Cardiopulmonary Exercise Testing in the Clinical and Prognostic Assessment of Diastolic Heart Failure

ObjectivesThis study sought to define the relative prognostic value of cardiopulmonary exercise testing (CPET) variables in heart failure (HF) patients with preserved versus reduced systolic function.BackgroundCardiopulmonary exercise testing has an established role in the assessment of patients with systolic heart failure (SHF). Two variables, peak Vo2and, more recently, the Ve/Vco2slope, have been shown to be extremely valuable in risk stratification. However, data are lacking in terms of the prognostic value of CPET in patients with diastolic heart failure (DHF).MethodsA total of 409 HF patients underwent CPET. Patients were divided into three groups according to the following left ventricular ejection fraction (LVEF) cutoffs: ≥40%, ≥45%, and ≥50%. The CPET response and the ability of peak Vo2and the Ve/Vco2slope to predict total mortality and hospitalization were examined.ResultsAt univariate Cox regression analysis, both the peak Vo2and the Ve/Vco2slope were significant predictors in SHF and DHF. Multivariate analysis documented a similar prognostic power of Ve/Vco2slope and peak Vo2in all SHF groups. Conversely, in DHF patients, Ve/Vco2slope outnumbered peak Vo2, remaining the only predictor regardless of LVEF. In DHF, the area under the receiver operating characteristic curve for the Ve/Vco2slope identified a cutoff of 32.6 (74% sensitivity, 52% specificity), 33.1 (76% sensitivity, 62% specificity), and 33.3 (97% sensitivity, 40% specificity) for an LVEF cutoff of ≥40%, ≥45%, and ≥50%, respectively.ConclusionsThese results extend the clinical and prognostic applicability of CPET to DHF. An impairment in exercise ventilation rather than peak Vo2holds clinical and prognostic impact in this increasing subset of patients