Gitt et al identified factors during exercise testing in patients with heart failure that can help predict patients at increased risk for early death. These patients may benefit from more aggressive management with cardiac transplantation. The authors are from Herzzentrum Ludwigshafen in Ludwigshafen, Germany, and Harbor-UCLA Medical Center in Torrance, California.


Patient selection: presence of congestive heart failure (CHF). Patients with severe extrracardiac disease limiting exercise performance were excluded.


Endpoint: death within 6 months


Exercise protocol: bicycle ergometry performed until (a) symptoms became intolerable or (b) criteria met to discontinue exercise.


Exercise parameters:

(1) oxygen uptake (VO2) at the anaerobic threshold in mL per kg per minute

(2) slope of plot for minute ventilation (VE) vs VCO2 ("ventilatory efficiency")


The risk for death at 6 months was greatest (risk ratio 5.1) for patients when both of the following are present:

(1) oxygen uptake at the anaerobic threshold < 11 mL per kg per minute

(2) ventilatory efficiency (slope VE vs VCO2) > 34


Each of these findings by themselves had a risk ratio for early death of 2.7.


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