh
AU - Spino, Cathie
AU - Richards, Blair
AU - Mann, Douglas L.
AU - Stewart, Garrick C.
AU - Aaronson, Keith D.
AU - Mancini, Donna M.
N1 - Publisher Copyright:
© 2021 American College of Cardiology Foundation
PY - 2021/3
Y1 - 2021/3
N2 - Objectives: This study sought to determine cardiopulmonary exercise (CPX) predictors of the combined outcome of durable mechanical circulatory support (MCS), transplantation, or death at 1 year among patients with ambulatory advanced heart failure (HF). Background: Optimal CPX predictors of outcomes in contemporary ambulatory advanced HF patients are unclear. Methods: REVIVAL (Registry Evaluation of Vital Information for ventricular assist devices [VADs] in Ambulatory Life) enrolled 400 systolic HF patients, INTERMACS (Interagency Registry for Mechanically Assisted Circulatory Support) profiles 4-7. CPX was performed by 273 subjects 2 ± 1 months after study enrollment. Discriminative power of maximal (peak oxygen consumption [peak VO2]; VO2 pulse, circulatory power [CP]; peak systolic blood pressure • peak VO2], peak end-tidal pressure CO2 [PEtCO2], and peak Borg scale score) and submaximal CPX parameters (ventilatory efficiency [VE/VCO2 slope]; VO2 at anaerobic threshold [VO2AT]; and oxygen uptake efficiency slope [OUES]) to predict the composite outcome were assessed by univariate and multivariate Cox regression and Harrell's concordance statistic. Results: At 1 year, there were 39 events (6 transplants, 15 deaths, 18 MCS implantations). Peak VO2, VO2AT, OUES, peak PEtCO2, and CP were higher in the no-event group (all p < 0.001), whereas VE/VCO2 slope was lower (p < 0.0001); respiratory exchange ratio was not different. CP (hazard ratio [HR]: 0.89; p = 0.001), VE/VCO2 slope (HR: 1.05; p = 0.001), and peak Borg scale score (HR: 1.20; p = 0.005) were significant predictors on multivariate analysis (model C-statistic: 0.80). Conclusions: Among patients with ambulatory advanced HF, the strongest maximal and submaximal CPX predictor of MCS implantation, transplantation, or death at 1 year were CP and VE/VCO2, respectively. The patient-reported measure of exercise effort (Borg scale score) contributed substantially to the prediction of outcomes, a surprising and novel finding that warrants further investigation.
AB - Objectives: This study sought to determine cardiopulmonary exercise (CPX) predictors of the combined outcome of durable mechanical circulatory support (MCS), transplantation, or death at 1 year among patients with ambulatory advanced heart failure (HF). Background: Optimal CPX predictors of outcomes in contemporary ambulatory advanced HF patients are unclear. Methods: REVIVAL (Registry Evaluation of Vital Information for ventricular assist devices [VADs] in Ambulatory Life) enrolled 400 systolic HF patients, INTERMACS (Interagency Registry for Mechanically Assisted Circulatory Support) profiles 4-7. CPX was performed by 273 subjects 2 ± 1 months after study enrollment. Discriminative power of maximal (peak oxygen consumption [peak VO2]; VO2 pulse, circulatory power [CP]; peak systolic blood pressure • peak VO2], peak end-tidal pressure CO2 [PEtCO2], and peak Borg scale score) and submaximal CPX parameters (ventilatory efficiency [VE/VCO2 slope]; VO2 at anaerobic threshold [VO2AT]; and oxygen uptake efficiency slope [OUES]) to predict the composite outcome were assessed by univariate and multivariate Cox regression and Harrell's concordance statistic. Results: At 1 year, there were 39 events (6 transplants, 15 deaths, 18 MCS implantations). Peak VO2, VO2AT, OUES, peak PEtCO2, and CP were higher in the no-event group (all p < 0.001), whereas VE/VCO2 slope was lower (p < 0.0001); respiratory exchange ratio was not different. CP (hazard ratio [HR]: 0.89; p = 0.001), VE/VCO2 slope (HR: 1.05; p = 0.001), and peak Borg scale score (HR: 1.20; p = 0.005) were significant predictors on multivariate analysis (model C-statistic: 0.80). Conclusions: Among patients with ambulatory advanced HF, the strongest maximal and submaximal CPX predictor of MCS implantation, transplantation, or death at 1 year were CP and VE/VCO2, respectively. The patient-reported measure of exercise effort (Borg scale score) contributed substantially to the prediction of outcomes, a surprising and novel finding that warrants further investigation.
KW - ambulatory heart failure
KW - cardiac transplant
KW - cardiopulmonary exercise stress test
KW - mechanical circulatory support
KW - predictors
UR - http://www.scopus.com/inward/record.url?scp=85100958986&partnerID=8YFLogxK
U2 - 10.1016/j.jchf.2020.11.008
DO - 10.1016/j.jchf.2020.11.008
M3 - Article
C2 - 33549559
AN - SCOPUS:85100958986
SN - 2213-1779
VL - 9
SP - 226
EP - 236
JO - JACC: Heart Failure
JF - JACC: Heart Failure
IS - 3
ER -