Limited predictive value of cardiopulmonary exercise indices in patients with moderate chronic heart failure treated with carvedilol
Peak oxygen consumption (VO2) is traditionally used for risk stratification in chronic heart failure (CHF); however, its predictive value is unknown with carvedilol treatment. Therefore, we sought to investigate the prognostic role of gas-exchange parameters obtained from symptom-limited cardiopulmo...
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| Veröffentlicht in: | The American heart journal 2004-03, Vol.147 (3), p.553-560 |
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| creator | Corrà, Ugo Mezzani, Alessandro Bosimini, Enzo Scapellato, Francesco Temporelli, Pier Luigi Eleuteri, Ermanno Giannuzzi, Pantaleo |
| description | Peak oxygen consumption (VO2) is traditionally used for risk stratification in chronic heart failure (CHF); however, its predictive value is unknown with carvedilol treatment. Therefore, we sought to investigate the prognostic role of gas-exchange parameters obtained from symptom-limited cardiopulmonary exercise testing (CPX) in patients with CHF that is treated with carvedilol.
A total of 508 consecutive patients (443 men, mean age [± SD] 59 ± 9 years) with a mean left ventricular ejection fraction (LVEF) of 25% ± 7% underwent CPX. The peak VO2 was 13.9 ± 3 mL/kg/min; the rate of increase of minute ventilation per unit of increase of carbon dioxide production (VE/VCO2 slope) was 32 ± 2. Outcomes (cardiovascular death or urgent heart transplantation) were determined when all patients who survived had been observed for a minimum of 6 months.
Patients were divided into groups according to treatment (carvedilol and non-carvedilol); 236 patients were treated with carvedilol (46%), at a mean dose of 25 ±13 mg. The VE/CO2 slope, LVEF, peak VO2, and carvedilol treatment were revealed by means of multivariate analysis to be independent and additional predictors in the total population; VE/VCO2 slope, LVEF, and peak VO2 were revealed to be independent and additional predictors in the patients in the noncarvedilol group (all
P 10 mL/kg/min.
Peak VO2 provides limited predictive information in patients with CHF that is treated with carvedilol, and no additional gas exchange parameter yields supplementary advice. |
| doi_str_mv | 10.1016/j.ahj.2003.10.026 |
| format | Article |
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A total of 508 consecutive patients (443 men, mean age [± SD] 59 ± 9 years) with a mean left ventricular ejection fraction (LVEF) of 25% ± 7% underwent CPX. The peak VO2 was 13.9 ± 3 mL/kg/min; the rate of increase of minute ventilation per unit of increase of carbon dioxide production (VE/VCO2 slope) was 32 ± 2. Outcomes (cardiovascular death or urgent heart transplantation) were determined when all patients who survived had been observed for a minimum of 6 months.
Patients were divided into groups according to treatment (carvedilol and non-carvedilol); 236 patients were treated with carvedilol (46%), at a mean dose of 25 ±13 mg. The VE/CO2 slope, LVEF, peak VO2, and carvedilol treatment were revealed by means of multivariate analysis to be independent and additional predictors in the total population; VE/VCO2 slope, LVEF, and peak VO2 were revealed to be independent and additional predictors in the patients in the noncarvedilol group (all
P <.001); and only peak VO2 was revealed to be an independent and additional predictor in the patients in the carvedilol group (
P <.01). In the carvedilol group, mortality rates were 26%, 11%, 10%, and 4% (
P <.05) in patients with peak VO2 ≤10 mL/kg/min, >10 to ≤14 mL/kg/min, >14 to18 mL/kg/min, and ≥18 mL/kg/min, respectively. No difference in mortality rates according to peak VO2 or additional outcome indices were identified in the 212 patients with peak VO2 >10 mL/kg/min.
Peak VO2 provides limited predictive information in patients with CHF that is treated with carvedilol, and no additional gas exchange parameter yields supplementary advice.</description><identifier>ISSN: 0002-8703</identifier><identifier>EISSN: 1097-6744</identifier><identifier>DOI: 10.1016/j.ahj.2003.10.026</identifier><identifier>PMID: 14999209</identifier><identifier>CODEN: AHJOA2</identifier><language>eng</language><publisher>New York, NY: Mosby, Inc</publisher><subject>Adrenergic beta-Antagonists - therapeutic use ; Beta blockers ; Biological and medical sciences ; Carbazoles - therapeutic use ; Cardiology. Vascular system ; Drug therapy ; Exercise Test ; Female ; Heart ; Heart attacks ; Heart failure ; Heart Failure - drug therapy ; Heart Failure - metabolism ; Heart failure, cardiogenic pulmonary edema, cardiac enlargement ; Humans ; Male ; Medical prognosis ; Medical sciences ; Middle Aged ; Mortality ; Multivariate analysis ; Oxygen Consumption ; Prognosis ; Propanolamines - therapeutic use ; Proportional Hazards Models ; Pulmonary Gas Exchange ; Regression analysis ; Risk Factors ; Stroke Volume ; Values ; Ventilation</subject><ispartof>The American heart journal, 2004-03, Vol.147 (3), p.553-560</ispartof><rights>2004 Mosby, Inc.</rights><rights>2004 INIST-CNRS</rights><rights>Copyright Elsevier Limited Mar 2004</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c407t-a367b37dd312f4eab71350a23b15cff926353c3cda8ab892e950cb1cd3e388f23</citedby><cites>FETCH-LOGICAL-c407t-a367b37dd312f4eab71350a23b15cff926353c3cda8ab892e950cb1cd3e388f23</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.proquest.com/docview/1504463905?pq-origsite=primo$$EHTML$$P50$$Gproquest$$H</linktohtml><link.rule.ids>314,780,784,3550,27924,27925,45995,64385,64387,64389,72469</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=15582509$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/14999209$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Corrà, Ugo</creatorcontrib><creatorcontrib>Mezzani, Alessandro</creatorcontrib><creatorcontrib>Bosimini, Enzo</creatorcontrib><creatorcontrib>Scapellato, Francesco</creatorcontrib><creatorcontrib>Temporelli, Pier Luigi</creatorcontrib><creatorcontrib>Eleuteri, Ermanno</creatorcontrib><creatorcontrib>Giannuzzi, Pantaleo</creatorcontrib><title>Limited predictive value of cardiopulmonary exercise indices in patients with moderate chronic heart failure treated with carvedilol</title><title>The American heart journal</title><addtitle>Am Heart J</addtitle><description>Peak oxygen consumption (VO2) is traditionally used for risk stratification in chronic heart failure (CHF); however, its predictive value is unknown with carvedilol treatment. Therefore, we sought to investigate the prognostic role of gas-exchange parameters obtained from symptom-limited cardiopulmonary exercise testing (CPX) in patients with CHF that is treated with carvedilol.
A total of 508 consecutive patients (443 men, mean age [± SD] 59 ± 9 years) with a mean left ventricular ejection fraction (LVEF) of 25% ± 7% underwent CPX. The peak VO2 was 13.9 ± 3 mL/kg/min; the rate of increase of minute ventilation per unit of increase of carbon dioxide production (VE/VCO2 slope) was 32 ± 2. Outcomes (cardiovascular death or urgent heart transplantation) were determined when all patients who survived had been observed for a minimum of 6 months.
Patients were divided into groups according to treatment (carvedilol and non-carvedilol); 236 patients were treated with carvedilol (46%), at a mean dose of 25 ±13 mg. The VE/CO2 slope, LVEF, peak VO2, and carvedilol treatment were revealed by means of multivariate analysis to be independent and additional predictors in the total population; VE/VCO2 slope, LVEF, and peak VO2 were revealed to be independent and additional predictors in the patients in the noncarvedilol group (all
P <.001); and only peak VO2 was revealed to be an independent and additional predictor in the patients in the carvedilol group (
P <.01). In the carvedilol group, mortality rates were 26%, 11%, 10%, and 4% (
P <.05) in patients with peak VO2 ≤10 mL/kg/min, >10 to ≤14 mL/kg/min, >14 to18 mL/kg/min, and ≥18 mL/kg/min, respectively. No difference in mortality rates according to peak VO2 or additional outcome indices were identified in the 212 patients with peak VO2 >10 mL/kg/min.
Peak VO2 provides limited predictive information in patients with CHF that is treated with carvedilol, and no additional gas exchange parameter yields supplementary advice.</description><subject>Adrenergic beta-Antagonists - therapeutic use</subject><subject>Beta blockers</subject><subject>Biological and medical sciences</subject><subject>Carbazoles - therapeutic use</subject><subject>Cardiology. Vascular system</subject><subject>Drug therapy</subject><subject>Exercise Test</subject><subject>Female</subject><subject>Heart</subject><subject>Heart attacks</subject><subject>Heart failure</subject><subject>Heart Failure - drug therapy</subject><subject>Heart Failure - metabolism</subject><subject>Heart failure, cardiogenic pulmonary edema, cardiac enlargement</subject><subject>Humans</subject><subject>Male</subject><subject>Medical prognosis</subject><subject>Medical sciences</subject><subject>Middle Aged</subject><subject>Mortality</subject><subject>Multivariate analysis</subject><subject>Oxygen Consumption</subject><subject>Prognosis</subject><subject>Propanolamines - therapeutic use</subject><subject>Proportional Hazards Models</subject><subject>Pulmonary Gas Exchange</subject><subject>Regression analysis</subject><subject>Risk Factors</subject><subject>Stroke Volume</subject><subject>Values</subject><subject>Ventilation</subject><issn>0002-8703</issn><issn>1097-6744</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2004</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>8G5</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>AZQEC</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><sourceid>DWQXO</sourceid><sourceid>GNUQQ</sourceid><sourceid>GUQSH</sourceid><sourceid>M2O</sourceid><recordid>eNp9kU1r3DAQhkVpaLZpf0AvRVCam7f68JfoKYR-BBZySc9iLI1ZGdtyJXnT3vvDq80uBHroaZjhmZmX9yXkHWdbznj9adjCftgKxmTut0zUL8iGM9UUdVOWL8mGMSaKtmHykryOcchtLdr6FbnkpVJKMLUhf3ZucgktXQJaZ5I7ID3AuCL1PTUQrPPLOk5-hvCb4i8MxkWkbs4sxlzpAsnhnCJ9dGlPJ28xQEJq9sHPztA9Qki0BzeuAWkKCMdnT2y-fsg_Rz--IRc9jBHfnusV-fH1y8Pt92J3_-3u9mZXmJI1qQBZN51srJVc9CVC13BZMRCy45XpeyVqWUkjjYUWulYJVBUzHTdWomzbXsgrcn26uwT_c8WY9OSiwXGEGf0adcNrVbWCZ_DDP-Dg1zBnbZpXrCxrqViVKX6iTPAxBuz1EtyUjdKc6WNAetA5IH0M6DjKAeWd9-fLazehfd44J5KBj2cAooGxDzBny5-5KgusnrjPJw6zYQeHQUeTgzDZ0YAmaevdf2T8Bc1zsD8</recordid><startdate>20040301</startdate><enddate>20040301</enddate><creator>Corrà, Ugo</creator><creator>Mezzani, Alessandro</creator><creator>Bosimini, Enzo</creator><creator>Scapellato, Francesco</creator><creator>Temporelli, Pier Luigi</creator><creator>Eleuteri, Ermanno</creator><creator>Giannuzzi, Pantaleo</creator><general>Mosby, Inc</general><general>Elsevier</general><general>Elsevier Limited</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7QO</scope><scope>7RV</scope><scope>7TS</scope><scope>7X7</scope><scope>7XB</scope><scope>88C</scope><scope>88E</scope><scope>8AO</scope><scope>8C1</scope><scope>8FD</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>8G5</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AN0</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FR3</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>GUQSH</scope><scope>K9.</scope><scope>KB0</scope><scope>M0S</scope><scope>M0T</scope><scope>M1P</scope><scope>M2O</scope><scope>MBDVC</scope><scope>NAPCQ</scope><scope>P64</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>Q9U</scope><scope>7X8</scope></search><sort><creationdate>20040301</creationdate><title>Limited predictive value of cardiopulmonary exercise indices in patients with moderate chronic heart failure treated with carvedilol</title><author>Corrà, Ugo ; Mezzani, Alessandro ; Bosimini, Enzo ; Scapellato, Francesco ; Temporelli, Pier Luigi ; Eleuteri, Ermanno ; Giannuzzi, Pantaleo</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c407t-a367b37dd312f4eab71350a23b15cff926353c3cda8ab892e950cb1cd3e388f23</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2004</creationdate><topic>Adrenergic beta-Antagonists - therapeutic use</topic><topic>Beta blockers</topic><topic>Biological and medical sciences</topic><topic>Carbazoles - therapeutic use</topic><topic>Cardiology. Vascular system</topic><topic>Drug therapy</topic><topic>Exercise Test</topic><topic>Female</topic><topic>Heart</topic><topic>Heart attacks</topic><topic>Heart failure</topic><topic>Heart Failure - drug therapy</topic><topic>Heart Failure - metabolism</topic><topic>Heart failure, cardiogenic pulmonary edema, cardiac enlargement</topic><topic>Humans</topic><topic>Male</topic><topic>Medical prognosis</topic><topic>Medical sciences</topic><topic>Middle Aged</topic><topic>Mortality</topic><topic>Multivariate analysis</topic><topic>Oxygen Consumption</topic><topic>Prognosis</topic><topic>Propanolamines - therapeutic use</topic><topic>Proportional Hazards Models</topic><topic>Pulmonary Gas Exchange</topic><topic>Regression analysis</topic><topic>Risk Factors</topic><topic>Stroke Volume</topic><topic>Values</topic><topic>Ventilation</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Corrà, Ugo</creatorcontrib><creatorcontrib>Mezzani, Alessandro</creatorcontrib><creatorcontrib>Bosimini, Enzo</creatorcontrib><creatorcontrib>Scapellato, Francesco</creatorcontrib><creatorcontrib>Temporelli, Pier Luigi</creatorcontrib><creatorcontrib>Eleuteri, Ermanno</creatorcontrib><creatorcontrib>Giannuzzi, Pantaleo</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Biotechnology Research Abstracts</collection><collection>Proquest Nursing & Allied Health Source</collection><collection>Physical Education Index</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Healthcare Administration Database (Alumni)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Public Health Database</collection><collection>Technology Research Database</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>Research Library (Alumni Edition)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>British Nursing Database</collection><collection>ProQuest Central Essentials</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central Korea</collection><collection>Engineering Research Database</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Central Student</collection><collection>Research Library Prep</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Healthcare Administration Database</collection><collection>Medical Database</collection><collection>Research Library</collection><collection>Research Library (Corporate)</collection><collection>Nursing & Allied Health Premium</collection><collection>Biotechnology and BioEngineering Abstracts</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central Basic</collection><collection>MEDLINE - Academic</collection><jtitle>The American heart journal</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Corrà, Ugo</au><au>Mezzani, Alessandro</au><au>Bosimini, Enzo</au><au>Scapellato, Francesco</au><au>Temporelli, Pier Luigi</au><au>Eleuteri, Ermanno</au><au>Giannuzzi, Pantaleo</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Limited predictive value of cardiopulmonary exercise indices in patients with moderate chronic heart failure treated with carvedilol</atitle><jtitle>The American heart journal</jtitle><addtitle>Am Heart J</addtitle><date>2004-03-01</date><risdate>2004</risdate><volume>147</volume><issue>3</issue><spage>553</spage><epage>560</epage><pages>553-560</pages><issn>0002-8703</issn><eissn>1097-6744</eissn><coden>AHJOA2</coden><abstract>Peak oxygen consumption (VO2) is traditionally used for risk stratification in chronic heart failure (CHF); however, its predictive value is unknown with carvedilol treatment. Therefore, we sought to investigate the prognostic role of gas-exchange parameters obtained from symptom-limited cardiopulmonary exercise testing (CPX) in patients with CHF that is treated with carvedilol.
A total of 508 consecutive patients (443 men, mean age [± SD] 59 ± 9 years) with a mean left ventricular ejection fraction (LVEF) of 25% ± 7% underwent CPX. The peak VO2 was 13.9 ± 3 mL/kg/min; the rate of increase of minute ventilation per unit of increase of carbon dioxide production (VE/VCO2 slope) was 32 ± 2. Outcomes (cardiovascular death or urgent heart transplantation) were determined when all patients who survived had been observed for a minimum of 6 months.
Patients were divided into groups according to treatment (carvedilol and non-carvedilol); 236 patients were treated with carvedilol (46%), at a mean dose of 25 ±13 mg. The VE/CO2 slope, LVEF, peak VO2, and carvedilol treatment were revealed by means of multivariate analysis to be independent and additional predictors in the total population; VE/VCO2 slope, LVEF, and peak VO2 were revealed to be independent and additional predictors in the patients in the noncarvedilol group (all
P <.001); and only peak VO2 was revealed to be an independent and additional predictor in the patients in the carvedilol group (
P <.01). In the carvedilol group, mortality rates were 26%, 11%, 10%, and 4% (
P <.05) in patients with peak VO2 ≤10 mL/kg/min, >10 to ≤14 mL/kg/min, >14 to18 mL/kg/min, and ≥18 mL/kg/min, respectively. No difference in mortality rates according to peak VO2 or additional outcome indices were identified in the 212 patients with peak VO2 >10 mL/kg/min.
Peak VO2 provides limited predictive information in patients with CHF that is treated with carvedilol, and no additional gas exchange parameter yields supplementary advice.</abstract><cop>New York, NY</cop><pub>Mosby, Inc</pub><pmid>14999209</pmid><doi>10.1016/j.ahj.2003.10.026</doi><tpages>8</tpages></addata></record> |
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| source | MEDLINE; ScienceDirect Journals (5 years ago - present); ProQuest Central UK/Ireland |
| subjects | Adrenergic beta-Antagonists - therapeutic use Beta blockers Biological and medical sciences Carbazoles - therapeutic use Cardiology. Vascular system Drug therapy Exercise Test Female Heart Heart attacks Heart failure Heart Failure - drug therapy Heart Failure - metabolism Heart failure, cardiogenic pulmonary edema, cardiac enlargement Humans Male Medical prognosis Medical sciences Middle Aged Mortality Multivariate analysis Oxygen Consumption Prognosis Propanolamines - therapeutic use Proportional Hazards Models Pulmonary Gas Exchange Regression analysis Risk Factors Stroke Volume Values Ventilation |
| title | Limited predictive value of cardiopulmonary exercise indices in patients with moderate chronic heart failure treated with carvedilol |
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