CARDIOVASCULAR MEDICINE

Ventilatory variables are strong prognostic markers in elderly patients with heart failure

M Mejhert, E Linder-Klingsell, M Edner, T Kahan, H Persson

Section of Cardiology, Division of Internal Medicine, Karolinska Institutet Danderyd Hospital, Stockholm, Sweden

Correspondence to:
Correspondence to:
Dr M Mejhert, Karolinska Institutet Danderyd Hospital, Section of Cardiology, Division of Internal Medicine, S-182 88 Stockholm, Sweden;
marit.mejhert{at}med.ds.sll.se

Objective: To evaluate the safety and prognostic capacity of cardiopulmonary exercise testing in patients 60 years old who are hospitalised with heart failure caused by left ventricular dysfunction.

Design: Prospective study.

Setting: University hospital.

Patients: Study participants were 67 patients (66% men) with clinical heart failure stabilised on medical treatment. The study is a part of a nursing intervention study. Mean (SD) age was 74 (6) years, New York Heart Association functional class II–III, and ejection fraction 0.36 (0.11).

Interventions: Cardiopulmonary exercise testing and echocardiography.

Main outcome measures: Peak oxygen consumption (O₂), peak ventilatory equivalents for carbon dioxide (E/CO₂) and oxygen (E/O₂), left ventricular volumes, and mortality.

Results: Mean (SD) peak O₂ was 11.7 (3.7) ml/kg/min, peak E/CO₂ 43 (9), and peak E/O₂ 46 (11). During 12–59 months of follow up, 14 patients died. In univariate analyses peak O₂, E/O₂, and E/CO₂ were all strongly related (p < 0.01) to mortality. In a multivariate Cox regression analysis, peak E/CO₂ was the strongest predictor of mortality (p < 0.001), followed by left ventricular end systolic volume (p < 0.001). A cut off of peak E/CO₂ at 45 gave a univariate hazard ratio of 6.7 for death during follow up. No adverse events occurred during the exercise test.

Conclusion: These findings extend results found in selected middle aged patients to elderly patients with heart failure and show that ventilatory parameters from a cardiopulmonary exercise test, such as peak O₂, E/O₂, and E/CO₂ are powerful predictors of mortality.

Keywords: heart failure; exercise testing; ventilatory parameters; prognosis

Abbreviations: AVPD, atrioventricular plane displacement; EF, ejection fraction; NYHA, New York Heart Association; OPTIMAL, optimising congestive heart failure outpatient clinical project; CO₂, carbon dioxide production; E, ventilatory equivalent; O₂, oxygen consumption

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This article has been cited by other articles:

• Corra, U., Mezzani, A., Bosimini, E., Giannuzzi, P. (2004). Cardiopulmonary Exercise Testing and Prognosis in Chronic Heart Failure*: A Prognosticating Algorithm for the Individual Patient. Chest 126: 942-950 [Abstract] [Full Text]  

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