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Ventilatory variables are strong prognostic markers in elderly patients with heart failure
  1. M Mejhert,
  2. E Linder-Klingsell,
  3. M Edner,
  4. T Kahan,
  5. H Persson
  1. Section of Cardiology, Division of Internal Medicine, Karolinska Institutet Danderyd Hospital, Stockholm, Sweden
  1. Correspondence to:
    Dr M Mejhert, Karolinska Institutet Danderyd Hospital, Section of Cardiology, Division of Internal Medicine, S-182 88 Stockholm, Sweden;


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 (V̇o2), peak ventilatory equivalents for carbon dioxide (V̇E/V̇co2) and oxygen (V̇E/V̇o2), left ventricular volumes, and mortality.

Results: Mean (SD) peak V̇o2 was 11.7 (3.7) ml/kg/min, peak V̇E/V̇co2 43 (9), and peak V̇E/V̇o2 46 (11). During 12–59 months of follow up, 14 patients died. In univariate analyses peak V̇o2, V̇E/V̇o2, and V̇E/V̇co2 were all strongly related (p < 0.01) to mortality. In a multivariate Cox regression analysis, peak V̇E/V̇co2 was the strongest predictor of mortality (p < 0.001), followed by left ventricular end systolic volume (p < 0.001). A cut off of peak V̇E/V̇co2 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 V̇o2, V̇E/V̇o2, and V̇E/V̇co2 are powerful predictors of mortality.

  • heart failure
  • exercise testing
  • ventilatory parameters
  • prognosis
  • AVPD, atrioventricular plane displacement
  • EF, ejection fraction
  • NYHA, New York Heart Association
  • OPTIMAL, optimising congestive heart failure outpatient clinical project
  • co2, carbon dioxide production
  • V̇E, ventilatory equivalent
  • o2, oxygen consumption

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