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Oxygen consumption trajectory flattening—yet another cardiopulmonary exercise testing parameter in chronic heart failure

Cardiopulmonary exercise testing (CPET) has gained major importance in heart failure (HF) units and in the evaluation of patients for heart transplantation (HTx) or left ventricular assist device (LVAD) implantation. While oxygen consumption at maximal effort (peak VO2) has been accepted even far beyond the field of cardiology, other parameters such as ventilatory efficiency,1 end-tidal partial pressure of carbon dioxide (PETCO2) 2 and exercise oscillatory ventilation (EOV),3 have broadened the spectrum of understanding and measurements of HF symptoms and helped in evaluation of prognosis. Most data are derived from patients with systolic HF and none of these parameters have conclusively helped to specifically characterize diastolic HF, which is currently in the focus of efforts to understand the HF epidemic.