title: Cardiopulmonary exercise testing in systolic heart failure in 2014: the evolving prognostic role: a position paper from the committee on exercise physiology and training of the heart failure association of the ESC.
abstract: The relationship between exercise capacity, as assessed by peak oxygen consumption, and outcome is well established in heart failure (HF), but the predictive value of cardiopulmonary exercise testing (CPET) has been recently questioned, for two main reasons. First, the decisional power of CPET in the selection of heart transplantation candidates has diminished, since newer therapeutic options and the shortage of donor hearts have restricted this curative option to extremely advanced HF patients, frequently not able to perform a symptom-limited CPET. Secondly, the use of CPET has become more complex and sophisticated, with many promising new prognostic indexes proposed each year. Thus, a modern interpretation of CPET calls for selective expertise that is not routinely available in all HF centres. This position paper examines the history of CPET in risk stratification in HF. Throughout five phases of achievements, the journey from a single CPET parameter (i.e. peak oxygen consumption) to a multiparametric approach embracing the full clinical picture in HF-including functional, neurohumoral, and laboratory findings-is illustrated and discussed. An innovative multifactorial model is proposed, with CPET at its core, that helps optimize our understanding and management of HF patients.
authors.affiliation: Cardiology Division, IRCCS Fondazione 'S. Maugeri', Centro Medico e di Riabilitazione di Veruno, Veruno, Novara, Italy.
authors.forename: Ugo
authors.initials: U
authors.lastname: Corrà
authors.forename: Massimo F
authors.initials: MF
authors.lastname: Piepoli
authors.forename: Stamatis
authors.initials: S
authors.lastname: Adamopoulos
authors.forename: Piergiuseppe
authors.initials: P
authors.lastname: Agostoni
authors.forename: Andrew J S
authors.initials: AJ
authors.lastname: Coats
authors.forename: Viviane
authors.initials: V
authors.lastname: Conraads
authors.forename: Ekaterini
authors.initials: E
authors.lastname: Lambrinou
authors.forename: Burkert
authors.initials: B
authors.lastname: Pieske
authors.forename: Ewa
authors.initials: E
authors.lastname: Piotrowicz
authors.forename: Jean-Paul
authors.initials: JP
authors.lastname: Schmid
authors.forename: Petar M
authors.initials: PM
authors.lastname: Seferović
authors.forename: Stefan D
authors.initials: SD
authors.lastname: Anker
authors.forename: Gerasimos
authors.initials: G
authors.lastname: Filippatos
authors.forename: Piotr P
authors.initials: PP
authors.lastname: Ponikowski
mesh_terms: D005080:Exercise Test / Q000379:methods*; D017079:Exercise Tolerance / Q000502:physiology*; D054143:Heart Failure, Systolic / Q000175:diagnosis* / Q000503:physiopathology; D006801:Humans; D017410:Practice Guidelines as Topic / Q000592:standards*; D011237:Predictive Value of Tests; D011379:Prognosis; D015203:Reproducibility of Results; D012955:Societies, Medical / Q000592:standards*
keywords: Dystolic heart failure; Exercise testing; Prognosis