Ventilatory variables are strong prognostic markers in elderly patients with heart failure.
OBJECTIVE
To evaluate the safety and prognostic capacity of cardiopulmonary exercise testing in patients > or = 60 years old who are hospitalised with heart failure caused by left ventricular dysfunction.


METHODS
Prospective study.


METHODS
University hospital.


METHODS
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).


METHODS
Cardiopulmonary exercise testing and echocardiography.


METHODS
Peak oxygen consumption (VO2), peak ventilatory equivalents for carbon dioxide (VE/VCO2) and oxygen (VE/VO2), left ventricular volumes, and mortality.


RESULTS
Mean (SD) peak VO2 was 11.7 (3.7) ml/kg/min, peak VE/VCO2 43 (9), and peak VE/VO2 46 (11). During 12-59 months of follow up, 14 patients died. In univariate analyses peak VO2, VE/VO2, and VE/VCO2 were all strongly related (p < 0.01) to mortality. In a multivariate Cox regression analysis, peak VE/VCO2 was the strongest predictor of mortality (p < 0.001), followed by left ventricular end systolic volume (p < 0.001). A cut off of peak VE/VCO2 at > or = 45 gave a univariate hazard ratio of 6.7 for death during follow up. No adverse events occurred during the exercise test.


CONCLUSIONS
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 VO2, VE/O2, and VE/VCO2 are powerful predictors of mortality.
Section of Cardiology, Division of Internal Medicine, Karolinska Institutet Danderyd Hospital, Stockholm, Sweden. marit.mejhert@med.ds.sll.se
M
M
Mejhert
E
E
Linder-Klingsell
M
M
Edner
T
T
Kahan
H
H
Persson
D000368:Aged; D004452:Echocardiography / Q000379:methods; D005080:Exercise Test; D005260:Female; D006333:Heart Failure / Q000503:physiopathology*; D006801:Humans; D008297:Male; D010101:Oxygen Consumption; D011379:Prognosis; D011446:Prospective Studies; D011659:Pulmonary Gas Exchange; D016019:Survival Analysis; D018487:Ventricular Dysfunction, Left / Q000503:physiopathology*