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(Chest. 2003;124:580-586.)
© 2003 American College of Chest Physicians

Prolonged Oxygen Uptake Kinetics During Low-Intensity Exercise Are Related to Poor Prognosis in Patients With Mild-to-Moderate Congestive Heart Failure*

Christoph Schalcher, MD; Hans Rickli, MD; Manuel Brehm, MD; Daniel Weilenmann, MD; Erwin Oechslin, MD; Wolfgang Kiowski, MD and Hans Peter Brunner-La Rocca, MD

* From the Division of Cardiology, Department of Internal Medicine, University Hospital, Zurich, Switzerland.

Correspondence to: Hans Peter Brunner-La Rocca, MD, Division of Cardiology, University Hospital, Petersgraben 4, 4031 Basel, Switzerland; e-mail: brunnerh{at}uhbs.ch

Study objective: To investigate the prognostic value of oxygen uptake (O2) kinetics during low-intensity exercise in patients with congestive heart failure.

Design: Prospective cohort study.

Setting: Tertiary care center.

Patients: One hundred forty-six consecutive patients (128 men) with chronic heart failure, followed up for a mean (± SD) duration of 25 ± 15 months.

Measurements: A treadmill exercise test was performed with "breath by breath" gas-exchange monitoring. O2 kinetics were defined as the O2 deficit (ie, {Delta}O2 x time[rest to steady state] - {Sigma}O2[rest to steady state]) and mean response time (MRT) [ie, O2 deficit/{Delta}O2]. Cardiac death, urgent cardiac transplantation, and hospitalization due to worsening heart failure were considered as the end points.

Results: Thirty patients (21%) died, 11 patients (8%) underwent urgent transplantation, and 32 patients (22%) were hospitalized. In univariate analysis, MRT was the most powerful predictor of survival, survival free of urgent transplantation, and survival free of hospitalization (hazard ratios [HRs] per 10 s, 1.65, 1.72, and 1.61, respectively; all p < 0.0001). The predictive value of MRT exceeded that of peak O2 (HR per mL/kg/min, 0.90; p = 0.02, 0.91; p = 0.007, and 0.95; p = 0.08, respectively). In multivariate analysis, MRT (HR per 10 s, 1.73; p = 0.0002), resting systolic BP (HR per 10 mm Hg, 0.65; p = 0.003), and the slope of the ventilatory response to exercise (HR per 10 U, 1.68; p = 0.02) were independent predictors of survival.

Conclusions: Our results suggest that O2 kinetics are strongly related to outcome in heart failure patients. Since it has several additional advantages over peak exercise testing (eg, less time-consuming, less demanding for the patients, less dependent on motivation, and applicable in patients with limitations other than cardiopulmonary disease), it has the potential to become a prognostic test for the assessment of heart failure patients.

Key Words: congestive heart failure • exercise test • oxygen consumption • prognosis




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