Prognostic value of blood pressure and heart rate responses during cardiopulmonary exercise testing in patients with heart failure: a stratified analysis by ejection fraction
H Mibe, K Kamiya, N Hamazaki, E Maekawa, C Noda, K Kida, N Suzuki, T Fujino, S Yamamoto, T Ikoma, Y Mizuno, I Matsumoto, S Miyazaki, T Nakade, Y MatsueAbstract
Background
Abnormal blood pressure and heart rate responses during cardiopulmonary exercise testing (CPET) have been reported as adverse prognostic indicators in patients with heart failure (HF). However, the clinical significance of exercise-induced circulatory responses in patients with HF with preserved ejection fraction (HFpEF) remains unclear.
Purpose
This study aimed to evaluate the associations of blood pressure and heart rate responses during CPET with adverse outcomes, stratified by left ventricular ejection fraction (LVEF).
Methods
In this multicenter retrospective cohort study conducted at 7 institutions in Japan, 491 patients with HF who underwent CPET were included. Patients were categorized into two groups according to LVEF: <50% [heart failure with reduced ejection fraction (HFrEF), n=286] and ≥50% (HFpEF, n=205). Blood pressure response was assessed using Δsystolic blood pressure (SBP), calculated as [Peak SBP - Rest SBP], and chronotropic response was evaluated using the chronotropic response index (CRI), calculated as [(peak heart rate - resting heart rate) / (220 - age - resting heart rate)]. The primary outcome was a composite of all-cause death and HF hospitalization within 3 years after CPET. We evaluated the prognostic ability of ΔSBP and CRI for all-cause mortality using the area under the curve (AUC) of the receiver operating characteristic curve.
Results
The primary outcome occurred in 91 of 491 patients (18.5%) in the overall cohort. In the HFrEF group (n=286), 66 events (23.1%) were observed, whereas 25 events (12.2%) occurred in the HFpEF group (n=205).
In the overall cohort (n=491), the AUCs were 0.619 [95% confidence interval (CI): 0.557–0.681] for CRI and 0.609 (95% CI: 0.545–0.673) for ΔSBP. In the HFrEF group (n=286), the AUCs were 0.627 (95% CI: 0.551–0.703) for CRI and 0.575 (95% CI: 0.497–0.652) for ΔSBP. In the HFpEF group (n=205), the AUCs were 0.577 (95% CI: 0.458–0.696) for CRI and 0.649 (95% CI: 0.528–0.769) for ΔSBP, indicating relatively higher predictive ability of ΔSBP in HFpEF.
Conclusion
Although overall prognostic performance of both ΔSBP and CRI was modest, exercise-induced ΔSBP showed relatively better predictive ability in HFpEF, suggesting potential clinical relevance in this subgroup.ESC figure_mibe