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(Circulation. 2005;111:2313-2318.)
© 2005 American Heart Association, Inc.

Heart Failure

Peak Oxygen Consumption as a Predictor of Death in Patients With Heart Failure Receiving ß-Blockers

James O. O’Neill, MB, MRCPI; James B. Young, MD; Claire E. Pothier, MA, MPH; Michael S. Lauer, MD

From the Department of Cardiovascular Medicine, The Cleveland Clinic Foundation, Cleveland, Ohio.

Reprint requests to Michael S. Lauer, MD, FACC, Dept of Cardiovascular Medicine, The Cleveland Clinic Foundation, Desk F25, 9500 Euclid Ave, Cleveland, OH 44195. E-mail Lauerm{at}ccf.org

Received November 26, 2004; revision received January 12, 2005; accepted January 20, 2005.

Background— Peak oxygen uptake (peak O₂) is a strong predictor of mortality and is commonly used in the evaluation of patients for cardiac transplantation. ß-Blockers reduce mortality in patients with heart failure, without influencing peak O₂, raising the possibility that peak O₂ is no longer suitable as an indicator of prognosis in these patients.

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 ß-blockers were younger, more likely to have coronary disease, and had a greater mean ejection fraction but had a similar peak O₂. There were 555 deaths (26%) and 194 (9%) transplants during a median follow-up of 3.5 years. Peak O₂ was a predictor of mortality irrespective of ß-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 ß-blockers and 1.27 (95% CI 1.18 to 1.36, P<0.0001) in patients receiving ß-blockers. Similar findings were noted when considering death or transplantation as an end point. ß-Blocker use was associated with better outcomes until peak O₂ values became very low (10 mL · kg^–1 · min^–1), at which level survival rates were equally poor.

Conclusion— Peak O₂ is a determinant of survival in patients in heart failure even in the setting of ß-blockade. Because of improved survival in patients treated with ß-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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