Preserved Right Ventricular Ejection Fraction Predicts Exercise Capacity and Survival in Advanced Heart Failure

J Am Coll Cardiol. 1995 Apr;25(5):1143-53. doi: 10.1016/0735-1097(94)00511-n.

Abstract

Objectives: This study was undertaken to determine which exercise and radionuclide ventriculographic variables predict prognosis in advanced heart failure.

Background: Although cardiopulmonary exercise testing is frequently used to predict prognosis in patients with advanced heart failure, little is known about the prognostic significance of ventriculographic variables.

Methods: The results of maximal symptom-limited cardiopulmonary exercise testing and first-pass radionuclide ventriculography in patients with advanced heart failure referred for evaluation for cardiac transplantation were analyzed.

Results: Sixty-seven patients with advanced heart failure (mean [+/- SD]; age 51 +/- 10 years, New York Heart Association functional classes III (58%) and IV (18%); mean left ventricular ejection fraction 0.22 +/- 0.07) underwent simultaneous upright bicycle ergometric cardiopulmonary exercise testing and first-pass rest/exercise radionuclide ventriculography. Mean peak oxygen consumption (VO2) was 11.8 +/- 4.2 ml/kg per min, and mean peak age- and gender-adjusted percent predicted oxygen consumption (%VO2) was 38 +/- 11.9%. Univariate predictors of overall survival included right ventricular ejection fraction > or = 0.35 at rest and > or = 0.35 at exercise and %VO2 > or = 45% (all p < 0.05). In a multivariate proportional hazards survival model, right ventricular ejection fraction > or = 0.35 at exercise (p < 0.01) and %VO2 > or = 45% (p = 0.01) were selected as independent predictors of overall survival. Univariate predictors of event-free survival included right ventricular ejection fraction > or = 0.35 at rest (p = 0.01) and > or = 0.35 at exercise (p < 0.01), functional class II (p < 0.05) and %VO2 > or = 45% (p = 0.05). Right ventricular ejection fraction > or = 0.35 at exercise (p = 0.01) was the only independent predictor of event-free survival in a multivariate proportional hazards model. Cardiac index at rest, VO2, left ventricular ejection fraction at rest, and exercise-related increase or decrease > 0.05 in left or right ventricular ejection fraction were not predictive of overall or event-free survival in any univariate or multivariate analysis.

Conclusions: 1) Right ventricular ejection fraction > or = 0.35 at rest and exercise is a more potent predictor of survival in advanced heart failure than VO2 or %VO2; 2) %VO2 rather than VO2 predicts survival in advanced heart failure; 3) neither %VO2 nor VO2 predicts survival to the combined end point of death or admission for inotropic or mechanical support in patients with advanced heart failure.

MeSH terms

  • Disease-Free Survival
  • Exercise Test
  • Exercise Tolerance / physiology*
  • Female
  • Follow-Up Studies
  • Heart Failure / diagnosis
  • Heart Failure / mortality*
  • Heart Failure / physiopathology
  • Heart Failure / surgery
  • Heart Transplantation
  • Humans
  • Life Tables
  • Male
  • Middle Aged
  • Oxygen Consumption
  • Predictive Value of Tests
  • Prognosis
  • Proportional Hazards Models
  • Sodium Pertechnetate Tc 99m
  • Stroke Volume / physiology*
  • Treatment Outcome
  • Ventricular Function, Right / physiology*
  • Ventriculography, First-Pass

Substances

  • Sodium Pertechnetate Tc 99m