Cardiopulmonary exercise testing in chronic heart failure patients treated with beta-blockers: Still a valid prognostic tool

Background: The advent of beta-blockers (BBs) has revolutionized the treatment of heart failure due to left ventricular dysfunction (HFrEF), as these drugs increase survival and reduce hospitalization without a significant impact on exercise tolerance. In this new prognostic scenario, the predictive role of cardiopulmonary exercise testing (CPET) has been questioned.

Aim: To evaluate the predictive value of CPET and "traditional" derived and calculated risk parameters in HFrEF patients on BBs.

Methods: We retrospectively correlated 17 CPET risk parameters with hard events (cardiac death or urgent heart transplantation) over a 3-year follow-up in 744 HFrEF patients treated with BBs at our Institute from 2000 to 2013.

Results: Events were observed in 121/744 (16%) patients. Most CPET parameters were related to outcome at univariable analysis, but at multivariable analysis only exertional oscillatory ventilation (EOV), peak systolic blood pressure (SBP) and percentage of predicted peak VO2 (VO2%) resulted as significant. A CPET model using the dichotomized cut-off values of peak SPB ≤ 140 mmHg (HR = 2,27, p = .000, CI = 0.58-3.85), peak VO2% ≤ 50% (HR = 1.65, p = .008, CI = 1.14-2.38) and EOV = yes had a likelihood ratio of 45.27 (p = .000).

Conclusions: CPET confirmed its value as a prognostic tool in HFrEF patients treated with BBs, but different CPET parameters emerged as predictive (EOV, peak VO2% and peak SBP).