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
Article

Abstract

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.

Keywords

Ventilation Aerobic capacity Expired gas Exercise Heart disease 

Abbreviations

AUC

Area under curve

CPX

Cardiopulmonary exercise testing

CV

Cardiovascular

DOR

Diagnostic odds ratio

EOV

Exercise oscillatory ventilation

EST

Exercise stress testing

FN

False negative

FP

False positive

HF

Heart failure

HT

Heart transplantation

LVEF

Left ventricular ejection fraction

NYHA

New York heart association

OUES

Oxygen uptake efficiency slope

SROC

Summary receiver operating characteristic

TN

True negative

TP

True positive

VE/VCO2

Minute ventilation/carbon dioxide production

VO2

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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