A meta-analysis of the prognostic significance of cardiopulmonary exercise testing in patients with heart failure

Heart Fail Rev. 2013 Jan;18(1):79-94. doi: 10.1007/s10741-012-9332-0.


The objective of the study is to assess the role of cardiopulmonary exercise testing (CPX) variables, including peak oxygen consumption (VO(2)), which is the most recognized CPX variable, the minute ventilation/carbon dioxide production (VE/VCO(2)) slope, the oxygen uptake efficiency slope (OUES), and exercise oscillatory ventilation (EOV) in a current meta-analysis investigating the prognostic value of a broader list of CPX-derived variables for major adverse cardiovascular events in patients with HF. A search for relevant CPX articles was performed using standard meta-analysis methods. Of the initial 890 articles found, 30 met our inclusion criteria and were included in the final analysis. The total subject populations included were as follows: peak VO(2) (7,319), VE/VCO(2) slope (5,044), EOV (1,617), and OUES (584). Peak VO(2), the VE/VCO(2) slope and EOV were all highly significant prognostic markers (diagnostic odds ratios ≥ 4.10). The OUES also demonstrated promise as a prognostic marker (diagnostic odds ratio = 8.08) but only in a limited number of studies (n = 2). No other independent variables (including age, ejection fraction, and beta-blockade) had a significant effect on the meta-analysis results for peak VO(2) and the VE/VCO(2) slope. CPX is an important component in the prognostic assessment of patients with HF. The results of this meta-analysis strongly confirm this and support a multivariate approach to the application of CPX in this patient population.

Publication types

  • Comparative Study
  • Meta-Analysis
  • Research Support, Non-U.S. Gov't
  • Review

MeSH terms

  • Adult
  • Blood Gas Analysis
  • Carbon Dioxide / analysis
  • Carbon Dioxide / blood*
  • Exercise Test / methods*
  • Female
  • Heart Failure / diagnosis*
  • Humans
  • Male
  • Middle Aged
  • Oxygen Consumption / physiology*
  • Prognosis
  • Pulmonary Gas Exchange
  • Sensitivity and Specificity
  • Severity of Illness Index
  • Stroke Volume / physiology*
  • Survival Analysis


  • Carbon Dioxide