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The initial slope of the VCO2/VO2-curve (s1) in cardiopulmonary exercise testing is a strong and independent predictor of outcome in patients with previous myocardial infarction

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Abstract

Background

Detecting heart failure (HF) patients at risk is a relevant clinical problem. Our goal was to define associations of clinical HF-markers and exercise parameters with respect to their prognostic power in HF-patients.

Methods

We performed cardiopulmonary exercise testing (CPET) in 103 ischemic HF-patients. CPET-parameters included peak VO2, VO2 at AT, peak oxygen pulse, minimal CO2 and O2 equivalents, VE/VCO2 and s1, a motivation-independent and submaximal parameter representing the initial slope of the VCO2/VO2-curve that has not been described in HF-patients so far.

Results

Median follow-up was 668 days. The combined endpoint of cardiovascular death and rehospitalization due to HF occurred in 14 patients. Patients with/without events differed significantly regarding their age, NYHA-class, LVEF and NT-proBNP serum-levels. Patients with events had significantly lower peak VO2- and higher s1-values. NT-proBNP serum-levels, NYHA-class and LVEF were significantly correlated with peak VO2. Only age, peak VO2 and s1 were independent predictors of adverse events. Using multivariate analysis, s1 was a strong and independent parameter with good sensitivity and specificity.

Conclusion

s1 is an independent and powerful predictor in HF-patients. Since s1 is independent of maximal exercise capacity, s1 might be more accurate for the evaluation of HF-patients not willing or unable to perform maximal exercise.

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Abbreviations

AT:

Anaerobic threshold

AUROC:

Area under the receiver operating characteristic curve

ACE:

Angiotensin converting enzyme

ARB:

Angiotensin receptor blocker

NT-proBNP:

N-terminal pro-brain natriuretic peptide

CAD:

Coronary artery disease

CHF:

Chronic heart failure

CPET:

Cardiopulmonary exercise test

CI:

Confidence interval

EqCO2 :

Ventilatory equivalent for CO2-exhalation

EqO2 :

Ventilatory equivalent for O2-inhalation

EqO2 min, EqCO2 min:

Minimal ventilatory equivalents for O2- and Co2-exchange

LVEF:

Left ventricular ejection fraction

Peak VO2 :

Peak oxygen uptake

Peak O2 pulse:

Peak oxygen uptake, adjusted to corresponding heart rate

RER:

Respiratory exchange ratio

RR:

Relative risk

S1:

Initial slope of the VCO2/VO2-curve

NYHA:

New York heart association

VE:

Minute ventilation

VE/VCO2 :

Slope of the VE/VCO2 curve

VO2 AT:

Oxygen uptake at the anaerobic threshold

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Authors and Affiliations

  1. Dept. of Cardiology, J. W. Goethe University Hospital, Theodor-Stern-Kai 7, 60590, Frankfurt/Main, Germany

    Joerg Honold, Lenka Geiger, Birgit Assmus, Ulrich Fischer-Rasokat, Volker Schaechinger, Andreas M. Zeiher & Ioakim Spyridopoulos MD

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  1. Joerg Honold
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  2. Lenka Geiger
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  3. Birgit Assmus
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  4. Ulrich Fischer-Rasokat
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  7. Ioakim Spyridopoulos MD
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Correspondence to Ioakim Spyridopoulos MD.

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Honold, J., Geiger, L., Assmus, B. et al. The initial slope of the VCO2/VO2-curve (s1) in cardiopulmonary exercise testing is a strong and independent predictor of outcome in patients with previous myocardial infarction. Clin Res Cardiol 97, 882–890 (2008). https://doi.org/10.1007/s00392-008-701-6

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  • DOI: https://doi.org/10.1007/s00392-008-701-6

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