Curriculum in CardiologyPrediction of severe cardiovascular events by VE/Vco2 slope versus peak Vo2 in systolic heart failure: A meta-analysis of the published literature
Section snippets
Methods
We conducted a search in PubMed and ISI Web of Science. In PubMed, the search was done following the criteria of Table I, in agreement with current recommendations for meta-analysis of diagnostic studies.11, 12, 13 Results were limited to human studies published in English, Spanish, and Portuguese. For ISI Web of Science, the following strategy was used: [(Ts = heart failure OR Ts = heart transplantation) AND (Ts = ventilatory efficiency OR Ts = VE/VCO2 OR Ts = VE-VCO2 OR Ts = VE/VCO2) AND
Results
Four hundred ninety-one articles were retrieved after our preliminary search, and 92 were considered potentially relevant based on the title and abstract contents. A careful selection was done from these articles, and 80 were excluded for several reasons. Twelve articles were chosen for final analysis (Figure 1).
Quality assessment proved in general to be fair, with most of the studies presenting a retrospective design and prolonged patient enrollment periods. Although test protocols were poorly
Discussion
The present meta-analysis clearly indicates the importance of measuring VE/Vco2 slope in heart failure. Traditionally, peak Vo2 had been considered as the gold standard variable in CPET for prediction of cardiovascular events. However, its prognostic accuracy has been challenged in the last decade. Many authors have expressed concern on the need to reconsider peak Vo2 efficacy in light of current heart failure treatments, particularly β-blocker use.26, 27, 28 After completing a search of the
Disclosures
The authors declare no conflict of interest.
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