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Dynamic analysis of exercise oxygen consumption predicts outcomes in advanced heart failure.

It is unclear whether cardiopulmonary stress testing provides prognostic information in patients with very advanced heart failure receiving contemporary medical therapy. Analysis of cardiopulmonary treadmill stress data in a group of patients with advanced heart failure and severe functional impairment was performed (N=102, peak exercise oxygen consumption [VO2] < or =14 mL/kg/min, 47% receiving beta-blockers). Dynamic variables (peak - baseline values) better predicted outcomes than did single value peak measurements, especially DeltaVO2. Multivariate analysis showed that usage of beta-blockers and DeltaVO2 (both P<.05) independently and significantly predicted outcomes. Subgroup analysis showed that DeltaVO2 was particularly useful in predicting outcomes in patients with ischemic cardiomyopathy or who were not receiving beta-blockers. Thus, in patients with very advanced heart failure, cardiopulmonary stress testing-derived DeltaVO2 provides important prognostic information useful to help predict clinical deterioration or death, particularly for patients with ischemic cardiomyopathy or who are not receiving beta-blockers.