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Role of cardiopulmonary exercise testing in clinical stratification in heart failure. A position paper from the Committee on Exercise Physiology and Training of the Heart Failure Association of the European Society of Cardiology
Author(s) -
Corrà Ugo,
Agostoni Pier Giuseppe,
Anker Stefan D.,
Coats Andrew J.S.,
Crespo Leiro Maria G.,
de Boer Rudolph A.,
Harjola VeliPekka,
Hill Loreena,
Lainscak Mitja,
Lund Lars H.,
Metra Marco,
Ponikowski Piotr,
Riley Jillian,
Seferović Petar M.,
Piepoli Massimo F.
Publication year - 2018
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.979
Subject(s) - medicine , heart failure , ejection fraction , risk stratification , cardiopulmonary exercise test , vo2 max , cardiology , intensive care medicine , quality of life (healthcare) , heart transplantation , aerobic exercise , physical therapy , heart rate , blood pressure , nursing
Traditionally, the main indication for cardiopulmonary exercise testing (CPET) in heart failure (HF) was for the selection of candidates to heart transplantation: CPET was mainly performed in middle‐aged male patients with HF and reduced left ventricular ejection fraction. Today, CPET is used in broader patients' populations, including women, elderly, patients with co‐morbidities, those with preserved ejection fraction, or left ventricular assistance device recipients, i.e. individuals with different responses to incremental exercise and markedly different prognosis. Moreover, the diagnostic and prognostic utility of symptom‐limited CPET parameters derived from submaximal tests is more and more considered, since many patients are unable to achieve maximal aerobic power. Repeated tests are also being used for risk stratification and evaluation of intervention, so that these data are now available. Finally, patients, physicians and healthcare decision makers are increasingly considering how treatments might impact morbidity and quality of life rather than focusing more exclusively on hard endpoints (such as mortality) as was often the case in the past. Innovative prognostic flowcharts, with CPET at their core, that help optimize risk stratification and the selection of management options in HF patients, have been developed.