Cardiopulmonary Exercise Testing in the Age of New Heart Failure Therapies: Still a Powerful Tool?

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 c...

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Published in:Biomedicines 2023-08, Vol.11 (8), p.2208
Main Authors: Garcia Brás, Pedro, Gonçalves, António Valentim, Reis, João Ferreira, Moreira, Rita Ilhão, Pereira-da-Silva, Tiago, Rio, Pedro, Timóteo, Ana Teresa, Silva, Sofia, Soares, Rui M, Ferreira, Rui Cruz
Format: Article
Language:English
Subjects:
Blood pressure
cardiorespiratory exercise testing
Cardiovascular agents
Care and treatment
Congestive heart failure
Ejection fraction
Ferric carboxymaltose
Fitness equipment
Heart failure
heart failure therapies
heart failure with reduced ejection fraction
Heart transplantation
Hypothesis testing
Ischemia
Lung transplantation
peak oxygen consumption
Power
Statistical analysis
VE/VCO2 slope
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Summary: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.
ISSN:2227-9059
2227-9059
DOI:10.3390/biomedicines11082208