This Article Full Text Full Text (PDF) 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 Mancini, D. Articles by LeJemtel, T. H. Search for Related Content PubMed PubMed Citation Articles by Mancini, D. Articles by LeJemtel, T. H. Pubmed/NCBI databases Compound via MeSH Substance via MeSH Hazardous Substances DB CARBON DIOXIDE OXYGEN Medline Plus Health Information Heart Failure Related Collections Congestive Exercise testing

(Circulation. 2007;115:2376-2378.)
© 2007 American Heart Association, Inc.

Editorial

Is Ventilatory Classification Preferable to Peak Oxygen Consumption for Risk Stratification in Heart Failure?

Donna Mancini, MD; Thierry H. LeJemtel, MD

From the Division of Cardiology (D.M.), Columbia University, New York, NY, and the Division of Cardiology (T.H.L.), Tulane University Medical School, New Orleans, La.

Correspondence to Donna Mancini, MD, Columbia Presbyterian Medical Center, 622 West 168th St, New York, NY 10032. E-mail dmm31@columbia.edu

Key Words: Editorials • exercise • heart failure

An extract of the first 250 words of the full text is provided, because this article has no abstract.

Since the 1980s, cardiopulmonary exercise testing has been applied to patients with congestive heart failure (CHF) to objectively assess exercise capacity, to risk stratify patients, and to assess the response to therapeutic interventions.¹ Subsequently, peak oxygen consumption (O₂) was reported to be a reliable prognostic index and to be particularly useful for the timing of cardiac transplantation in patients with advanced CHF caused by left ventricular systolic dysfunction.² As peak O₂ is derived from the Fick equation and as most patients achieve comparable arterial-venous oxygen differences when they give maximal effort, peak O₂ has provided a noninvasive marker for peak cardiac output response and thus cardiac reserve. However, peak O₂ is affected not only by the cardiac output response to exercise as observed in healthy subjects but also by limited skeletal muscle mass and perfusion in patients with advanced CHF. Thus the usefulness of peak O₂ to predict prognosis in patients with CHF also results from an objective quantification of the derangements that the failing heart causes in the periphery. Not unexpectedly, CHF patients with severe skeletal muscle wasting and low peak O₂ have a worse prognosis than patients with little or no muscle wasting and moderately reduced peak O₂. Numerous studies before and after the advent of ß-blocker therapy have repeatedly demonstrated the effectiveness of peak O₂ to predict outcome in patients with heart failure.^3–5 The prognostic power of ancillary data collected during cardiopulmonary testing, such as O₂ at anaerobic threshold, percentage predicted peak O₂ and . . . [Full Text of this Article]

This article has been cited by other articles:

				C. C. Lang, P. Karlin, J. Haythe, T. K. Lim, and D. M. Mancini Peak Cardiac Power Output, Measured Noninvasively, Is a Powerful Predictor of Outcome in Chronic Heart Failure Circ Heart Fail, January 1, 2009; 2(1): 33 - 38. [Abstract] [Full Text] [PDF]

				Can Ventilatory Efficiency Be Used to Classify Patients with Heart Failure? Journal Watch Cardiology, June 6, 2007; 2007(606): 3 - 3. [Full Text]