(Circulation. 1999;100:2411.)
© 1999 American Heart Association, Inc.
Clinical Investigation and Reports |
Ventilatory and Heart Rate Responses to Exercise
Better Predictors of Heart Failure Mortality Than Peak Oxygen Consumption
From the George M. and Linda Kaufman Center for Heart Failure, Desk F25, Department of Cardiology, Cleveland Clinic Foundation, Cleveland, Ohio.
Correspondence and reprint requests to Michael S. Lauer, MD, FACC, Section of Heart Failure and Cardiac Transplantation Medicine, Department of Cardiology, Desk F25, Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH 44195.
Background—An abnormally low
chronotropic response and an abnormally high ventilatory response
(
E/CO2) to exercise
are common in patients with severe heart failure, but their relative
prognostic impacts have not been well explored.
Methods and Results—Consecutive patients with heart failure
referred for metabolic stress testing who were not taking
ß-blockers or intravenous inotropes (n=470) were followed
for 1.5 years. The chronotropic index was calculated while peak
O2 and
E/CO2 were directly
measured. Chronotropic index and peak O2
were considered abnormal if in the lowest 25th percentiles of the
patient cohort, whereas
E/CO2 was considered
abnormal if in the highest 25th percentile. For comparative purposes, a
group of 17 healthy controls underwent metabolic testing as
well. Compared with controls, heart failure patients had markedly
abnormal ventilatory and chronotropic responses to exercise. In the
heart failure cohort, there were 71 deaths. In univariate
analyses, predictors of death included high
E/CO2, low
chronotropic index, low O2, low resting
systolic blood pressure, and older age.
Nonparametric Kaplan-Meier plots demonstrated that by
dividing the population according to peak
E/CO2 and peak
O2, it is possible to identify low,
intermediate, and very high risk groups. In
multivariate analyses, the only independent
predictors of death were high
E/CO2 (adjusted
relative risk [RR] 3.20, 95% CI 1.95 to 5.26,
P<0.0001) and low chronotropic index (adjusted RR 1.94,
95% CI 1.18 to 3.19, P=0.0009).
Conclusions—The ventilatory and chronotropic responses to exercise are powerful and independent predictors of heart failure mortality.
Key Words: heart failure • mortality • exercise • heart rate • ventilation
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