This Article Full Text Full Text (PDF) CME: Take the course for this article: Circulation: June 30, 2009, Volume 119, Number 25 Data Supplement All Versions of this Article: 119/25/3189    most recent CIRCULATIONAHA.109.848382v1 Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Hsich, E. Articles by Lauer, M. S. Search for Related Content PubMed PubMed Citation Articles by Hsich, E. Articles by Lauer, M. S. Related Collections Congestive Exercise testing Related Articles

(Circulation. 2009;119:3189-3197.)
© 2009 American Heart Association, Inc.

Exercise Physiology

Importance of Treadmill Exercise Time as an Initial Prognostic Screening Tool in Patients With Systolic Left Ventricular Dysfunction

Eileen Hsich, MD; Eiran Z. Gorodeski, MD, MPH; Randall C. Starling, MD, MPH; Eugene H. Blackstone, MD; Hemant Ishwaran, PhD; Michael S. Lauer, MD

From the Departments of Cardiovascular Medicine (E.H., E.Z.G., R.C.S.), Quantitative Health Sciences (H.I.), and Cardiothoracic Surgery (E.H.B.) at the Cleveland Clinic and Case Western Reserve University School of Medicine (E.H., R.C.S.), Cleveland, Ohio; and the Division of Prevention and Population Sciences (M.S.L.), National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Md.

Reprint requests to Michael S. Lauer, MD, FACC, FAHA, Director, Division of Prevention and Population Science, National Heart, Lung, and Blood Institute, National Institutes of Health, Rockledge Center II, 6701 Rockledge Dr, Room 10122, Bethesda, MD 20892. E-mail lauerm{at}nhlbi.nih.gov

Received January 2, 2009; accepted April 15, 2009.

Background— We sought to determine whether treadmill exercise time may be of value as an initial prognostic screening tool in ambulatory patients with impaired systolic function who are referred for cardiopulmonary exercise testing.

Methods and Results— We studied 2231 adult systolic heart failure patients (27% of whom were women) who underwent cardiopulmonary stress testing using a modified Naughton protocol. We assessed the value of treadmill exercise time for prediction of all-cause death and a composite of death or United Network for Organ Sharing status 1 heart transplantation. During a mean follow-up of 5 years, 742 patients (33%) died. There were 249 United Network for Organ Sharing status 1 heart transplants (11%). Treadmill exercise time was predictive of death and the composite outcome in both women and men, even after accounting for peak oxygen consumption and other clinical covariates (adjusted hazard ratio of lowest versus high sex-specific quartile for prediction of death 1.70, 95% confidence interval 1.05 to 2.75, P=0.03; for prediction of the composite outcome, 1.75, 95% confidence interval 1.15 to 2.66, P=0.009). For a 1-minute change in exercise time, there was a 7% increased hazard of death (eg, comparing 480 to 540 seconds, hazard ratio =1.07, 95% confidence interval 1.02 to 1.12, P=0.004).

Conclusions— Because cardiopulmonary stress testing is not available in every hospital, treadmill exercise time with a modified Naughton protocol may be of value as an initial prognostic screening tool.

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