Heart 2000;83:147-151 ( February )

Cardiovascular medicine

Chronic heart failure in the elderly: value of cardiopulmonary exercise testing in risk stratification L C Davies^a, D P Francis^a, M Piepoli^b, A C Scott^b, P Ponikowski^b, A J S Coats^b

^a Royal Brompton Hospital, Sydney Street, London SW3 6NP, UK, ^b National Heart & Lung Institute, Imperial College of Science, Technology and Medicine, Dovehouse Street, London SW3 6LY, UK

Correspondence to: Dr L C Davies, Heart Failure Unit, Royal Brompton Hospital, Sydney Street, London SW3 6NP, UK email: c.davies{at}rbh.nthames.nhs.uk

Accepted 11 October 1999

OBJECTIVETo assess the value of cardiopulmonary exercise testing in predicting prognosis in a cohort of elderly patients with chronic heart failure (CHF).
DESIGNA retrospective cohort study of all patients with CHF over the age of 70 years assessed between January 1992 and May 1997.
SETTINGTertiary centre.
PATIENTS50 patients (mean (SD) age 75.9 (4.5) years, 8 women) with CHF New York Heart Association (NYHA) class I (3 patients), II (25 patients), III (20 patients), and IV (2 patients). Follow up was complete for two years in all patients.
RESULTSThe patients underwent cardiopulmonary exercise testing (peak oxygen consumption 15.2 (4.5) ml/kg/min, minute ventilation/carbon dioxide production (VE/VCO₂) slope 38.7 (11.8)); radionucleide ventriculography (left ventricular ejection fraction 32.8 (14.3)%); serum sodium measurement (139 (2.8) mmol/l); and echocardiography (left ventricular end diastolic dimension 6.1 (1.1) cm, left ventricular end systolic dimension 4.7 (1.5) cm). At the end of follow up in May 1999, 26 patients had died. The median follow up of the survivors was 47.7 months (interquartile range 31.5-53.5 months). On univariate analysis VE/VCO₂ slope (p < 0.0001), NYHA class (p < 0.001), peak oxygen uptake (VO₂) (p < 0.01), left ventricular end systolic dimension (p < 0.05), and serum sodium concentration (p < 0.05) had significant predictive power. Stepwise multivariate analysis identified only VE/VCO₂ slope (p < 0.01), NYHA class (p < 0.05), and peak VO₂ (p< 0.05) as conveying significant independent prognostic information.
CONCLUSIONElderly patients with CHF have a high mortality, with the majority dead within two years. Cardiopulmonary exercise testing provides important information for risk stratification within this group and its use should not be neglected.


Keywords: cardiopulmonary exercise testing; chronic heart failure; elderly patients; risk factor stratification

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© 2000 by Heart
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