SPC365

Prognostic Value of Cardiopulmonary Exercise Testing in Ambulatory Heart Failure Patients

Session: Sessão de Posters 55 - Congestão, instabilidade e marcadores prognósticos na insuficiência cardíaca avançada
Speaker: Luana Alves

Congress: CPC 2026
Topic: D. Heart Failure
Theme: 10. Chronic Heart Failure
Subtheme: 10.3 Chronic Heart Failure – Diagnostic Methods
Session Type: Posters Eletrónicos
FP Number: ---
Authors: Luana Alves; José Silva-Cardoso; Rui André Rodrigues; Sandra Amorim

<p style="text-align:justify"><span style="font-size:medium"><span style="font-family:Aptos,sans-serif"><span style="color:#000000"><strong><span style="font-family:&quot;Times New Roman&quot;,serif">Background: </span></strong><span style="font-family:&quot;Times New Roman&quot;,serif">Cardiopulmonary exercise testing (CPET) plays a central role in the functional and prognostic assessment of patients with heart failure (HF). While peak oxygen uptake (peak VO2) is the most commonly used parameter, its prognostic utility may be limited&nbsp;in patients unable to achieve maximal effort, and the role of complementary CPET-derived indices remains incompletely defined. </span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:medium"><span style="font-family:Aptos,sans-serif"><span style="color:#000000"><strong><span style="font-family:&quot;Times New Roman&quot;,serif">Objectives: </span></strong><span style="font-family:&quot;Times New Roman&quot;,serif">To evaluate the prognostic value of CPET-derived parameters and their association with clinical severity and outcomes in ambulatory HF patients. </span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:medium"><span style="font-family:Aptos,sans-serif"><span style="color:#000000"><strong><span style="font-family:&quot;Times New Roman&quot;,serif">Methods: </span></strong><span style="font-family:&quot;Times New Roman&quot;,serif">We conducted a single-centre retrospective cohort study of patients with HF, NYHA (New York Heart Association) class I&ndash;IV, INTERMACS (Interagency Registry for Mechanically Assisted Circulatory Support) profile 4&ndash;7, who underwent CPET between January 2023 and September 2025. Patients with prior heart transplantation, LVAD (left ventricular assist device), isolated pulmonary hypertension, hypertrophic or infiltrative cardiomyopathy were excluded. Clinical, laboratory and&nbsp;echocardiographic data, as well as Seattle Heart Failure Model (SHFM) scores were collected from the closest assessment to CPET. The primary outcome was a composite of all-cause mortality, heart transplantation or LVAD implantation. </span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:medium"><span style="font-family:Aptos,sans-serif"><span style="color:#000000"><strong><span style="font-family:&quot;Times New Roman&quot;,serif">Results:&nbsp; </span></strong><span style="font-family:&quot;Times New Roman&quot;,serif">Eighty-one patients were included (mean age 51.5 &plusmn; 13.0 years; 74% male); among these,&nbsp;41 (50.6%) achieved a maximal CPET. Over a mean follow-up of 577 &plusmn; 433 days, 17 patients (21.0%) experienced the primary outcome, including death in 5 patients (6.2%), heart transplantation in 10 (12.3%) and LVAD implantation in 2 (2.5%). Patients with events showed lower peak VO2 (14.1 &plusmn; 3.2 vs 17.9 &plusmn; 5.3 mL/kg/min, p = 0.006), circulatory power (1844 &plusmn; 553 vs 2569 &plusmn; 983, p = 0.005) and peak PetCO2 (29.4 &plusmn; 5.7 vs 36.5 &plusmn; 5.6 mmHg, p &lt; 0.001), and higher VE/VCO2 slope (40.6 &plusmn; 8.8 vs 30.9 &plusmn; 6.8, p &lt; 0.001). These associations were preserved in patients undergoing submaximal CPET. In multivariable Cox regression, VE/VCO2 slope emerged as the sole independent CPET-derived predictor of adverse outcomes (HR 1.09 per unit, 95% CI 1.03&ndash;1.15; p = 0.002), with no significant interaction with exercise maximality. Overall discriminative performance was good (AUC = 0.78).</span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:medium"><span style="font-family:Aptos,sans-serif"><span style="color:#000000"><strong><span style="font-family:&quot;Times New Roman&quot;,serif">Conclusions: </span></strong><span style="font-family:&quot;Times New Roman&quot;,serif">CPET provides robust prognostic information in ambulatory HF patients regardless of exercise maximality. Multiple CPET-derived variables, including peak VO2, circulatory power and peak PetCO2, were associated with adverse outcomes; however, ventilatory inefficiency, quantified by VE/VCO2 slope, emerged as the strongest independent prognostic marker, retaining its predictive value even in submaximal exercise tests. These findings support the use of comprehensive CPET-based risk stratification in routine HF assessment, even when maximal effort is not achieved.</span></span></span></span></p>