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Cardiopulmonary exercise testing in systolic heart failure in 2014: the evolving prognostic role
Author(s) -
Corrà Ugo,
Piepoli Massimo F.,
Adamopoulos Stamatis,
Agostoni Piergiuseppe,
Coats Andrew J.S.,
Conraads Viviane,
Lambrinou Ekaterini,
Pieske Burkert,
Piotrowicz Ewa,
Schmid JeanPaul,
Seferović Petar M.,
Anker Stefan D.,
Filippatos Gerasimos,
Ponikowski Piotr P.
Publication year - 2014
Publication title -
european journal of heart failure
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 5.149
H-Index - 133
eISSN - 1879-0844
pISSN - 1388-9842
DOI - 10.1002/ejhf.156
Subject(s) - medicine , heart failure , economic shortage , cardiopulmonary exercise test , cardiology , vo2 max , intensive care medicine , risk stratification , heart rate , blood pressure , linguistics , philosophy , government (linguistics)
The relationship between exercise capacity, as assessed by peak oxygen consumption, and outcome is well established in heart failure ( HF ), but the predictive value of cardiopulmonary exercise testing ( CPET ) has been recently questioned, for two main reasons. First, the decisional power of CPET in the selection of heart transplantation candidates has diminished, since newer therapeutic options and the shortage of donor hearts have restricted this curative option to extremely advanced HF patients, frequently not able to perform a symptom‐limited CPET . Secondly, the use of CPET has become more complex and sophisticated, with many promising new prognostic indexes proposed each year. Thus, a modern interpretation of CPET calls for selective expertise that is not routinely available in all HF centres. This position paper examines the history of CPET in risk stratification in HF . Throughout five phases of achievements, the journey from a single CPET parameter (i.e. peak oxygen consumption) to a multiparametric approach embracing the full clinical picture in HF —including functional, neurohumoral, and laboratory findings—is illustrated and discussed. An innovative multifactorial model is proposed, with CPET at its core, that helps optimize our understanding and management of HF patients.