title: Prognostic value of cardiopulmonary exercise testing in Idiopathic Dilated Cardiomyopathy.
abstract: BACKGROUND
  Although cardiopulmonary exercise testing (CPET) is considered as an important tool in risk stratification of patients with heart failure (HF), prognostic data in the specific setting of Idiopathic Dilated Cardiomyopathy (iDCM) are still undetermined. The aim of the study was to test the prognostic value of CPET in a large cohort of iDCM patients.
  
  
  RESULTS
  We analyzed 381 iDCM patients who consecutively performed CPET. The study end-point was a composite of cardiovascular death/urgent heart transplantation (CVD/HTx). In the overall population the average values of peak oxygen consumption (peak VO2/kg) and percent-predicted peak VO2(peak VO2%) were 17.1±5.1ml/kg/min and 59±15%, respectively. Mean VE/VCO2slope was 29.8±6.1. During a median follow-up of 47months (interquartile range 23-84), 83 patients experienced CVD/HTx. Peak VO2% (Area Under the Curve [AUC] 0.74; 95% CI 0.71-0.85, p<0.001) and VE/VCO2slope (AUC 0.78; 95% CI 0.74-0.84, p<0.001) were more accurate in predicting CVD/HTx compared to peak VO2/kg (AUC 0.60; 95% CI 0.54-0.68, p=0.003) (p<0.001 for both comparisons). The most accurate threshold values for outcome prediction in our iDCM cohort were <60% for peak VO2% and >29 for VE/VCO2slope. At multivariable analysis peak VO2% and VE/VCO2slope were the strongest predictors of CVD/HTx, either as continuous and categorical variables, whereas peak VO2/kg was not independently related with prognosis.
  
  
  CONCLUSIONS
  In a large population of iDCM patients peak VO2% and VE/VCO2slope emerged as the strongest prognostic CPET variables. Prospective studies will be necessary to confirm these data.
authors: Cardiovascular Department, Azienda Sanitaria Universitaria Integrata di Trieste "Ospedali Riuniti" and University of Trieste, Italy. Electronic address: gianfranco.sinagra@asuits.sanita.fvg.it.
authors: Gianfranco
authors: G
authors: Sinagra
authors: Cardiovascular Department, Azienda Sanitaria Universitaria Integrata di Trieste "Ospedali Riuniti" and University of Trieste, Italy.
authors: Annamaria
authors: A
authors: Iorio
authors: Cardiovascular Department, Azienda Sanitaria Universitaria Integrata di Trieste "Ospedali Riuniti" and University of Trieste, Italy.
authors: Marco
authors: M
authors: Merlo
authors: Cardiovascular Department, Azienda Sanitaria Universitaria Integrata di Trieste "Ospedali Riuniti" and University of Trieste, Italy.
authors: Antonio
authors: A
authors: Cannatà
authors: Cardiovascular Department, Azienda Sanitaria Universitaria Integrata di Trieste "Ospedali Riuniti" and University of Trieste, Italy.
authors: Davide
authors: D
authors: Stolfo
authors: Cardiovascular Department, Azienda Sanitaria Universitaria Integrata di Trieste "Ospedali Riuniti" and University of Trieste, Italy.
authors: Elena
authors: E
authors: Zambon
authors: Cardiovascular Department, Azienda Sanitaria Universitaria Integrata di Trieste "Ospedali Riuniti" and University of Trieste, Italy.
authors: Concetta
authors: C
authors: Di Nora
authors: Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy.
authors: Stefania
authors: S
authors: Paolillo
authors: Cardiovascular Department, Azienda Sanitaria Universitaria Integrata di Trieste "Ospedali Riuniti" and University of Trieste, Italy.
authors: Giulia
authors: G
authors: Barbati
authors: Cardiac Surgery and Paediatric and Congenital Cardiology Unit, Azienda Ospedaliero Universitaria, Ancona, Italy.
authors: Emanuela
authors: E
authors: Berton
authors: Cardiovascular Department, Azienda Sanitaria Universitaria Integrata di Trieste "Ospedali Riuniti" and University of Trieste, Italy.
authors: Cosimo
authors: C
authors: Carriere
authors: Department of Clinical and Molecular Medicine, University of Rome "La Sapienza", Rome, Italy.
authors: Damiano
authors: D
authors: Magrì
authors: Unità Operativa Cardiologia Riabilitativa, Ospedale S.Giuseppe, Multimedica Spa, IRCCS, Milano, Italy.
authors: Gaia
authors: G
authors: Cattadori
authors: Pneumology Department, "Ospedali Riuniti" and University of Trieste, Italy.
authors: Marco
authors: M
authors: Confalonieri
authors: Cardiovascular Center, Azienda Sanitaria Universitaria Integrata di Trieste, Italy.
authors: Andrea
authors: A
authors: Di Lenarda
authors: Centro Cardiologico Monzino, IRCCS, Milano, Italy; Dipartimento di Scienze Cliniche e di Comunità, Sezione Cardiovascolare, Università di Milano, Milano, Italy.
authors: Piergiuseppe
authors: P
authors: Agostoni
mesh_terms: D000328:Adult; D002311:Cardiomyopathy, Dilated / Q000175:diagnosis* / Q000453:epidemiology / Q000503:physiopathology*; D004562:Electrocardiography / Q000379:methods*; D005080:Exercise Test / Q000379:methods*; D005260:Female; D006801:Humans; D007558:Italy / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012189:Retrospective Studies
keywords: Cardiopulmonary exercise testing; Heart failure; Idiopathic Dilated Cardiomyopathy; Prognostic risk stratification