Exercise haemodynamic variables rather than ventilatory efficiency indexes contribute to risk assessment in chronic heart failure patients treated with carvedilol

• Published in: European heart journal 2009-12, Vol.30 (24), p.3000-3006
• Main Authors: Corrà, Ugo, Mezzani, Alessandro, Giordano, Andrea, Bosimini, Enzo, Giannuzzi, Pantaleo
• Format: Article
• Language: English
• Subjects: Adrenergic beta-Antagonists - therapeutic use; Carbazoles - therapeutic use; Chronic Disease; Exercise; Exercise - physiology; Female; Heart failure; Heart Failure - drug therapy; Heart Failure - mortality; Heart Failure - physiopathology; Hemodynamics - drug effects; Humans; Male; Middle Aged; Oxygen Consumption - physiology; Prognosis; Propanolamines - therapeutic use; Respiratory Function Tests; Respiratory Insufficiency - physiopathology; Risk Assessment - methods
• ISSN: 0195-668X; 1522-9645
• DOI: 10.1093/eurheartj/ehp138

Aims To evaluate the prognostic significance of traditional cardiopulmonary exercise testing (CPET) parameters in chronic heart failure (CHF) patients treated with beta-blockers. Methods and results A total of 631 CHF patients were followed for cardiovascular death over 3.8 ± 1.4 years; among them 79 (13%) died. All prognostic CPET parameters were related to outcome at univariate analysis, with haemodynamic-derived parameters [peak systolic blood pressure (SBP), peak circulatory power (CP) = peak oxygen consumption (pVO2) × peak SBP] and exertional oscillatory ventilation (EOV) reaching the highest χ2 (46.5, 40.9, and 22.6, respectively, all with P < 0.0001). Exertional oscillatory ventilation, although associated with high mortality rate (43 vs. 11%, P < 0.001), was detected in 42 (7%) patients. In non-EOV, again both peak SBP and peak CP reached the highest χ2 (30.6, and 21.6, respectively, all with P < 0.0001). Regarding CPET parameters, at multivariable analysis, peak SBP was the strongest risk index both in total and non-EOV populations, with 11% risk reduction every 5 mmHg increase. Conclusion All traditional CPET risk parameters were informative in beta-blockers CHF patients, but peak SBP, peak CP, and EOV were the most predictive. In this low-risk population, EOV, although underrepresented, considerably enhanced risk stratification, although other ventilatory efficiency indexes provided less impressive predictive content. In large majority of non-EOV patients, peak SBP improved risk evaluation beyond other CPET parameters.