TY - JOUR T1 - The prognostic value of the cardiorespiratory optimal point during submaximal exercise testing in heart failure JO - Revista Portuguesa de Cardiologia T2 - AU - Ferreira Reis,João AU - Gonçalves,António AU - Brás,Pedro AU - Moreira,Rita AU - Pereira-da-Silva,Tiago AU - Timóteo,Ana Teresa AU - Soares,Rui AU - Cruz Ferreira,Rui SN - 08702551 M3 - 10.1016/j.repc.2021.06.023 DO - 10.1016/j.repc.2021.06.023 UR - https://revportcardiol.org/pt-the-prognostic-value-cardiorespiratory-optimal-articulo-S0870255122002566 AB - IntroductionPeak oxygen consumption (pVO2) is a key parameter for assessing the prognosis of heart failure with reduced ejection fraction (HFrEF). However, it is less reliable when the cardiopulmonary exercise test (CPET) is not maximal. ObjectiveTo compare the prognostic power of various exercise parameters in submaximal CPET. MethodsAdult patients with HFrEF undergoing CPET in a tertiary center were prospectively assessed. Submaximal CPET was defined as a respiratory exchange ratio ≤1.10. Patients were followed for one year for the primary endpoint of cardiac death and urgent heart transplantation (HT). Various CPET parameters were analyzed as potential predictors of the combined endpoint and their prognostic power (area under the curve [AUC]) was compared using the Hanley-McNeil test. ResultsCPET was performed in 442 HFrEF patients (mean age 56±12 years, 80% male), of whom 290 (66%) had a submaximal CPET. Seventeen patients (6%) reached the primary endpoint. The cardiorespiratory optimal point (COP) had the highest AUC value (0.989, p<0.001), and significantly higher prognostic power than other tested parameters, with pVO2 presenting an AUC of 0.753 (p=0.001). COP ≥36 had significantly lower survival free of HT during follow-up (p<0.001) and presented a sensitivity of 100% and a specificity of 89% for the primary endpoint. ConclusionCOP had the highest prognostic power of all parameters analyzed in a submaximal CPET. This parameter can help stratify HFrEF patients who are physiologically unable to reach a maximal level of exercise. ER -