Prognostic value of cardiopulmonary exercise testing using percent achieved of predicted peak oxygen uptake for patients with ischemic and dilated cardiomyopathy

Abstract Objectives . We tested the hypothesis that percent achieved of predicted peak oxygen uptake (predicted V0 2 max) improves the prognostic accuracy of identifying high risk ambulatory patients with congestive heart failure considered for heart transplantation compared with absolute peak oxygen uptake (V0 2 max) in 181 patients with ischemic or dilated cardiomyopathy. Background . Peak oxygen uptake during exercise has been shown to be a useful prognostic measurement to risk stratify patients with heart failure. The prognostic value of percent predicted Vo2max has not been assessed in these patients. Methods . We retrospectively studied 181 ambulatory patients referred to the Saint Louis University Heart Failure Unit. Clinical, hemodynamic (137 patients) and coronary angiographic (145 patients) data were recorded, and all patients underwent symptom-limited cardiopulmonary exercise. Results . During a mean follow-up period of 12 ± 6 months, 26 patients died, and 18 were listtd as Status 1 priority for heart transplantation. The actuarial 1- and 2-year survival of the 89 patients who achieved ≤50% predicted V0 2 max was 74% and 43%, respectively, compared with 98% and 90% in the 92 who achieved >50% predicted Vo 2 max (p = 0.001). Multivariable analysis selected ≤50% predicted V0 2 max as the most significant predictor of cardiac death (p = 0.007) and cardiac death or Status 1 priority (p = 0.0005). Conclusions . Percent achieved of predicted V0 2 max provides important information that can be used te risk stratify ambulatory patients with heart failure with ischemic or dilated etiology that exceeds that provided by measurement of Vo 2 max alone. Patients who achieve >50% predicted V0 2 max have as excellent short-term prognosis when treated medically O bestir transplantation can be safely deferred.