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

Ugo Corrà, Pier Giuseppe Agostoni, Stefan D Anker, Andrew J S Coats, Maria G Crespo Leiro, Rudolph A de Boer, Veli-Pekka Hairola, Loreena Hill, Mitja Lainscak, Lars H Lund, Marco Metra, Piotr Ponikowski, Jillian Riley, Petar M Seferović, Massimo F Piepoli

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Abstract

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.

Original languageEnglish
Pages (from-to)3-15
JournalEuropean Journal of Heart Failure
Volume20
Issue number1
Early online date18 Sep 2017
DOIs
Publication statusPublished - Jan 2018
Externally publishedYes

Keywords

  • Journal Article
  • Review

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    Corrà, U., Agostoni, P. G., Anker, S. D., Coats, A. J. S., Crespo Leiro, M. G., de Boer, R. A., Hairola, V-P., Hill, L., Lainscak, M., Lund, L. H., Metra, M., Ponikowski, P., Riley, J., Seferović, P. M., & Piepoli, M. F. (2018). 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, 20(1), 3-15. https://doi.org/10.1002/ejhf.979