Abstract 14465: Clinical Characteristics and Prognostic Impact of Extremely Poor Blood Pressure Response to Bicycle Exercise
Background: Poor systolic blood pressure (SBP) response to exercise has been proposed to be a strong predictor of mortality in patients with heart failure (HF) by several studies, but not emphasized by others. This discrepancy is because its significance would differ depending on HF etiology, HF severity, mode of exercise, the cutoff value of SBP, and others. The present study examined the clinical and prognostic value of extremely poor SBP response (ExPR, defined as peak SBP<110mmHg and ΔSBP<20mmHg) to bicycle exercise.
Methods: From a consecutive series (n=3424) of cardiopulmonary exercise testing with bicycle ergometry performed for recent 6 years, we examined the occurrence of ExPR. Patients unable to attain a peak RER >1.0 were excluded. Blood pressure was manually measured with a sphygmomanometer every minute during exercise and at peak exericse. Clinical characteristics and adverse cardiac events were investigated.
Results: ExPR was found in 89 patients (2.6%) of whom 82 (92%) had LVEF <40%. Most of them (75/89, 84%) suffered from non-ischemic cardiomyopathy. They had severely depressed LV function (LVEF 24±10%) and elevated BNP level (293±223 pg/ml). During the mean follow-up period of 3.9 years, 15% (13/89) were listed for heart transplantation, and 33% (29/89) died or received transplantation. Subgroup survival analysis of patients with LV dysfunction (LVEF <40%, n=665) revealed that all cause mortality was markedly higher in ExPR patients (n=82) than in patients with preserved BP response (n=583, Figure). By multivariate analysis correcting for age, BMI, LVEF, BNP, peak VO2, and VE/VCO2 slope, ExPR was found to be the strongest and independent prognostic indicator (χ2 7.48, p<0.01).
Conclusions: Extremely poor SBP response (peak SBP<110mmHg and ΔSBP<20mmHg) to bicycle exercise is rare, but if found, it most often represents the presence of severe LV dysfunction (mostly due to non-ischemic cardiomyopathy) with concomitant high mortality.
- © 2011 by American Heart Association, Inc.