Cardiopulmonary exercise testing and prognosis in heart failure due to systolic left ventricular dysfunction: a validation study of the European Society of Cardiology Guidelines and Recommendations (2008) and further developments

Eur J Prev Cardiol. 2012 Feb;19(1):32-40. doi: 10.1177/1741826710393994. Epub 2011 Feb 22.


Aims: The study aims were to validate the cardiopulmonary exercise testing (CPET) parameters recommended by the European Society of Cardiology 2008 Guidelines for risk assessment in heart failure (HF) (ESC-predictors) and to verify the predictive role of 11 supplementary CPET (S-predictors) parameters.

Methods and results: We followed 749 HF patients for cardiovascular death and urgent heart transplantation for 3 years: 139 (19%) patients had cardiac events. ESC-predictors - peak oxygen consumption (VO(2)), slope of minute ventilation vs carbon dioxide production (VE/VCO(2)) and exertional oscillatory ventilation - were all related to outcome at univariate and multivariable analysis. The ESC/2008 prototype based on ESC-predictors presented a Harrell's C concordance index of 0.725, with a likely χ2 of 98.31. S-predictors - predicted peak VO(2), peak oxygen pulse, peak respiratory exchange ratio, peak circulatory power, peak VE/VCO(2), VE/VCO(2) slope normalized by peak VO(2), VO(2) efficiency slope, ventilatory anaerobic threshold detection, peak end-tidal CO(2) partial pressure, peak heart rate, and peak systolic arterial blood pressure (SBP) - were all linked to outcome at univariate analysis. When individually added to the ESC/2008 prototype, only peak SBP and peak O(2) pulse significantly improved the model discrimination ability: the ESC + peak SBP prototype had a Harrell's C index 0.750 and reached the highest likely χ2 (127.16, p < 0.0001).

Conclusions: We evaluated the longest list of CPET prognostic parameters yet studied in HF: ESC-predictors were independent predictors of cardiovascular events, and the ESC prototype showed a convincing predictive capacity, whereas none of 11 S-predictors enhanced the prognostic performance, except peak SBP.

Publication types

  • Validation Study

MeSH terms

  • Aged
  • Blood Pressure
  • Chi-Square Distribution
  • Exercise Test / standards*
  • Female
  • Heart Failure / diagnosis*
  • Heart Failure / etiology
  • Heart Failure / mortality
  • Heart Failure / physiopathology
  • Heart Failure / surgery
  • Heart Rate
  • Heart Transplantation
  • Humans
  • Italy / epidemiology
  • Male
  • Middle Aged
  • Multivariate Analysis
  • Oxygen Consumption
  • Practice Guidelines as Topic
  • Predictive Value of Tests
  • Prognosis
  • Pulmonary Ventilation
  • Reproducibility of Results
  • Retrospective Studies
  • Risk Assessment
  • Risk Factors
  • Societies, Medical / standards*
  • Time Factors
  • Ventricular Dysfunction, Left / complications*
  • Ventricular Dysfunction, Left / mortality
  • Ventricular Dysfunction, Left / physiopathology
  • Ventricular Function, Left*