RESUMO
AIM: To specify the prognostic value of parameters of cardiopulmonary exercise testing (CPET) in patients with chronic heart value (CHF) on optimal medical treatment depending on gender, age, left ventricular ejection fraction (LVEF), cardiac rhythm and achievement of target respiratory exchange ratio (RER) > or = 1.0. MATERIALS AND METHODS: 111 patients (83 male, mean age 60.6 +/- 12.8 years) with CHF NYHA class I-III on optimal treatment were included in the study. One third had preserved EF, 27.9%--permanent atrial fibrillation (AFib). Average followup was 19.4 +/- 9.6 months. Prognostic value of CPET indices and Heart Failure Survival Score (HFSS) for cardiovascular mortality (CVM) and combined endpoint including CVM or CHF hospitalization were evaluated using logistic regression analysis. RESULTS: CVM amounted 14.4%, combined endpoint was observed in 46.8% of patients. HFSS had the highest predictive value for CVM (in all subgroups of patients) and for combined endpoint (except patients with AFib). In men, patients younger than 65 years, with reduced LVEF and with Afib CVM was also related to ventilatory indices (VE/VCO2, ventilatory class and PetCO2 peak), and combined endpoint was related to VO2peak and its derivativatives. Only HFSS and VE/VCO2 had prognostic value for CVM in patients with AFib. Ventilatory parameters were associated with combined endpoint in all subgroups except Afib. Blood pressure response and heart rate recovery had prognostic significance only in patients with sinus rhythm. Target RER > or = 1.0 was achieved only in 40.5% patients. In patients with RER < 1.0 significant relationship between VO2 peak and combined endpoint was observed. CONCLUSIONS; Heart Failure Survival Score, VE/VCO2, ventilatory class and PetCO peak are the strongest predictors of cardiovascular mortality and heart failure hospitalizations in all subgroups of patients with CHF. CPET has the highest significance for men, age < 65 years, patients with LVEF < 45% and sinus rhythm. In these subgroups VO2 peak and Weber class have predictive value for decompensation of CHF whether RER > or = 1.0 or not. Blood pressure response and heart rate recovery have prognostic significance only in patients with sinus rhythm.