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Although Robbins et al 1 correctly state that other investigators have shown that exercise-related ventilatory abnormalities can be useful in predicting mortality, 3 they fail to acknowledge the fact that our group4 previously published similar findings, which demonstrated that ventilatory abnormalities were related to outcome in congestive heart failure. Importantly, we demonstrated that by combining ventilatory abnormalities and peak exercise oxygen consumption, patients at a particularly high risk for death could be identified. These findings are similar to the data presented in Figures 1, 5, and 7 of the article by Robbins et al.1 In patients with minute ventilation/carbon dioxide production (V̇E/V̇CO2) .50 and a peak exercise oxygen consumption ,15 mL z kg z min, we described a mortality rate of 82% (median follow-up time, 5526329 days) compared with a mortality of 22% in patients with a V ̇ E/V̇CO2 ,50 and a peak exercise oxygen consumption,15 mL z kg z min. In addition, Robbins et al 1

Ventilatory and Heart Rate Responses to Exercise: Better Predictors of Heart Failure Mortality Than Peak Exercise Oxygen Consumption