Clinical InvestigationsThe prognostic value of body mass index and standard exercise testing in male Veterans with congestive heart failure*
Section snippets
Population
A total of 6,213 consecutive male veterans referred to one of two clinical exercise laboratories (Long Beach, California, 1987-1991; Palo Alto, California, 1992-2000) were used for analysis. From the total population, 522 patients had a history of CHF or clinical findings and test results. Echocardiograms were routinely obtained as part of the clinical evaluation but their measurements were not entered into our database. However, they did allow for exclusion of patients with serious valvular
Results
Although nonsustained ventricular tachycardia or frequent PVCs occurred in 18% of patients and 4% exhibited exertional hypotension during treadmill testing, there were no major complications in this group of CHF patients. A mean Borg scale of 17 was consistent with a near maximal effort in the majority of patients. The baseline data for the two groups along with subgroup comparisons between those who died and those who survived are included in Tables 1 and 2.
Discussion
In this population of patients with a history of CHF referred for exercise testing, mortality was higher in patients with lower exercise capacity (METs), lower BMI, ischemic etiology of CHF, and older age. A simple scoring system using these four parameters strongly predicts mortality.
Large academic centers that evaluate patients with advanced heart failure predominantly use peak VO2 consumption for prognostic information. The preponderance of published literature also focuses on this method of
References (45)
- et al.
The relationship between obesity and mortality in patients with heart failure
J Am Coll Cardiol
(2001) - et al.
Differential clinical prognostic classifications in dilated and ischemic advanced heart failure: the EPICAL study
Am Heart J
(2000) - et al.
Correlates and prognostic implication of exercise capacity in chronic congestive heart failure
Am J Cardiol
(1985) - et al.
Exercise-related ventilatory abnormalities and survival in congestive heart failure
Am J Cardiol
(1997) - et al.
Clinical determinants of mortality in patients with angiographically diagnosed ischemic or non-ischemic cardiomyopathy
J Am Coll Cardiol
(1997) - et al.
Predictors of total mortality and sudden death in mild to moderate heart failure. Captopril-Digoxin Study Group
J Am Coll Cardiol
(1989) - et al.
Clinical and exercise test predictors of all-cause mortality
Chest
(2001) - et al.
New practical treadmill protocol for clinical use
Am J Cardiol
(1977) - et al.
A comparison of the ramp versus standard exercise protocols
J Am Coll Cardiol
(1991) - et al.
A nomogram to predict exercise capacity from a specific activity questionnaire and clinical data
Am J Cardiol
(1994)
Cardiac morphology and left ventricular function in normotensive morbidly obese patients with and without congestive heart failure, and effect of weight loss
Am J Cardiol
Survival of patients with severe congestive heart failure treated with oral milrinone
J Am Coll Cardiol
Decreased coronary sinus oxygen content: a predictor of adverse prognosis in patients with severe congestive heart failure
J Am Coll Cardiol
Contrasting clinical properties and exercise responses in obese and lean hypertensive patients
J Am Coll Cardiol
Serial exercise testing and prognosis in selected patients considered for cardiac transplantation
Am Heart J
Predictors of prognosis in patients with stable mild to moderate heart failure
J Card Fail
Prevalence and mortality rate of congestive heart failure in the United States
J Am Coll Cardiol
Chronic heart failure in the very elderly: clinical status, survival, and prognostic factors in 188 patients more than 70 years old
Am Heart J
Heart failure with preserved systolic dysfunction
J Am Coll Cardiol
Poor survival of patients with idiopathic cardiomyopathy considered too well for transplantation
Am J Med
Clinical, hemodynamic, and cardiopulmonary exercise test determinants of survival in patients referred for evaluation of heart failure
Ann Int Med
Value of peak oxygen consumption for optimal timing of cardiac transplantation in ambulatory patients with heart failure
Circulation
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Reprint requests: Victor Froelicher, MD, Cardiology Division (111C), VA Palo Alto Health Care System, 3801 Miranda Ave, Palo Alto, CA 94304.