title: Metabolic parameters derived from cardiopulmonary stress testing for prediction of prognosis in patients with heart failure: the ochsner experience.
abstract: Cardiopulmonary parameters, particularly peak oxygen consumption, have proven utility in prognostic stratification for patients with heart failure. These have been typically corrected for total body weight as opposed to lean body mass (LBM). For practical purposes, fat consumes virtually no oxygen and receives minimal perfusion. Based on this rationale and on observations from previous studies, several investigations conducted at the Ochsner Clinic Foundation have assessed the prognostic value of metabolic parameters when corrected for LBM. Three studies reviewed in this discussion consistently found greater prognostic value for LBM-corrected parameters, especially peak oxygen consumption and oxygen pulse. These findings lead to a strong recommendation for LBM correction of cardiopulmonary exercise stress test-derived parameters for more accurate prognostic stratification in patients with heart failure, especially in the obese population. Other centers have studied additional parameters such as the ventilation to carbon dioxide production slope, oxygen uptake efficiency slope, and partial pressure of end-tidal carbon dioxide during exercise and rest. In multiple studies, these ventilation-dependent parameters have shown prognostic superiority compared with the standard peak oxygen consumption even when obtained from submaximal exercise data. However, no study to our knowledge has compared these parameters with LBM-adjusted values as described herein. The prognostic validity of cardiopulmonary exercise stress test-derived parameters requires further investigation in patients treated with β-blockers.
authors: Cardiac Rehabilitation and Exercise Laboratories, Ochsner Clinic Foundation, New Orleans, LA.
authors: Joaquin
authors: J
authors: Crespo
authors: Carl J
authors: CJ
authors: Lavie
authors: Richard V
authors: RV
authors: Milani
authors: Yvonne E
authors: YE
authors: Gilliland
authors: Hamang M
authors: HM
authors: Patel
authors: Hector O
authors: HO
authors: Ventura
references: Circulation. 2000 Jun 20;101(24):2803-9
references: 10859285
references: N Engl J Med. 1991 Aug 1;325(5):303-10
references: 2057035
references: Am J Cardiol. 1985 Apr 1;55(8):1037-42
references: 3984864
references: Arq Bras Cardiol. 2008 Jul;91(1):39-48
references: 18660944
references: J Card Fail. 2007 Aug;13(6):462-9
references: 17675060
references: J Am Coll Cardiol. 2002 May 1;39(9):1563; author reply 1563-4
references: 11985924
references: Eur Heart J. 2000 Jan;21(2):154-61
references: 10637089
references: Heart. 1996 Nov;76(5):393-6
references: 8944583
references: Heart. 1997 Dec;78(6):572-6
references: 9470873
references: Am Heart J. 2008 Nov;156(5):982-8
references: 19061716
references: JAMA. 2003 Jan 8;289(2):229-30
references: 12517236
references: J Am Coll Cardiol. 2003 Aug 20;42(4):677-9
references: 12932600
references: Congest Heart Fail. 2007 May-Jun;13(3):177-80
references: 17541313
references: Chest. 2002 May;121(5):1581-8
references: 12006447
references: Chest. 1998 Mar;113(3):599-601
references: 9515831
references: Circulation. 2002 Dec 10;106(24):3079-84
references: 12473555
references: J Am Coll Cardiol. 1997 Jun;29(7):1585-90
references: 9180123
references: J Am Coll Cardiol. 2000 Dec;36(7):2126-31
references: 11127451
references: Am J Cardiol. 2004 Mar 1;93(5):588-93
references: 14996584
references: J Heart Lung Transplant. 1995 Sep-Oct;14(5):981-9
references: 8800737
references: Clin Chest Med. 1983 May;4(2):101-10
references: 6342917
references: Eur Heart J. 2006 Mar;27(6):684-90
references: 16338939
references: Circulation. 2004 Jul 27;110(4):e27-31
references: 15277333
references: Int J Cardiol. 2007 Apr 12;117(1):103-8
references: 16843545
references: Am Heart J. 2006 Apr;151(4):851.e7-13
references: 16569547
references: J Am Coll Cardiol. 1998 Mar 1;31(3):577-82
references: 9502638
references: Am Heart J. 2002 Mar;143(3):418-26
references: 11868046
references: Int J Cardiol. 2006 May 24;109(3):351-8
references: 16046017
references: J Am Coll Cardiol. 1996 Nov 15;28(6):1567-72
references: 8917273
references: Eur J Cardiovasc Prev Rehabil. 2003 Aug;10(4):267-72
references: 14555881
references: Am Heart J. 2005 Jan;149(1):175-80
references: 15660050
references: Circulation. 1991 Mar;83(3):778-86
references: 1999029
references: Int J Cardiol. 2000 Feb 15;72(3):255-63
references: 10716136
references: Congest Heart Fail. 2009 Jan-Feb;15(1):41-2
references: 19187407
references: Chest. 1996 Aug;110(2):310-2
references: 8697822
references: Am J Cardiol. 1995 May 1;75(14):940-2
references: 7733007
references: Eur Heart J. 2002 May;23(10):806-14
references: 12009721
references: Am J Cardiol. 2003 Apr 1;91(7):891-4
references: 12667583
references: Congest Heart Fail. 2008 Nov-Dec;14(6):310-5
references: 19076854
references: Am J Cardiol. 1997 Nov 1;80(9):1236-8
references: 9359563
references: Mayo Clin Proc. 2006 Dec;81(12):1603-11
references: 17165639
references: Eur J Cardiovasc Prev Rehabil. 2003 Dec;10(6):463-8
references: 14671470
references: Am Heart J. 2008 Dec;156(6):1177-83
references: 19033016
references: Chest. 2002 May;121(5):1572-80
references: 12006446
references: Am Heart J. 2004 Feb;147(2):354-60
references: 14760336
references: Am J Cardiol. 1985 Jan 11;55(2):22A-31A
references: 3966407
references: Am Heart J. 2002 Mar;143(3):427-32
references: 11868047