The prognostic value of the cardiopulmonary exercise test in patients with heart failure who have been treated with beta-blockers [Turk Kardiyol Dern Ars]
Turk Kardiyol Dern Ars. 2013; 41(2): 105-112 | DOI: 10.5543/tkda.2013.87404

The prognostic value of the cardiopulmonary exercise test in patients with heart failure who have been treated with beta-blockers

Clémentine Dufay-bougon1, Annette Belin2, Ziad Said Dahdouh1, Sophie Barthelemy3, Jean-paul Mabire4, Rémi Sabatier1, Paul Milliez1, Gilles Grollier1
1Departments of Cardiology, CHU de Caen, Caen, France
2Departments of Cardiac Surgery, CHU de Caen, Caen, France
3Department of Cardiac Rehabilitation, Clinique De La Miséricorde, Caen, France
4Department of Cardiac Rehabilitation, Hospital of Côte Fleurie, Trouville, France


OBJECTIVES
The prevalence of chronic heart failure and a reduced ejection fraction (CHF-REF) has increased over the last decade. The cardiopulmonary exercise test (CPET) is an established tool for managing these patients. For patients who are administered beta-blockers, its predictive value is debated. The aim of this study was to assess the prognostic values of several parameters in patients with CHF-REF who were on beta-blockers.

STUDY DESIGN
390 patients with CHF-REF underwent CPET after cardiac rehabilitation and were followed for two years.

RESULTS
The primary endpoints were all-cause mortality, cardiac- related mortality and major cardiovascular events (hospitalization for HF, heart transplantation and acute coronary syndrome or arrhythmia). The mean beta-blockers dosage was 68.9% of the target dose. The two-year mortality rate was 13%, while the mean age of the population was 57.1 years. In addition, most of the patients were men (85.5% vs. 14.5%). The resting LVEF was 35.7±9.4 and the maximal oxygen uptake (peak VO2) was 19.5 ml/kg/min. The peak VO2, VE/ VCO2 slope and circulatory power were significant predictors of risk. The prognosis was better when the initial linear VE/VCO2 slope was lower than 30, and the final steeper VE/ VCO2 slope was lower than 32. There was no difference between the two slopes. The oxygen uptake efficiency slope, oxygen uptake, heart rate recovery, VE/VCO2/VO2 index and ventilatory threshold had no prognostic value.

CONCLUSION
The peak VO2, circulatory power and VE/VCO2 slope were prognostic indicators for patients with CHF-REF who were on beta-blockers.

Keywords: Adrenergic beta-antagonists/therapeutic use, heart failure/ drug therapy; oxygen consumption/physiology; predictive value of tests; prognosis.

How to cite this article
Clémentine Dufay-bougon, Annette Belin, Ziad Said Dahdouh, Sophie Barthelemy, Jean-paul Mabire, Rémi Sabatier, Paul Milliez, Gilles Grollier. The prognostic value of the cardiopulmonary exercise test in patients with heart failure who have been treated with beta-blockers. Turk Kardiyol Dern Ars. 2013; 41(2): 105-112

Corresponding Author: Ziad Said Dahdouh, France
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