on May 2, 2005
Published online before print May 2, 2005, doi: 10.1161/01.CIR.0000164270.72123.18
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Submitted on November 26, 2004
From the Department of Cardiovascular Medicine, The Cleveland Clinic Foundation, Cleveland, Ohio. * To whom correspondence should be addressed. E-mail: Lauerm{at}ccf.org.
Background--Peak oxygen uptake (peak V·O2) is a strong predictor of mortality and is commonly used in the evaluation of patients for cardiac transplantation. Methods and Results--We analyzed prospectively gathered data on 2105 patients referred for cardiopulmonary testing for all-cause mortality and for occurrence of death or transplantation. Patients receiving Conclusion--Peak V·O2 is a determinant of survival in patients in heart failure even in the setting of
Revised on January 12, 2005
Accepted on January 20, 2005
Peak Oxygen Consumption as a Predictor of Death in Patients With Heart Failure Receiving
James O. O’Neill MB, MRCPI, 
-Blockers
-Blockers reduce mortality in patients with heart failure, without influencing peak V·O2, raising the possibility that peak V·O2 is no longer suitable as an indicator of prognosis in these patients.-blockers were younger, more likely to have coronary disease, and had a greater mean ejection fraction but had a similar peak V·O2. There were 555 deaths (26%) and 194 (9%) transplants during a median follow-up of 3.5 years. Peak V·O2 was a predictor of mortality irrespective of -blocker use; a decrease of 1 mL · kg-1 · min-1 resulted in an adjusted hazard ratio (HR) of 1.13 (95% CI 1.09 to 1.17, P<0.0001) in patients not receiving -blockers and 1.27 (95% CI 1.18 to 1.36, P<0.0001) in patients receiving -blockers. Similar findings were noted when considering death or transplantation as an end point. -Blocker use was associated with better outcomes until peak V·O2 values became very low (
10 mL · kg-1 · min-1), at which level survival rates were equally poor.-blockade. Because of improved survival in patients treated with -blockers, the cut point value of 14 mg · kg-1 · min-1 for referral for cardiac transplantation in these patients requires reevaluation, and a lower cut point may be more appropriate.
Key words: heart failure • exercise • adrenergic beta-antagonists • prognosis • ventricular dysfunction, left
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