Rediscovering CPET: the prognostic value of hemodynamic gain index in heart failure

Abstract Introduction Cardiopulmonary exercise testing (CPET) is recommended in patients with heart failure (HF) to optimize prescription and as part of the evaluation for transplantation. Hemodynamic gain index (HGI) derived from CPET has been proposed a new marker risk stratification general population cohorts. Purpose We aimed evaluate prognostic value HGI HF. Methods conducted single-centre study assessing consecutive HF who underwent 2013 2017. was calculated based on rate (HR) systolic blood pressure (SBP): = [(HRpeak × SBPpeak) ? (HRrest SBPrest)] / SBPrest). Classic recently variables were collected, including peak O2 uptake (pVO2), minute ventilation–CO2 production (VE/VCO2 slope), circulatory power (CP pVO2 SBP), ventilatory (VP SBP/(VE/VCO2) slope). The primary outcome composite hospitalization, transplant, all-cause mortality. Results A total 212 (mean age 55.4±10.9, 76.9% male) included. Most had dilated cardiomyopathy (43.9%) followed by ischaemic aetiology (38.7%), mean left ventricle ejection fraction 29±13%. most used protocol modified Naughton (76.6%), original (18.7%), Bruce (4.8%). Mean 16.7±5.9mL kg–1 min–1 median VE/VCO2 slope 37.5 [32.7–44.3]. VP 3.46±1.31mmHg while CP 1927 [1427–2697]mmHg min/mL/kg. 0.90±0.5 bpm/mmHg. Despite weak, there significant positive correlations between (rs=0.55, p<0.01), (r=0.60, (rs=0.68, but negative correlation (rs=?0.45, p<0.01). grouped terciles: T1 (<0.59), T2 (0.59–1.02), T3 (>1.02). After follow-up 71 [49–81] months, occurred 66.0% (rehospitalization, death 56.1%, 25.9%, 32.5%, respectively). In group, multivariable-adjusted odds ratio (OR) 3.73 (95% CI 1.97–7.06, p<0.01) compared T3. OR 0.47 0.27–0.81, T1. There no differences groups. Kaplan-Meier estimates during according tercile are shown Figure 1. Conclusion inversely associated mortality failure, enhancing role stratification. Funding Acknowledgement Type funding sources: None.