0
Clinical Investigations: CARDIOLOGY |

Noninvasive Assessment of Cardiac Pumping Capacity During Exercise Predicts Prognosis in Patients With Congestive Heart Failure*

Christoph Scharf, MD; Tobias Merz, MD; Wolfgang Kiowski, MD; Erwin Oechslin, MD; Christoph Schalcher, MD; Hans Peter Brunner-La Rocca, MD
Author and Funding Information

*From the Heart Failure and Cardiac Transplantation Unit, Division of Cardiology, University Hospital of Zürich, Switzerland.

Correspondence to: Christoph Scharf, MD, Department of Cardiac Electrophysiology, University of Michigan, 1500 E Medical Center Dr, Ann Arbor, MI 48109; e-mail: CScharf@umich.edu



Chest. 2002;122(4):1333-1339. doi:10.1378/chest.122.4.1333
Text Size: A A A
Published online

Background: Prognostic parameters in patients with congestive heart failure (CHF) are important for guiding therapeutic options. Maximal oxygen uptake (V̇o2max) is a widely used parameter for prognostic assessment in patients with CHF and correlates with exercise cardiac output; however, afterload is not taken into account.

Methods: The concept of a noninvasive surrogate of cardiac power output combines exercise systolic BP (SBP), as an estimate of afterload, with V̇o2max, as an estimate of exercise cardiac output neglecting preload. Thus, a variable termed exercise cardiac power (ECP) is defined as the product of V̇o2max (expressed as a percent predicted value) and SBP (ECP, expressed as %mm Hg, is the product of V̇o2max, expressed as percentage of predicted maximum, times systolic pressure. The prognostic value of ECP obtained during routine treadmill ergospirometry was assessed in patients referred to our heart failure clinic. Patients undergoing heart transplantation were censored at the time of transplantation.

Results: One hundred fifty-four patients were followed prospectively for a mean (± SE) duration of 625 ± 32 days. Thirty-two patients (21%) died. ECP was the most powerful predictor of mortality, was the combined end point of mortality or hospitalization for worsening heart failure (all p < 0.001), and was an independent predictor in multivariate analysis. An ECP of < 5,000 %mm Hg indicated a poor prognosis with a 1-year mortality rate of 37%, whereas only 2% of the patients having an ECP of > 9,000 %mm Hg died during the first year.

Conclusion: The integration of afterload and V̇o2max improves the prognostic value of each indicator, and provides an easily available and independent predictor of mortality and morbidity in CHF patients. This integrative concept of cardiac hydraulic performance is superior to V̇o2max and can be used in routine ergospirometry.

Figures in this Article

Sign In to Access Full Content

MEMBER & INDIVIDUAL SUBSCRIBER

Want Access?

NEW TO CHEST?

Become a CHEST member and receive a FREE subscription as a benefit of membership.

Individuals can purchase this article on ScienceDirect.

Individuals can purchase a subscription to the journal.

Individuals can purchase a subscription to the journal or buy individual articles.

Learn more about membership or Purchase a Full Subscription.

INSTITUTIONAL ACCESS

Institutional access is now available through ScienceDirect and can be purchased at myelsevier.com.

Sign In to Access Full Content

MEMBER & INDIVIDUAL SUBSCRIBER

Want Access?

NEW TO CHEST?

Become a CHEST member and receive a FREE subscription as a benefit of membership.

Individuals can purchase this article on ScienceDirect.

Individuals can purchase a subscription to the journal.

Individuals can purchase a subscription to the journal or buy individual articles.

Learn more about membership or Purchase a Full Subscription.

INSTITUTIONAL ACCESS

Institutional access is now available through ScienceDirect and can be purchased at myelsevier.com.

Figures

Tables

References

NOTE:
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).

Some tools below are only available to our subscribers or users with an online account.

Sign In to Access Full Content

MEMBER & INDIVIDUAL SUBSCRIBER

Want Access?

NEW TO CHEST?

Become a CHEST member and receive a FREE subscription as a benefit of membership.

Individuals can purchase this article on ScienceDirect.

Individuals can purchase a subscription to the journal.

Individuals can purchase a subscription to the journal or buy individual articles.

Learn more about membership or Purchase a Full Subscription.

INSTITUTIONAL ACCESS

Institutional access is now available through ScienceDirect and can be purchased at myelsevier.com.

Related Content

Customize your page view by dragging & repositioning the boxes below.

Find Similar Articles
CHEST Journal Articles
PubMed Articles
Guidelines
Adults with systolic heart failure.
Michigan Quality Improvement Consortium | 7/17/2009
  • CHEST Journal
    Print ISSN: 0012-3692
    Online ISSN: 1931-3543