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Multicenter Study
. 2013 Mar;6(2):211-8.
doi: 10.1161/CIRCHEARTFAILURE.112.000073. Epub 2013 Feb 7.

Validation of a cardiopulmonary exercise test score in heart failure

Jonathan Myers  1 , Ricardo Oliveira, Frederick Dewey, Ross Arena, Marco Guazzi, Paul Chase, Daniel Bensimhon, Mary Ann Peberdy, Euan Ashley, Erin West, Lawrence P Cahalin, Daniel E Forman
Affiliations
Multicenter Study

Validation of a cardiopulmonary exercise test score in heart failure

Jonathan Myers et al. Circ Heart Fail. 2013 Mar.

Abstract

Background: Cardiopulmonary exercise test (CPX) responses are strong predictors of outcomes in patients with heart failure. We recently developed a CPX score that integrated the additive prognostic information from CPX. The purpose of this study was to validate the score in a larger, independent sample of patients.

Methods and results: A total of 2625 patients with heart failure underwent CPX and were followed for cardiovascular (CV) mortality and major CV events (death, transplantation, left ventricular assist device implantation). Net reclassification improvement (NRI) for the score and each of its components were determined at 3 years. The VE/VCO2 slope was the strongest predictor of risk and was attributed a relative weight of 7, with weighted scores for abnormal heart rate recovery, oxygen uptake efficiency slope, end-tidal CO2 pressure, and peak VO2 having scores of 5, 3, 3, and 2, respectively. A summed score of >15 was associated with an annual mortality rate of 12.2% and a relative risk >9 for total events, whereas a score of <5 was associated with an annual mortality rate of 1.2%. The composite score was the most accurate predictor of CV events among all CPX responses considered (C indexes, 0.70 for CV mortality and 0.72 for the composite outcome). Each component of the score provided significant NRI compared with peak VO2 (category-free NRI, 0.61-0.77), and the score provided significant NRI above clinical risk factors for both CV events and mortality (NRI, 0.63 and 0.65 for CPX score compared with clinical variables alone).

Conclusions: These results validate the application of a simple, integrated multivariable score based on readily available CPX responses.

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Figures

Figure 1.
Figure 1.
Kaplan–Meier curves illustrating cumulative survival for increasing cardiopulmonary exercise test scores. P<0.01 by log-rank test.
Figure 2.
Figure 2.
Kaplan–Meier curves illustrating event-free survival for the composite outcome (death, transplantation, and left ventricular assist device implantation) by increasing cardiopulmonary exercise test scores. P<0.01 by log-rank test.
See this image and copyright information in PMC

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