title: The prognostic value of the cardiopulmonary exercise test in patients with heart failure who have been treated with beta-blockers.
abstract: OBJECTIVE
  The prevalence of chronic heart failure and a reduced ejection fraction (CHF-REF) has increased over the last decade. The cardiopulmonary exercise test (CPET) is an established tool for managing these patients. For patients who are administered beta-blockers, its predictive value is debated. The aim of this study was to assess the prognostic values of several parameters in patients with CHF-REF who were on beta-blockers.
  
  
  METHODS
  390 patients with CHF-REF underwent CPET after cardiac rehabilitation and were followed for two years.
  
  
  RESULTS
  The primary endpoints were all-cause mortality, cardiac-related mortality and major cardiovascular events (hospitalization for HF, heart transplantation and acute coronary syndrome or arrhythmia). The mean beta-blockers dosage was 68.9% of the target dose. The two-year mortality rate was 13%, while the mean age of the population was 57.1 years. In addition, most of the patients were men (85.5% vs. 14.5%). The resting LVEF was 35.7 ± 9.4 and the maximal oxygen uptake (peak VO₂) was 19.5 ml/kg/min. The peak VO₂, VE/VCO₂ slope and circulatory power were significant predictors of risk. The prognosis was better when the initial linear VE/VCO₂ slope was lower than 30, and the final steeper VE/VCO₂ slope was lower than 32. There was no difference between the two slopes. The oxygen uptake efficiency slope, oxygen uptake, heart rate recovery, VE/VCO₂/VO₂ index and ventilatory threshold had no prognostic value.
  
  
  CONCLUSIONS
  The peak VO₂, circulatory power and VE/VCO₂ slope were prognostic indicators for patients with CHF-REF who were on beta-blockers.
authors.affiliation: Department of Cardiology, CHU de Caen, France.
authors.forename: Clémentine
authors.initials: C
authors.lastname: Dufay-Bougon
authors.forename: Annette
authors.initials: A
authors.lastname: Belin
authors.forename: Ziad Said
authors.initials: ZS
authors.lastname: Dahdouh
authors.forename: Sophie
authors.initials: S
authors.lastname: Barthelemy
authors.forename: Jean-Paul
authors.initials: JP
authors.lastname: Mabire
authors.forename: Rémi
authors.initials: R
authors.lastname: Sabatier
authors.forename: Paul
authors.initials: P
authors.lastname: Milliez
authors.forename: Gilles
authors.initials: G
authors.lastname: Grollier
mesh_terms: D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use*; D017677:Age Distribution; D000368:Aged; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use; D002245:Carbon Dioxide / Q000378:metabolism; D004359:Drug Therapy, Combination; D005080:Exercise Test; D005260:Female; D006333:Heart Failure / Q000188:drug therapy* / Q000401:mortality / Q000503:physiopathology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010101:Oxygen Consumption; D011379:Prognosis; D017678:Sex Distribution; D013318:Stroke Volume
chemical_list: D000319:Adrenergic beta-Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors; D002245:Carbon Dioxide