Prediction of left ventricular reverse remodeling in patients with heart failure with reduced ejection fraction using cardiopulmonary exercise testing.

BACKGROUND

With advances in the treatment of heart failure with reduced ejection fraction (HFrEF), the prediction of left ventricular reverse remodeling (LVRR) has become increasingly important. Cardiopulmonary exercise testing (CPET) is a non-invasive test recommended for prognostic risk assessment in HFrEF; however, it is not known whether it predicts LVRR. We aimed to investigate whether the parameters obtained from CPET are useful in predicting LVRR in HFrEF.

METHODS

We retrospectively evaluated 230 consecutive patients with HFrEF [left ventricular ejection fraction (LVEF) ≤40 %] hospitalized for acute heart failure (59 ± 14 years, 78 % males) who underwent CPET before discharge. We investigated whether the CPET parameters, peak oxygen consumption (VO2), and the minute ventilation (VE) vs. carbon dioxide production (VCO2) slope could predict LVRR within 1 year (LVEF >50 %).

RESULTS

Among 230 patients, 89 (39 %) exhibited LVRR. In multivariable logistic analysis, higher peak VO2 [odds ratio (OR): 1.13, 95 % confidence interval (CI): 1.05-1.22, p < 0.001] and lower VE vs. VCO2 slope (OR: 0.95, 95 % CI: 0.91-0.98, p < 0.001) were independently associated with LVRR. In receiver operating characteristic curve analysis, peak VO2 [area under the curve (AUC): 0.657, p < 0.001, optimal cut-off: 15.5 mL/min/kg] and VE vs. VCO2 slope (AUC: 0.663, p < 0.001, optimal cut-off: 35.8) were significant predictors of LVRR. Moreover, combining the peak VO2 and VE vs. VCO2 slope improved the predictive value (AUC: 0.682).

CONCLUSIONS

CPET is a valuable test for the non-invasive detection of LVRR. The combination of peak VO2 and the VE vs. VCO2 slope is useful for predicting LVRR among hospitalized patients with HFrEF receiving pharmacological treatment.