Variables Measured During Cardiopulmonary Exercise Testing as Predictors of Mortality in Chronic Systolic Heart Failure
Abstract Background Data from a cardiopulmonary exercise (CPX) test are used to determine prognosis in patients with chronic heart failure (HF). However, few published studies have simultaneously compared the relative prognostic strength of multiple CPX variables. Objectives The study sought to desc...
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| creator | Keteyian, Steven J., PhD Patel, Mahesh, MD Kraus, William E., MD Brawner, Clinton A., PhD McConnell, Timothy R., PhD Piña, Ileana L., MD, MPH Leifer, Eric S., PhD Fleg, Jerome L., MD Blackburn, Gordon, PhD Fonarow, Gregg C., MD Chase, Paul J., PhD Piner, Lucy, MS Vest, Marianne, MA O’Connor, Christopher M., MD Ehrman, Jonathan K., PhD Walsh, Mary N., MD Ewald, Gregory, MD Bensimhon, Dan, MD Russell, Stuart D., MD |
| description | Abstract Background Data from a cardiopulmonary exercise (CPX) test are used to determine prognosis in patients with chronic heart failure (HF). However, few published studies have simultaneously compared the relative prognostic strength of multiple CPX variables. Objectives The study sought to describe the strength of the association among variables measured during a CPX test and all-cause mortality in patients with HF with reduced ejection fraction (HFrEF), including the influence of sex and patient effort, as measured by respiratory exchange ratio (RER). Methods Among patients (n = 2,100, 29% women) enrolled in the HF-ACTION (HF-A Controlled Trial Investigating Outcomes of exercise traiNing) trial, 10 CPX test variables measured at baseline (e.g., peak oxygen uptake [V o2 ], exercise duration, percent predicted peak V o2 [%ppV o2 ], ventilatory efficiency) were examined. Results Over a median follow-up of 32 months, there were 357 deaths. All CPX variables, except RER, were related to all-cause mortality (all p < 0.0001). Both %ppV o2 and exercise duration were equally able to predict (Wald chi-square: ∼141) and discriminate (c-index: 0.69) mortality. Peak V o2 (ml·kg–1 ·min–1 ) was the strongest predictor of mortality among men (Wald chi-square: 129) and exercise duration among women (Wald chi-square: 41). Multivariable analyses showed that %ppV o2 , exercise duration, and peak V o2 (ml·kg–1 ·min–1 ) were similarly able to predict and discriminate mortality. In men, a 10% 1-year mortality rate corresponded to a peak V o2 of 10.9 ml·kg–1 ·min–1 versus 5.3 ml·kg–1 ·min–1 in women. Conclusions Peak V o2 , exercise duration, and % ppV o2 carried the strongest ability to predict and discriminate the likelihood of death in patients with HFrEF. The prognosis associated with a given peak V o2 differed by sex. (Exercise Training Program to Improve Clinical Outcomes in Individuals With Congestive Heart Failure; NCT00047437 ) |
| doi_str_mv | 10.1016/j.jacc.2015.11.050 |
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However, few published studies have simultaneously compared the relative prognostic strength of multiple CPX variables. Objectives The study sought to describe the strength of the association among variables measured during a CPX test and all-cause mortality in patients with HF with reduced ejection fraction (HFrEF), including the influence of sex and patient effort, as measured by respiratory exchange ratio (RER). Methods Among patients (n = 2,100, 29% women) enrolled in the HF-ACTION (HF-A Controlled Trial Investigating Outcomes of exercise traiNing) trial, 10 CPX test variables measured at baseline (e.g., peak oxygen uptake [V o2 ], exercise duration, percent predicted peak V o2 [%ppV o2 ], ventilatory efficiency) were examined. Results Over a median follow-up of 32 months, there were 357 deaths. All CPX variables, except RER, were related to all-cause mortality (all p < 0.0001). Both %ppV o2 and exercise duration were equally able to predict (Wald chi-square: ∼141) and discriminate (c-index: 0.69) mortality. Peak V o2 (ml·kg–1 ·min–1 ) was the strongest predictor of mortality among men (Wald chi-square: 129) and exercise duration among women (Wald chi-square: 41). Multivariable analyses showed that %ppV o2 , exercise duration, and peak V o2 (ml·kg–1 ·min–1 ) were similarly able to predict and discriminate mortality. In men, a 10% 1-year mortality rate corresponded to a peak V o2 of 10.9 ml·kg–1 ·min–1 versus 5.3 ml·kg–1 ·min–1 in women. Conclusions Peak V o2 , exercise duration, and % ppV o2 carried the strongest ability to predict and discriminate the likelihood of death in patients with HFrEF. The prognosis associated with a given peak V o2 differed by sex. (Exercise Training Program to Improve Clinical Outcomes in Individuals With Congestive Heart Failure; NCT00047437 )</description><identifier>ISSN: 0735-1097</identifier><identifier>EISSN: 1558-3597</identifier><identifier>DOI: 10.1016/j.jacc.2015.11.050</identifier><identifier>PMID: 26892413</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>Adult ; Aged ; Cardiology ; Cardiovascular ; Cause of Death - trends ; Confidence intervals ; Disease Progression ; Efficiency ; Exercise ; Exercise Test - methods ; Female ; Follow-Up Studies ; Heart attacks ; Heart failure ; Heart Failure, Systolic - diagnosis ; Heart Failure, Systolic - mortality ; Heart Failure, Systolic - physiopathology ; Heart rate ; Humans ; Internal Medicine ; Male ; Medical prognosis ; Middle Aged ; Mortality ; Oxygen Consumption - physiology ; peak Vo2 ; Predictive Value of Tests ; Prognosis ; respiratory exchange ratio ; sex ; Stroke Volume - physiology ; Studies ; survival ; Survival Rate - trends ; Time Factors ; United States - epidemiology ; Ventilation ; Women</subject><ispartof>Journal of the American College of Cardiology, 2016-02, Vol.67 (7), p.780-789</ispartof><rights>American College of Cardiology Foundation</rights><rights>2016 American College of Cardiology Foundation</rights><rights>Copyright © 2016 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.</rights><rights>Copyright Elsevier Limited Feb 23, 2016</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c571t-f3829abc70ca5e41aaa5937799e40db9eccc7f8068a0d459749c37c906be6a683</citedby><cites>FETCH-LOGICAL-c571t-f3829abc70ca5e41aaa5937799e40db9eccc7f8068a0d459749c37c906be6a683</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://dx.doi.org/10.1016/j.jacc.2015.11.050$$EHTML$$P50$$Gelsevier$$Hfree_for_read</linktohtml><link.rule.ids>230,314,777,781,882,3537,27905,27906,45976</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/26892413$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Keteyian, Steven J., PhD</creatorcontrib><creatorcontrib>Patel, Mahesh, MD</creatorcontrib><creatorcontrib>Kraus, William E., MD</creatorcontrib><creatorcontrib>Brawner, Clinton A., PhD</creatorcontrib><creatorcontrib>McConnell, Timothy R., PhD</creatorcontrib><creatorcontrib>Piña, Ileana L., MD, MPH</creatorcontrib><creatorcontrib>Leifer, Eric S., PhD</creatorcontrib><creatorcontrib>Fleg, Jerome L., MD</creatorcontrib><creatorcontrib>Blackburn, Gordon, PhD</creatorcontrib><creatorcontrib>Fonarow, Gregg C., MD</creatorcontrib><creatorcontrib>Chase, Paul J., PhD</creatorcontrib><creatorcontrib>Piner, Lucy, MS</creatorcontrib><creatorcontrib>Vest, Marianne, MA</creatorcontrib><creatorcontrib>O’Connor, Christopher M., MD</creatorcontrib><creatorcontrib>Ehrman, Jonathan K., PhD</creatorcontrib><creatorcontrib>Walsh, Mary N., MD</creatorcontrib><creatorcontrib>Ewald, Gregory, MD</creatorcontrib><creatorcontrib>Bensimhon, Dan, MD</creatorcontrib><creatorcontrib>Russell, Stuart D., MD</creatorcontrib><creatorcontrib>HF-ACTION Investigators</creatorcontrib><title>Variables Measured During Cardiopulmonary Exercise Testing as Predictors of Mortality in Chronic Systolic Heart Failure</title><title>Journal of the American College of Cardiology</title><addtitle>J Am Coll Cardiol</addtitle><description>Abstract Background Data from a cardiopulmonary exercise (CPX) test are used to determine prognosis in patients with chronic heart failure (HF). However, few published studies have simultaneously compared the relative prognostic strength of multiple CPX variables. Objectives The study sought to describe the strength of the association among variables measured during a CPX test and all-cause mortality in patients with HF with reduced ejection fraction (HFrEF), including the influence of sex and patient effort, as measured by respiratory exchange ratio (RER). Methods Among patients (n = 2,100, 29% women) enrolled in the HF-ACTION (HF-A Controlled Trial Investigating Outcomes of exercise traiNing) trial, 10 CPX test variables measured at baseline (e.g., peak oxygen uptake [V o2 ], exercise duration, percent predicted peak V o2 [%ppV o2 ], ventilatory efficiency) were examined. Results Over a median follow-up of 32 months, there were 357 deaths. All CPX variables, except RER, were related to all-cause mortality (all p < 0.0001). Both %ppV o2 and exercise duration were equally able to predict (Wald chi-square: ∼141) and discriminate (c-index: 0.69) mortality. Peak V o2 (ml·kg–1 ·min–1 ) was the strongest predictor of mortality among men (Wald chi-square: 129) and exercise duration among women (Wald chi-square: 41). Multivariable analyses showed that %ppV o2 , exercise duration, and peak V o2 (ml·kg–1 ·min–1 ) were similarly able to predict and discriminate mortality. In men, a 10% 1-year mortality rate corresponded to a peak V o2 of 10.9 ml·kg–1 ·min–1 versus 5.3 ml·kg–1 ·min–1 in women. Conclusions Peak V o2 , exercise duration, and % ppV o2 carried the strongest ability to predict and discriminate the likelihood of death in patients with HFrEF. The prognosis associated with a given peak V o2 differed by sex. (Exercise Training Program to Improve Clinical Outcomes in Individuals With Congestive Heart Failure; NCT00047437 )</description><subject>Adult</subject><subject>Aged</subject><subject>Cardiology</subject><subject>Cardiovascular</subject><subject>Cause of Death - trends</subject><subject>Confidence intervals</subject><subject>Disease Progression</subject><subject>Efficiency</subject><subject>Exercise</subject><subject>Exercise Test - methods</subject><subject>Female</subject><subject>Follow-Up Studies</subject><subject>Heart attacks</subject><subject>Heart failure</subject><subject>Heart Failure, Systolic - diagnosis</subject><subject>Heart Failure, Systolic - mortality</subject><subject>Heart Failure, Systolic - physiopathology</subject><subject>Heart rate</subject><subject>Humans</subject><subject>Internal Medicine</subject><subject>Male</subject><subject>Medical prognosis</subject><subject>Middle Aged</subject><subject>Mortality</subject><subject>Oxygen Consumption - physiology</subject><subject>peak Vo2</subject><subject>Predictive Value of Tests</subject><subject>Prognosis</subject><subject>respiratory exchange ratio</subject><subject>sex</subject><subject>Stroke Volume - physiology</subject><subject>Studies</subject><subject>survival</subject><subject>Survival Rate - trends</subject><subject>Time Factors</subject><subject>United States - epidemiology</subject><subject>Ventilation</subject><subject>Women</subject><issn>0735-1097</issn><issn>1558-3597</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2016</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqFkkFvEzEQhS0EoiHwBzggS1y4JHjWu-u1hCqh0FKkViC1cLUm3knr4KyDvVuaf1-vUgr0ACdb8jfjefMeYy9BzEFA_XY9X6O180JANQeYi0o8YhOoqmYmK60es4lQspqB0OqAPUtpLYSoG9BP2UFRN7ooQU7Yz28YHS49JX5GmIZILf8wRNdd8gXG1oXt4Dehw7jjRzcUrUvELyj1I4CJf8m8s32IiYcVPwuxR-_6HXcdX1zF0DnLz3epDz5fTghjz4_R-fzLc_ZkhT7Ri7tzyr4eH10sTmannz9-Wrw_ndlKQT9byabQuLRKWKyoBESstFRKaypFu9RkrVWrJutC0ZZZdamtVFaLekk11o2cssN93-2w3FBrqesjerONbpM1mYDO_P3SuStzGa5NqWqAvMApe3PXIIYfQ1ZuNi5Z8h47CkMy0EhV6FJJ_X9U1UqopoFxrNcP0HUYYpc3MVK1FKJR49_FnrIxpBRpdT83CDNGwKzNGAEzRsAAmByBXPTqT8X3Jb88z8C7PUB579eOoknWUWezk5Fsb9rg_t3_8EG59S4bjf477Sj91mFSYYQ5H0M4ZhAqkX2TIG8BZ5PY7Q</recordid><startdate>20160223</startdate><enddate>20160223</enddate><creator>Keteyian, Steven J., PhD</creator><creator>Patel, Mahesh, MD</creator><creator>Kraus, William E., MD</creator><creator>Brawner, Clinton A., PhD</creator><creator>McConnell, Timothy R., PhD</creator><creator>Piña, Ileana L., MD, MPH</creator><creator>Leifer, Eric S., PhD</creator><creator>Fleg, Jerome L., MD</creator><creator>Blackburn, Gordon, PhD</creator><creator>Fonarow, Gregg C., MD</creator><creator>Chase, Paul J., PhD</creator><creator>Piner, Lucy, MS</creator><creator>Vest, Marianne, MA</creator><creator>O’Connor, Christopher M., MD</creator><creator>Ehrman, Jonathan K., PhD</creator><creator>Walsh, Mary N., MD</creator><creator>Ewald, Gregory, MD</creator><creator>Bensimhon, Dan, MD</creator><creator>Russell, Stuart D., MD</creator><general>Elsevier Inc</general><general>Elsevier Limited</general><scope>6I.</scope><scope>AAFTH</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>7T5</scope><scope>7TK</scope><scope>H94</scope><scope>K9.</scope><scope>NAPCQ</scope><scope>7X8</scope><scope>7U7</scope><scope>C1K</scope><scope>5PM</scope></search><sort><creationdate>20160223</creationdate><title>Variables Measured During Cardiopulmonary Exercise Testing as Predictors of Mortality in Chronic Systolic Heart Failure</title><author>Keteyian, Steven J., PhD ; Patel, Mahesh, MD ; Kraus, William E., MD ; Brawner, Clinton A., PhD ; McConnell, Timothy R., PhD ; Piña, Ileana L., MD, MPH ; Leifer, Eric S., PhD ; Fleg, Jerome L., MD ; Blackburn, Gordon, PhD ; Fonarow, Gregg C., MD ; Chase, Paul J., PhD ; Piner, Lucy, MS ; Vest, Marianne, MA ; O’Connor, Christopher M., MD ; Ehrman, Jonathan K., PhD ; Walsh, Mary N., MD ; Ewald, Gregory, MD ; Bensimhon, Dan, MD ; Russell, Stuart D., MD</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c571t-f3829abc70ca5e41aaa5937799e40db9eccc7f8068a0d459749c37c906be6a683</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2016</creationdate><topic>Adult</topic><topic>Aged</topic><topic>Cardiology</topic><topic>Cardiovascular</topic><topic>Cause of Death - trends</topic><topic>Confidence intervals</topic><topic>Disease Progression</topic><topic>Efficiency</topic><topic>Exercise</topic><topic>Exercise Test - methods</topic><topic>Female</topic><topic>Follow-Up Studies</topic><topic>Heart attacks</topic><topic>Heart failure</topic><topic>Heart Failure, Systolic - diagnosis</topic><topic>Heart Failure, Systolic - mortality</topic><topic>Heart Failure, Systolic - physiopathology</topic><topic>Heart rate</topic><topic>Humans</topic><topic>Internal Medicine</topic><topic>Male</topic><topic>Medical prognosis</topic><topic>Middle Aged</topic><topic>Mortality</topic><topic>Oxygen Consumption - physiology</topic><topic>peak Vo2</topic><topic>Predictive Value of Tests</topic><topic>Prognosis</topic><topic>respiratory exchange ratio</topic><topic>sex</topic><topic>Stroke Volume - physiology</topic><topic>Studies</topic><topic>survival</topic><topic>Survival Rate - trends</topic><topic>Time Factors</topic><topic>United States - epidemiology</topic><topic>Ventilation</topic><topic>Women</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Keteyian, Steven J., PhD</creatorcontrib><creatorcontrib>Patel, Mahesh, MD</creatorcontrib><creatorcontrib>Kraus, William E., MD</creatorcontrib><creatorcontrib>Brawner, Clinton A., PhD</creatorcontrib><creatorcontrib>McConnell, Timothy R., PhD</creatorcontrib><creatorcontrib>Piña, Ileana L., MD, MPH</creatorcontrib><creatorcontrib>Leifer, Eric S., PhD</creatorcontrib><creatorcontrib>Fleg, Jerome L., MD</creatorcontrib><creatorcontrib>Blackburn, Gordon, PhD</creatorcontrib><creatorcontrib>Fonarow, Gregg C., MD</creatorcontrib><creatorcontrib>Chase, Paul J., PhD</creatorcontrib><creatorcontrib>Piner, Lucy, MS</creatorcontrib><creatorcontrib>Vest, Marianne, MA</creatorcontrib><creatorcontrib>O’Connor, Christopher M., MD</creatorcontrib><creatorcontrib>Ehrman, Jonathan K., PhD</creatorcontrib><creatorcontrib>Walsh, Mary N., MD</creatorcontrib><creatorcontrib>Ewald, Gregory, MD</creatorcontrib><creatorcontrib>Bensimhon, Dan, MD</creatorcontrib><creatorcontrib>Russell, Stuart D., MD</creatorcontrib><creatorcontrib>HF-ACTION Investigators</creatorcontrib><collection>ScienceDirect Open Access Titles</collection><collection>Elsevier:ScienceDirect:Open Access</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Immunology Abstracts</collection><collection>Neurosciences Abstracts</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Premium</collection><collection>MEDLINE - Academic</collection><collection>Toxicology Abstracts</collection><collection>Environmental Sciences and Pollution Management</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Journal of the American College of Cardiology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Keteyian, Steven J., PhD</au><au>Patel, Mahesh, MD</au><au>Kraus, William E., MD</au><au>Brawner, Clinton A., PhD</au><au>McConnell, Timothy R., PhD</au><au>Piña, Ileana L., MD, MPH</au><au>Leifer, Eric S., PhD</au><au>Fleg, Jerome L., MD</au><au>Blackburn, Gordon, PhD</au><au>Fonarow, Gregg C., MD</au><au>Chase, Paul J., PhD</au><au>Piner, Lucy, MS</au><au>Vest, Marianne, MA</au><au>O’Connor, Christopher M., MD</au><au>Ehrman, Jonathan K., PhD</au><au>Walsh, Mary N., MD</au><au>Ewald, Gregory, MD</au><au>Bensimhon, Dan, MD</au><au>Russell, Stuart D., MD</au><aucorp>HF-ACTION Investigators</aucorp><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Variables Measured During Cardiopulmonary Exercise Testing as Predictors of Mortality in Chronic Systolic Heart Failure</atitle><jtitle>Journal of the American College of Cardiology</jtitle><addtitle>J Am Coll Cardiol</addtitle><date>2016-02-23</date><risdate>2016</risdate><volume>67</volume><issue>7</issue><spage>780</spage><epage>789</epage><pages>780-789</pages><issn>0735-1097</issn><eissn>1558-3597</eissn><abstract>Abstract Background Data from a cardiopulmonary exercise (CPX) test are used to determine prognosis in patients with chronic heart failure (HF). However, few published studies have simultaneously compared the relative prognostic strength of multiple CPX variables. Objectives The study sought to describe the strength of the association among variables measured during a CPX test and all-cause mortality in patients with HF with reduced ejection fraction (HFrEF), including the influence of sex and patient effort, as measured by respiratory exchange ratio (RER). Methods Among patients (n = 2,100, 29% women) enrolled in the HF-ACTION (HF-A Controlled Trial Investigating Outcomes of exercise traiNing) trial, 10 CPX test variables measured at baseline (e.g., peak oxygen uptake [V o2 ], exercise duration, percent predicted peak V o2 [%ppV o2 ], ventilatory efficiency) were examined. Results Over a median follow-up of 32 months, there were 357 deaths. All CPX variables, except RER, were related to all-cause mortality (all p < 0.0001). Both %ppV o2 and exercise duration were equally able to predict (Wald chi-square: ∼141) and discriminate (c-index: 0.69) mortality. Peak V o2 (ml·kg–1 ·min–1 ) was the strongest predictor of mortality among men (Wald chi-square: 129) and exercise duration among women (Wald chi-square: 41). Multivariable analyses showed that %ppV o2 , exercise duration, and peak V o2 (ml·kg–1 ·min–1 ) were similarly able to predict and discriminate mortality. In men, a 10% 1-year mortality rate corresponded to a peak V o2 of 10.9 ml·kg–1 ·min–1 versus 5.3 ml·kg–1 ·min–1 in women. Conclusions Peak V o2 , exercise duration, and % ppV o2 carried the strongest ability to predict and discriminate the likelihood of death in patients with HFrEF. The prognosis associated with a given peak V o2 differed by sex. (Exercise Training Program to Improve Clinical Outcomes in Individuals With Congestive Heart Failure; NCT00047437 )</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>26892413</pmid><doi>10.1016/j.jacc.2015.11.050</doi><tpages>10</tpages><oa>free_for_read</oa></addata></record> |
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| identifier | ISSN: 0735-1097 |
| ispartof | Journal of the American College of Cardiology, 2016-02, Vol.67 (7), p.780-789 |
| issn | 0735-1097 1558-3597 |
| language | eng |
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| source | MEDLINE; Elsevier ScienceDirect Journals; Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals; Alma/SFX Local Collection |
| subjects | Adult Aged Cardiology Cardiovascular Cause of Death - trends Confidence intervals Disease Progression Efficiency Exercise Exercise Test - methods Female Follow-Up Studies Heart attacks Heart failure Heart Failure, Systolic - diagnosis Heart Failure, Systolic - mortality Heart Failure, Systolic - physiopathology Heart rate Humans Internal Medicine Male Medical prognosis Middle Aged Mortality Oxygen Consumption - physiology peak Vo2 Predictive Value of Tests Prognosis respiratory exchange ratio sex Stroke Volume - physiology Studies survival Survival Rate - trends Time Factors United States - epidemiology Ventilation Women |
| title | Variables Measured During Cardiopulmonary Exercise Testing as Predictors of Mortality in Chronic Systolic Heart Failure |
| url | https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2025-01-19T14%3A10%3A12IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-proquest_pubme&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=Variables%20Measured%20During%20Cardiopulmonary%20Exercise%20Testing%20as%20Predictors%20of%20Mortality%20in%20Chronic%20Systolic%20Heart%20Failure&rft.jtitle=Journal%20of%20the%20American%20College%20of%20Cardiology&rft.au=Keteyian,%20Steven%20J.,%20PhD&rft.aucorp=HF-ACTION%20Investigators&rft.date=2016-02-23&rft.volume=67&rft.issue=7&rft.spage=780&rft.epage=789&rft.pages=780-789&rft.issn=0735-1097&rft.eissn=1558-3597&rft_id=info:doi/10.1016/j.jacc.2015.11.050&rft_dat=%3Cproquest_pubme%3E3957377711%3C/proquest_pubme%3E%3Curl%3E%3C/url%3E&disable_directlink=true&sfx.directlink=off&sfx.report_link=0&rft_id=info:oai/&rft_pqid=1766300877&rft_id=info:pmid/26892413&rft_els_id=1_s2_0_S0735109715077931&rfr_iscdi=true |