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Original Research: CARDIOVASCULAR DISEASE |

Oxygen Uptake Efficiency Plateau Best Predicts Early Death in Heart FailureOxygen Uptake Efficiency: Early Death Predictor

Xing-Guo Sun, MD; James E. Hansen, MD, FCCP; William W. Stringer, MD, FCCP; American Heart Association Task Force on Practice Guidelines (Writing Committee to Update the 2001 Guidelines for the Evaluation and Management of Heart Failure)
Author and Funding Information

From the Department of Medicine, Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, David Geffen School of Medicine at UCLA, St. John’s Cardiovascular Research Center, Torrance, CA.

Correspondence to: Xing-Guo Sun, MD, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100037, China, e-mail: xgsun@labiomed.org


Dr Sun is currently at the State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College (Bejing, China).

Funding/Support: The study was partially supported by Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (http://www.chestpubs.org/site/misc/reprints.xhtml).


© 2012 American College of Chest Physicians


Chest. 2012;141(5):1284-1294. doi:10.1378/chest.11-1270
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Background:  The responses of oxygen uptake efficiency (ie, oxygen uptake/ventilation = V˙ o2/V˙ e) and its highest plateau (OUEP) during incremental cardiopulmonary exercise testing (CPET) in patients with chronic left heart failure (HF) have not been previously reported. We planned to test the hypothesis that OUEP during CPET is the best single predictor of early death in HF.

Methods:  We evaluated OUEP, slope of V˙ o2 to log(V˙ e) (oxygen uptake efficiency slope), oscillatory breathing, and all usual resting and CPET measurements in 508 patients with low-ejection-fraction (< 35%) HF. Each had further evaluations at other sites, including cardiac catheterization. Outcomes were 6-month all-reason mortality and morbidity (death or > 24 h cardiac hospitalization). Statistical analyses included area under curve of receiver operating characteristics, ORs, univariate and multivariate Cox regression, and Kaplan-Meier plots.

Results:  OUEP, which requires only moderate exercise, was often reduced in patients with HF. A low % predicted OUEP was the single best predictor of mortality (P < .0001), with an OR of 13.0 (P < .001). When combined with oscillatory breathing, the OR increased to 56.3, superior to all other resting or exercise parameters or combinations of parameters. Other statistical analyses and morbidity analysis confirmed those findings.

Conclusions:  OUEP is often reduced in patients with HF. Low % predicted OUEP (< 65% predicted) is the single best predictor of early death, better than any other CPET or other cardiovascular measurement. Paired with oscillatory breathing, it is even more powerful.

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