Heart Failure Reviews

, Volume 18, Issue 1, pp 79–94

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

  • Lawrence P. Cahalin
  • Paul Chase
  • Ross Arena
  • Jonathan Myers
  • Daniel Bensimhon
  • Mary Ann Peberdy
  • Euan Ashley
  • Erin West
  • Daniel E. Forman
  • Sherry Pinkstaff
  • Carl J. Lavie
  • Marco Guazzi


The objective of the study is to assess the role of cardiopulmonary exercise testing (CPX) variables, including peak oxygen consumption (VO2), which is the most recognized CPX variable, the minute ventilation/carbon dioxide production (VE/VCO2) 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 VO2 (7,319), VE/VCO2 slope (5,044), EOV (1,617), and OUES (584). Peak VO2, the VE/VCO2 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 VO2 and the VE/VCO2 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.


Ventilation Aerobic capacity Expired gas Exercise Heart disease 



Area under curve


Cardiopulmonary exercise testing




Diagnostic odds ratio


Exercise oscillatory ventilation


Exercise stress testing


False negative


False positive


Heart failure


Heart transplantation


Left ventricular ejection fraction


New York heart association


Oxygen uptake efficiency slope


Summary receiver operating characteristic


True negative


True positive


Minute ventilation/carbon dioxide production


Oxygen consumption

Copyright information

© Springer Science+Business Media, LLC 2012

Authors and Affiliations

  • Lawrence P. Cahalin
    • 1
  • Paul Chase
    • 2
  • Ross Arena
    • 3
  • Jonathan Myers
    • 4
  • Daniel Bensimhon
    • 2
  • Mary Ann Peberdy
    • 5
  • Euan Ashley
    • 6
  • Erin West
    • 7
  • Daniel E. Forman
    • 7
  • Sherry Pinkstaff
    • 8
  • Carl J. Lavie
    • 9
    • 10
  • Marco Guazzi
    • 11
  1. 1.Department of Physical Therapy, Leonard M. Miller School of MedicineUniversity of MiamiCoral GablesUSA
  2. 2.Lebauer Cardiovascular Research FoundationGreensboroUSA
  3. 3.Physical Therapy Program, Department of Orthopaedics and Department of Internal Medicine, Division of CardiologyUniversity of New MexicoAlbuquerqueUSA
  4. 4.Division of CardiologyVA Palo Alto Healthcare SystemPalo AltoUSA
  5. 5.Department of Internal MedicineVirginia Commonwealth UniversityRichmondUSA
  6. 6.Cardiovascular MedicineStanford UniversityPalo AltoUSA
  7. 7.Division of Cardiovascular MedicineBrigham and Women’s HospitalBostonUSA
  8. 8.Physical Therapy Program, Brooks College of HealthUniversity of North FloridaJacksonvilleUSA
  9. 9.Department of Cardiovascular Diseases, John Ochsner Heart and Vascular Institute, Ochsner Clinical SchoolThe University of Queensland School of MedicineNew OrleansUSA
  10. 10.Pennington Biomedical Research CenterLouisiana State University SystemBaton RougeUSA
  11. 11.Cardiology, I.R.C.C.S. Policlinico San DonatoUniversity of MilanoSan Donato MilaneseItaly

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