title: Prognostic value of cardiopulmonary exercise testing in heart failure with preserved ejection fraction. The Henry Ford HospITal CardioPulmonary EXercise Testing (FIT-CPX) project.
abstract: BACKGROUND
  Although cardiopulmonary exercise (CPX) testing in patients with heart failure and reduced ejection fraction is well established, there are limited data on the value of CPX variables in patients with HF and preserved ejection fraction (HFpEF). We sought to determine the prognostic value of select CPX measures in patients with HFpEF.
  
  
  METHODS
  This was a retrospective analysis of patients with HFpEF (ejection fraction ≥ 50%) who performed a CPX test between 1997 and 2010. Selected CPX variables included peak oxygen uptake (VO2), percent predicted maximum oxygen uptake (ppMVO2), minute ventilation to carbon dioxide production slope (VE/VCO2 slope) and exercise oscillatory ventilation (EOV). Separate Cox regression analyses were performed to assess the relationship between each CPX variable and a composite outcome of all-cause mortality or cardiac transplant.
  
  
  RESULTS
  We identified 173 HFpEF patients (45% women, 58% non-white, age 54 ± 14 years) with complete CPX data. During a median follow-up of 5.2 years, there were 42 deaths and 5 cardiac transplants. The 1-, 3-, and 5-year cumulative event-free survival was 96%, 90%, and 82%, respectively. Based on the Wald statistic from the Cox regression analyses adjusted for age, sex, and β-blockade therapy, ppMVO2 was the strongest predictor of the end point (Wald χ(2) = 15.0, hazard ratio per 10%, P < .001), followed by peak VO2 (Wald χ(2) = 11.8, P = .001). VE/VCO2 slope (Wald χ(2)= 0.4, P = .54) and EOV (Wald χ(2) = 0.15, P = .70) had no significant association to the composite outcome.
  
  
  CONCLUSIONS
  These data support the prognostic utility of peak VO2 and ppMVO2 in patients with HFpEF. Additional studies are needed to define optimal cut points to identify low- and high-risk patients.
authors.affiliation: St Luke's Mid America Heart Institute, University of Missouri, Kansas City, MO. Electronic address: shafiqa@umkc.edu.
authors.forename: Ali
authors.initials: A
authors.lastname: Shafiq
authors.affiliation: Division of Cardiovascular Medicine, Henry Ford Hospital, Detroit, MI.
authors.forename: Clinton A
authors.initials: CA
authors.lastname: Brawner
authors.affiliation: Division of Cardiovascular Medicine, Henry Ford Hospital, Detroit, MI.
authors.forename: Heather A
authors.initials: HA
authors.lastname: Aldred
authors.affiliation: Division of Cardiovascular Medicine, Henry Ford Hospital, Detroit, MI.
authors.forename: Barry
authors.initials: B
authors.lastname: Lewis
authors.affiliation: Division of Cardiovascular Medicine, Henry Ford Hospital, Detroit, MI.
authors.forename: Celeste T
authors.initials: CT
authors.lastname: Williams
authors.affiliation: Division of Cardiovascular Medicine, Henry Ford Hospital, Detroit, MI.
authors.forename: Christina
authors.initials: C
authors.lastname: Tita
authors.affiliation: Division of Cardiovascular Medicine, Henry Ford Hospital, Detroit, MI.
authors.forename: John R
authors.initials: JR
authors.lastname: Schairer
authors.affiliation: Division of Cardiovascular Medicine, Henry Ford Hospital, Detroit, MI.
authors.forename: Jonathan K
authors.initials: JK
authors.lastname: Ehrman
authors.affiliation: Division of Cardiovascular Medicine, Henry Ford Hospital, Detroit, MI.
authors.forename: Mauricio
authors.initials: M
authors.lastname: Velez
authors.affiliation: Division of Cardiovascular Medicine, Henry Ford Hospital, Detroit, MI.
authors.forename: Yelena
authors.initials: Y
authors.lastname: Selektor
authors.affiliation: Division of Cardiovascular Medicine, Henry Ford Hospital, Detroit, MI.
authors.forename: David E
authors.initials: DE
authors.lastname: Lanfear
authors.affiliation: Division of Cardiovascular Medicine, Henry Ford Hospital, Detroit, MI.
authors.forename: Steven J
authors.initials: SJ
authors.lastname: Keteyian
mesh_terms: D006328:Cardiac Catheterization; D018450:Disease Progression; D018572:Disease-Free Survival; D004452:Echocardiography; D005080:Exercise Test / Q000639:trends*; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000175:diagnosis* / Q000401:mortality / Q000503:physiopathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D055414:Myocardial Perfusion Imaging; D011379:Prognosis; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013318:Stroke Volume / Q000502:physiology*; D015996:Survival Rate / Q000639:trends; D013997:Time Factors; D014481:United States / Q000453:epidemiology