Clinical TrialDevelopment of a Cardiopulmonary Exercise Prognostic Score for Optimizing Risk Stratification in Heart Failure: The (P)e(R)i(O)dic (B)reathing During (E)xercise (PROBE) Study
Section snippets
Methods
This was a multicenter study consisting of HF patients from the cardiopulmonary exercise laboratories at San Paolo Hospital, Palo Alto Health Care System, Palo Alto, CA; Virginia Commonwealth University, Richmond, VA; and the LeBauer Cardiovascular Research Foundation, Greensboro, NC. Six hundred and ninety-five subjects diagnosed to have HF, who underwent a symptom-limited CPET between June 1998 and June 2007, were included. Subjects with significant obstructive lung disease evidenced by a
Results
The case series comprised 695 patients; 31% from Italy (Cardiopulmonary Laboratory at S. Paolo Hospital, Milano) and 61% from the United States (23% from Virginia Commonwealth University; 26% from Palo Alto Health System Care and 20% from the LeBauer Research Foundation). Table 1 shows the baseline clinical characteristics of patient population. Distribution of the covariates is shown in Table 2. The median follow-up time was 24 months and there were 134 cardiac-related deaths during this
Discussion
EPB is an abnormal pathophysiological phenomenon that occurs at a rate that varies from 18% to 30% across different HF populations and carries key information on the clinical evolution of HF syndrome.6, 7, 8, 9, 19, 20, 21 The pathogenesis of EPB, although complicated, seems to derive from a combination of deregulatory pathways involved in the mechanical and neural feedback control of the cardiopulmonary system.19, 20 EPB prevalence is similar in both systolic and diastolic HF.22 Present
Conclusions and Perspectives
The present results underscore the importance of systematic recognition, analysis, and reporting of EPB occurrence in the CPET summary report. EPB alone is a strong prognostic marker, but when combined with other established CPET variables, the prognostic power of CPET is enhanced. The value of EPB is supported by the following: 1) PROBE scores excluding EPB were not significant predictors of risk with the exception of patients with a high VE/VCO2 slope; 2) in patients already at high risk
Disclosures
None.
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Supported by a Grant from the Monzino Foundation, Milano-ITALY,
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