title: Maximal dyspnea on exertion during cardiopulmonary exercise testing is related to poor prognosis and echocardiography with tissue Doppler imaging in heart failure.
abstract: This study tested the hypothesis that increasing levels of maximal dyspnea on exertion (DOE) during cardiopulmonary exercise testing (CPX) is associated with heart failure (HF) disease severity and worsening prognosis. Three hundred seventy-six HF patients underwent CPX where ventilatory efficiency (minute ventilation/carbon dioxide production; VE/VCO(2) slope), peak oxygen consumption (VO(2)), and maximal DOE were determined. A subgroup of 243 patients underwent echocardiography with tissue Doppler imaging to measure the ratio between mitral early (E) to mitral annular (E') velocity as well as other variables. Maximal DOE was significantly correlated with E/E' (r(s)=.49; P<.001). In the multivariate Cox regression, the VE/VCO(2) slope was the strongest prognostic marker obtained from CPX (Multivariate chi-square, 48.0; P<.001) while maximal DOE (residual chi-square, 17.4; P<.001) and peak VO(2) (residual chi-square, 7.5; P=.006) added predictive value. These results suggest that increasing DOE reflects the degree of disease severity and adds prognostic value to established CPX variables.
authors.affiliation: Cardiopulmonary Laboratory, Cardiology Division, University of Milano, San Paolo Hospital, Milano, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Guazzi
authors.forename: Jonathan
authors.initials: J
authors.lastname: Myers
authors.forename: Mary Ann
authors.initials: MA
authors.lastname: Peberdy
authors.forename: Daniel
authors.initials: D
authors.lastname: Bensimhon
authors.forename: Paul
authors.initials: P
authors.lastname: Chase
authors.forename: Ross
authors.initials: R
authors.lastname: Arena
mesh_terms: D002245:Carbon Dioxide / Q000378:metabolism; D016001:Confidence Intervals; D004417:Dyspnea / Q000209:etiology*; D015150:Echocardiography, Doppler; D054459:Elasticity Imaging Techniques / Q000379:methods; D005080:Exercise Test; D005260:Female; D006333:Heart Failure / Q000150:complications / Q000000981:diagnostic imaging / Q000503:physiopathology*; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000502:physiology; D015999:Multivariate Analysis; D010101:Oxygen Consumption; D005082:Physical Exertion; D011379:Prognosis; D016016:Proportional Hazards Models; D012372:ROC Curve; D012189:Retrospective Studies
chemical_list: D002245:Carbon Dioxide