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

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Study objective:To investigate the prognostic value of oxygen uptake (V̇O2) 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. V̇O2kinetics were defined as the O2 deficit (ie, ΔV̇O2 × time [rest to steady state] − ΣV̇O2[rest to steady state]) and mean response time (MRT) [ie, O2 deficit/ΔV̇O2]. 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 V̇O2 (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 V̇O2 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.

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