scholarly journals Ventricular arrhythmias not meeting criteria for terminating cardiopulmonary exercise testing stratify prognosis and disease severity in heart failure of preserved, midrange, and reduced ejection fraction

2020 ◽  
Vol 43 (7) ◽  
pp. 698-705
Author(s):  
Dejana Popovic ◽  
Ross Arena ◽  
Djordje Jakovljevic ◽  
Arsen Ristic ◽  
Marco Guazzi
Keyword(s):  
Heart Failure ◽  
Ejection Fraction ◽  
Disease Severity ◽  
Exercise Testing ◽  
Ventricular Arrhythmias ◽  
Cardiopulmonary Exercise Testing ◽  
Reduced Ejection Fraction ◽  
Cardiopulmonary Exercise

scholarly journals Performance of Heart Failure Patients with Severely Reduced Ejection Fraction during Cardiopulmonary Exercise Testing on Treadmill and Cycle Ergometer; Similarities and Differences

2021 ◽  
Vol 18 (24) ◽  
pp. 12958
Author(s):  
Reza Mazaheri ◽  
Mohammad Sadeghian ◽  
Mahshid Nazarieh ◽  
David Niederseer ◽  
Christian Schmied
Keyword(s):  
Heart Failure ◽  
Ejection Fraction ◽  
Exercise Testing ◽  
Cardiopulmonary Exercise Testing ◽  
Cycle Ergometer ◽  
Strong Positive Correlation ◽  
Reduced Ejection Fraction ◽  
Heart Failure Patients ◽  
Cardiopulmonary Exercise ◽  
Peak Vo2

Background: Peak oxygen consumption (VO2) measured by cardiopulmonary exercise testing (CPET) is a significant predictor of mortality and future transplantation in heart failure patients with severely reduced ejection fraction (HFrEF). The present study evaluated the differences in peak VO2 and other prognostic variables between treadmill and cycle CPETs in these patients. Methods: In this cross-over study design, thirty males with severe HFrEF underwent CPET on both a treadmill and a cycle ergometer within 2–5 days apart, and important CPET parameters between two exercise test modalities were compared. Results: Peak VO2 was 23.12% higher on the treadmill than on cycle (20.55 ± 3.3 vs. 16.69 ± 3.01, p < 0.001, respectively). Minute ventilation to carbon dioxide production (VE/VCO2) slope was not different between the two CPET modes (p = 0.32). There was a strong positive correlation between the VE/VCO2 slopes during treadmill and cycle testing (r = 0.79; p < 0.001). VE/VCO2 slope was not related to peak respiratory exchange ratio (RER) in either modality (treadmill, r = 0.13, p = 0.48; cycle, r = 0.25, p = 0.17). The RER level was significantly higher on the cycle ergometer (p < 0.001). Conclusion: Peak VO2 is higher on treadmill than on cycle ergometer in severe HFrEF patients. In addition, VE/VCO2 slope is not a modality dependent parameter and is not related to the patients’ effort during CPET.

P6327Non-terminating ventricular arrhythmias during exercise testing reflect poorer prognosis and advanced disease severity in heart failure regardless of ejection fraction

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
D Popovic ◽  
M Guazzi ◽  
R Arena
Keyword(s):  
Heart Failure ◽  
Ejection Fraction ◽  
Disease Severity ◽  
Exercise Testing ◽  
Ventricular Arrhythmias ◽  
Advanced Disease ◽  
Cardiopulmonary Exercise Testing ◽  
Systolic Pressure ◽  
Left Ventricular ◽  
Secondary Outcome

Abstract Introduction Electrocardiography is an integral component of cardiopulmonary exercise testing (CPET), a standard of care in patients with heart failure (HF). We hypothetized that ventricular arrhythmias during CPET that do not meet test-termination criteria (NTVA) set forth by current guidelines may help in phenotyping disease severity and prognosis in HF with either reduced (rEF), and mid-range (mrEF)/preserved (pEF) left ventricular (LV) ejection fraction. Methods 319 patients with HF (199 HFrEF; 80 HFmrEF; 41 HFpEF) underwent CPET. Tricuspid annular plane systolic excursion (TAPSE) and pulmonary artery systolic pressure (PASP) were measured by echocardiography. B-type natriuretic peptide (BNP) at rest and peak exercise were also determined. The patients were tracked for the primary [cardiac death] and secondary composite outcome [all-cause death, heart transplantation/left ventricular assist device implantation, hospitalization for cardiac reasons]. Results 47 (15%) of the patients demonstrated NTVA during CPET, regardless of coronary artery disease prevalence. Patients without arrhythmias had a significantly higher LVEF (p<0.05), TAPSE/PASP ratio (p<0.001), peak oxygen consumption (p<0.01), lower resting and peak BNP (p<0.001) and the minute ventilation/carbon dioxide production slope (p<0.001) compared to those with NTVA. 71 patients died during the tracking period, 54 for cardiac reasons. NTVA during CPX were a significant predictor of primary and secondary outcome in all patients with HF (HR: 5.3, 3.7; 95% CI: 3.1–9.1, 2.4–5.5, p<0.001, respectively) as well as in subgroups categorized according to reduced, middle range and preserved LVEF (p<0.001). Conclusion These results indicate that exercise-induced ventricular arrhythmias not reaching criteria for test termination are nonetheless indicative of an advanced disease severity phenotype and worse prognosis.

Abstract 13745: Severity of Functional Mitral Regurgitation During Maximal Exercise Testing in Heart Failure: Additional Value of Combining Echocardiography with Cardiopulmonary Exercise Testing

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Greta Generati ◽  
Francesco Bandera ◽  
Marta Pellegrino ◽  
Valentina Labate ◽  
Eleonora Alfonzetti ◽  
...  
Keyword(s):  
Heart Failure ◽  
Mitral Regurgitation ◽  
Ejection Fraction ◽  
Exercise Testing ◽  
Cardiopulmonary Exercise Testing ◽  
Functional Mitral Regurgitation ◽  
Peak Exercise ◽  
Cardiopulmonary Exercise ◽  
Pulmonary Hemodynamic ◽  
Increased Risk

Background: In heart failure (HF) patients the severity of mitral regurgitation (MR) at rest has a well established prognostic value and its increase during exercise further adds to an increased risk. Our goal was to define the relationship between the degree of exercise MR severity with cardiopulmonary and echocardiographic related phenotypes in a cohort of HF patients. Methods: 71 HF reduced ejection fraction patients (mean age 67±11; male 72%; ischemic etiology 61%; NYHA class I, II, III and IV 13%, 36%, 39% and 12%, mean ejection fraction 33±9%) underwent cardiopulmonary exercise test (CPET) on tiltable cycle-ergometer combined with echocardiography at rest and during exercise. The population was divided into two groups according to the degree of functional peak MR: no to mild/moderate MR (no MR, MR1+ and MR2+) vs moderate/severe MR (MR3+ and MR4+). Results: A good correlation (ρ coefficient= 0.49) was found between the degree of dynamic MR and PASP at peak exercise. Despite similar echocardiographic profile at rest patients with significant peak MR (MR≥3+) had worse exercise performance (lower peak VO2, O2 pulse and workload) and impaired ventilatory efficiency (higher VE/VCO2 slope). Conclusions: In HF patients the severity of exercise-induced MR is associated with the most unfavorable performance and pulmonary hemodynamic response. A combined approach with CPET and echocardiographic assessment can help to early unmask and target functional MR and its related unfavorable phenotypes.

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