Article

The study aims were to validate the cardiopulmonary exercise testing (CPET)
parameters recommended by the European Society of Cardiology 2008 Guidelines for
risk assessment in heart failure (HF) (ESC-predictors) and to verify the
predictive role of 11 supplementary CPET (S-predictors) parameters. METHODS : We followed 749 HF patients for cardiovascular death and urgent heart
transplantation for 3 years: 139 (19%) patients had cardiac events.
ESC-predictors - peak oxygen consumption (VO(2)), slope of minute ventilation vs
carbon dioxide production (VE/VCO(2)) and exertional oscillatory ventilation -
were all related to outcome at univariate and multivariable analysis. The
ESC/2008 prototype based on ESC-predictors presented a Harrell's C concordance
index of 0.725, with a likely chi2 of 98.31. S-predictors - predicted peak VO(2),
peak oxygen pulse, peak respiratory exchange ratio, peak circulatory power, peak
VE/VCO(2), VE/VCO(2) slope normalized by peak VO(2), VO(2) efficiency slope,
ventilatory anaerobic threshold detection, peak end-tidal CO(2) partial pressure,
peak heart rate, and peak systolic arterial blood pressure (SBP) - were all
linked to outcome at univariate analysis. When individually added to the ESC/2008
prototype, only peak SBP and peak O(2) pulse significantly improved the model
discrimination ability: the ESC + peak SBP prototype had a Harrell's C index
0.750 and reached the highest likely chi2 (127.16, p < 0.0001). CONCLUSIONS: We
evaluated the longest list of CPET prognostic parameters yet studied in HF:
ESC-predictors were independent predictors of cardiovascular events, and the ESC
prototype showed a convincing predictive capacity, whereas none of 11
S-predictors enhanced the prognostic performance, except peak SBP.

Langue : ANGLAIS