Circulation. 2002;106:3079-3084
Published online before print November 18, 2002, doi: 10.1161/01.CIR.0000041428.99427.06
Published online before print November 18, 2002, doi: 10.1161/01.CIR.0000041428.99427.06
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(Circulation. 2002;106:3079.)
© 2002 American Heart Association, Inc.
Clinical Investigation and Reports |
Exercise Anaerobic Threshold and Ventilatory Efficiency Identify Heart Failure Patients for High Risk of Early Death
From Herzzentrum Ludwigshafen (A.K.G., C.K., T.K., A.K., M.B., S.S., A.S., J.S.), Department of Cardiology, Ludwigshafen, Germany; and Harbor–UCLA Medical Center (K.W.), Torrance, Calif.
Correspondence to Anselm K. Gitt, MD, Herzzentrum Ludwigshafen, Bremser Str 79, 67063 Ludwigshafen, Germany. E-mail gitta{at}klilu.de
Background— The maximal oxygen uptake (peak 
O2) is used in risk stratification of patients with chronic heart failure (CHF). Peak O2 might be lower than maximally possible if exercise is stopped early because of lack of patient motivation or premature cessation by the investigator. In contrast, the anaerobic threshold (O2AT) and the ventilatory efficiency (E versus CO2 slope) are less subject to these influences. Thus, we compared these parameters with peak O2 in identifying patients with CHF at increased risk for death within 6 months after evaluation.
Methods and Results— We performed cardiopulmonary exercise tests with gas exchange measurements in 223 consecutive patients with CHF (114 coronary artery disease, 92 dilated cardiomyopathy, 17 others) at the Herzzentrum Ludwigshafen between 1995 and 1998. We measured peak O2, O2AT and E versus CO2 slope. We selected peak O2 of 
14 mL/kg per minute, O2AT of <11 mL/kg per minute, and E versus CO2 slope of >34 as threshold values for high risk of death. The median follow-up time was 644 days. Patients with peak O2 of 14 mL/kg per minute had a >3-fold-increased risk (OR=3.4; CI, 1.3 to 9.1), with O2AT <11 mL/min per kg or E versus CO2 slope >34 a 5-fold increased risk for early death (OR=5.3; CI, 1.5 to 19.0; OR=4.8; CI, 1.7 to 13.8, respectively). In patients with both O2AT <11 mL/kg per minute and E versus CO2 slope >34, the risk of early death was 10-fold higher (OR=9.6; CI, 2.1 to 44.7). After correction for age, sex, left ventricular ejection fraction, and New York Heart Association class in a multivariate analysis, the combination of O2AT <11 mL/kg per minute and E versus CO2 slope >34 was the best predictor of 6-month mortality (RR=5.1, P=0.001).
Conclusions— O2AT of <11 mL/kg per minute and slope of E versus CO2 >34, combined, better identified patients at high risk for early death from CHF than did peak O2 and should therefore be considered when prioritizing patients for heart transplantation.
Key Words: heart failure • exercise • transplantation • ventilation • prognosis
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