PHYSIOLOGICAL-PARAMETERS DURING THE INITIAL-STAGES OF CARDIOPULMONARYEXERCISE TESTING IN PATIENTS WITH CHRONIC HEART-FAILURE - THEIR VALUEIN THE ASSESSMENT OF CLINICAL SEVERITY AND PROGNOSIS

Aims To analyse the relationship between initial exercise parameters a nd peak oxygen consumption and prognosis in 96 patients with congestiv e heart failure.Methods and Results Comparison of responses during the initial 6 min of cardiopulmonary exercise testing (Naughton modified protocol) in patients stratified to the Weber classification, and anal ysis of their predictive value with respect to peak oxygen uptake and prognosis. All patients had a left ventricular ejection fraction <0.45 and a valid cardiopulmonary exercise test, during which they remained in sinus rhythm. Significant differences in several parameters were s een in the initial stages, including oxygen pulse (P<0.04) and ventila tion equivalent for oxygen (P<0.004). These parameters remained as ind ependent predictors of peak oxygen uptake in the algorithm derived fro m baseline and initial stage variables. In a multivariate Cox proporti onal hazards model, the predicted peak oxygen uptake (P<0.003) was an independent predictor of mortality. Conclusion In patients with conges tive heart failure, the initial 6 min parameters of a cardiopulmonary exercise test have additional value in the assessment of clinical seve rity and prognosis. This may be of clinical relevance since a limited incremental exercise protocol may be more objective than more traditio nal 6 min walking tests and less demanding.