Role of cardiopulmonary exercise testing in clinical stratification in heart failure. A position paper from the Committee on Exercise Physiology and Training of the Heart Failure Association of the European Society of Cardiology

European Journal of Heart Failure - Tập 20 Số 1 - Trang 3-15 - 2018
Ugo Corrà1, Piergiuseppe Agostoni2,3, Stefan D. Anker4, Andrew J.S. Coats5, María G. Crespo‐Leiro6, Rudolf A. de Boer7, Veli‐Pekka Harjola8, Loreena Hill9, Mitja Lainščak10,11, Lars H. Lund12,13, Marco Metra14, Piotr Ponikowski15, Jillian Riley16, Petar Seferović17, Massimo Piepoli18
1Cardiology Division, Istituti Clinici Scientifici Maugeri, Centro Medico di Riabilitazione di Veruno, Veruno, Novara, Italy
2Cardiology Center of Monzino, IRCCS, Milan, Italy
3Cardiology Center of Monzino, IRCCS, Milan, Italy; and Cardiovascular Section, Department of Clinical Sciences and Community Health University of Milan Milan Italy
4Division of Cardiology and Metabolism ‐ Heart Failure, Cachexia & Sarcopenia, Department of Cardiology (CVK) and Berlin‐Brandenburg Center for Regenerative Therapies (BCRT), at Charité University Medicine, Berlin; Department of Cardiology and Pneumology University Medicine Göttingen (UMG), Göttingen, Germany; German Center for Cardiovascular Research (DZHK) Berlin Germany
5University of Warwick, Coventry, UK
6Heart Failure and Heart Transplant Unit Complejo Hospitalario Universitario A Coruña (CHUAC), CIBERCV La Coruña Spain
7University Medical Center Groningen, Groningen, The Netherlands
8Emergency Medicine, University of Helsinki, Department of Emergency Medicine and Services Helsinki University Hospital Helsinki Finland
9School of Nursing and Midwifery, Queen's University Belfast, UK
10Faculty of Medicine University of Ljubljana; and Center for Heart Failure, General Hospital Murska Sobota Slovenia
11Faculty of Medicine, University of Ljubljana
12Department of Medicine, Karolinska Institutet
13Department of Medicine, Karolinska Institutet, and Heart and Vascular Theme, Karolinska University Hospital, Stockholm, Sweden
14University of Brescia, Italy
15Wroclaw Medical University, Wroclaw, Poland
16National Heart and Lung Institute, Imperial College, London, UK
17Internal Medicine, University of Belgrade School of Medicine, Belgrade, Serbia
18Heart Failure Unit, Cardiac Department, Guglielmo da Saliceto Hospital, Piacenza, Italy

Tóm tắt

Traditionally, the main indication for cardiopulmonary exercise testing (CPET) in heart failure (HF) was for the selection of candidates to heart transplantation: CPET was mainly performed in middle‐aged male patients with HF and reduced left ventricular ejection fraction. Today, CPET is used in broader patients' populations, including women, elderly, patients with co‐morbidities, those with preserved ejection fraction, or left ventricular assistance device recipients, i.e. individuals with different responses to incremental exercise and markedly different prognosis. Moreover, the diagnostic and prognostic utility of symptom‐limited CPET parameters derived from submaximal tests is more and more considered, since many patients are unable to achieve maximal aerobic power. Repeated tests are also being used for risk stratification and evaluation of intervention, so that these data are now available. Finally, patients, physicians and healthcare decision makers are increasingly considering how treatments might impact morbidity and quality of life rather than focusing more exclusively on hard endpoints (such as mortality) as was often the case in the past. Innovative prognostic flowcharts, with CPET at their core, that help optimize risk stratification and the selection of management options in HF patients, have been developed.

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European Journal of Heart Failure

Tập 20 Số 1

3-15

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