Independent and Added Value of Cardiopulmonary Exercise Testing to New York Heart Association Classification in Patients With Heart Failure

Isabela Pilar Moraes Alves de Souza; João Victor Santos Pereira Ramos; Anderson Donelli da Silveira; Ricardo Stein; Rebeca Sadigursky Ribeiro; Alexandre Meira Pazelli; Queila Borges de Oliveira; Eduardo Sahade Darzé; Luiz Eduardo Fonteles Ritt

doi:10.1097/HCR.0000000000000863

Independent and Added Value of Cardiopulmonary Exercise Testing to New York Heart Association Classification in Patients With Heart Failure

J Cardiopulm Rehabil Prev. 2024 May 7. doi: 10.1097/HCR.0000000000000863. Online ahead of print.

Authors

Isabela Pilar Moraes Alves de Souza¹, João Victor Santos Pereira Ramos, Anderson Donelli da Silveira, Ricardo Stein, Rebeca Sadigursky Ribeiro, Alexandre Meira Pazelli, Queila Borges de Oliveira, Eduardo Sahade Darzé, Luiz Eduardo Fonteles Ritt

Affiliation

¹ Author Affiliations: D'Or Institute for Research and Education, Cardio Pulmonar Hospital, Salvador, Bahia, Brazil (Mss de Souza and de Oliveira, Drs Darzé and Ritt); Bahiana School of Medicine and Public Health, Salvador, Bahia, Brazil (Ms de Souza, Drs Ramos, Ribeiro, Pazelli, Darzé, and Ritt); and Clinicas Hospital, Federal University of Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil (Drs da Silveira and Stein).

PMID: 38709847
DOI: 10.1097/HCR.0000000000000863

Abstract

Purpose: The objective of this study was to evaluate the independent and added value of a cardiopulmonary exercise test (CPX) to New York Heart Association (NYHA) functional analysis in patients with heart failure (HF) and ejection fraction (EF) <50%.

Methods: Patients (n = 613) with HF and EF < 50% underwent CPX and were followed for 28 ± 17 mo with respect to primary outcomes (death or heart transplantation).

Results: Mean patient age was 57 ± 12 yr and 64% were male. Most patients were classified as NYHA class II (41%). The composite rate of primary outcomes was 12%; death occurred in 9% and heart transplant in 4%. Independent predictors of primary outcomes were: EF (HR = 0.95: 95% CI, 0.92-0.98; P = .001) and NYHA (HR = 2.06: 95% CI, 1.54-2.75; P < .0001). When added to the model, peak oxygen uptake (peak) was an independent predictor (HR = 0.90: 95% CI, 0.84-0.96; P = .001), as was the percentage of predicted peak (HR = 0.03: 95% CI, 0.007-0.147; P < .001), minute ventilation/carbon dioxide production slope (HR = 1.02: 95% CI, 1.01-1.04; P = .012), and CPX score (HR = 1.16: 95% CI, 1.06-1.27; P = .001).

Conclusions: CPX variables were independent predictors of HJ prognosis, even when controlled by NYHA functional class. Despite being independent predictors, the value added to NYHA classification was modest and lacked statistical significance.

Plain language summary

Patients with heart failure (HF) underwent cardiopulmonary exercise testing (CPX) and were followed with respect to primary outcomes (death or heart transplantation). Independent predictors of primary outcomes were: ejection fraction and New York Heart Association (NYHA). The CPX variables were independent predictors of HF prognosis, even when controlled by NYHA. However, the value added to NYHA classification was modest.