A meta-analysis of the prognostic significance of cardiopulmonary exercise testing in patients with heart failure

Lawrence P. Cahalin, Paul Chase, Ross Arena, Jonathan Myers, Daniel Bensimhon, Mary Ann Peberdy, Euan Ashley, Erin West, Daniel E. Forman, Sherry Pinkstaff, Carl J. Lavie, Marco Guazzi

Research output: Contribution to journalReview articlepeer-review

85 Scopus citations


The objective of the study is to assess the role of cardiopulmonary exercise testing (CPX) variables, including peak oxygen consumption (VO 2), which is the most recognized CPX variable, the minute ventilation/carbon dioxide production (VE/VCO2) slope, the oxygen uptake efficiency slope (OUES), and exercise oscillatory ventilation (EOV) in a current meta-analysis investigating the prognostic value of a broader list of CPX-derived variables for major adverse cardiovascular events in patients with HF. A search for relevant CPX articles was performed using standard meta-analysis methods. Of the initial 890 articles found, 30 met our inclusion criteria and were included in the final analysis. The total subject populations included were as follows: peak VO2 (7,319), VE/VCO2 slope (5,044), EOV (1,617), and OUES (584). Peak VO2, the VE/VCO 2 slope and EOV were all highly significant prognostic markers (diagnostic odds ratios ≥ 4.10). The OUES also demonstrated promise as a prognostic marker (diagnostic odds ratio = 8.08) but only in a limited number of studies (n = 2). No other independent variables (including age, ejection fraction, and beta-blockade) had a significant effect on the meta-analysis results for peak VO2 and the VE/VCO2 slope. CPX is an important component in the prognostic assessment of patients with HF. The results of this meta-analysis strongly confirm this and support a multivariate approach to the application of CPX in this patient population.

Original languageEnglish (US)
Pages (from-to)79-94
Number of pages16
JournalHeart Failure Reviews
Issue number1
StatePublished - Jan 2013


  • Aerobic capacity
  • Exercise
  • Expired gas
  • Heart disease
  • Ventilation

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine


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