Predictive value of cardiopulmonary exercise testing combined with N-terminal pro-brain natriuretic peptide to poor prognosis in patients with heart failure with preserved ejection fraction
Wu Xiujuan
Lin Song
Ma Ke
Gao Chuanyu
Ding Rongjing
Liu Weili
Abstract：Objective To discuss whether cardiopulmonary exercise testing(CPET)combined with N-terminal pro-brain natriuretic peptide(NT-proBNP)could predict a poor prognosis or not in patients with heart failure with preserved ejection fraction(HFpEF).Methods HFpEF patients undergone CPET(n=119)were chosen from Fuwai Central China Cardiovascular Hospital from Dec.16,2017 to Aug.16,2022.The baseline materials were collected,and according to whether major adverse cardiovascular events(MACE)occurred or not during follow-up period,into good prognosis group(n=92)and poor prognosis group(n=27).The baseline materials were compared between 2 groups,and independent risk factors of poor prognosis were screened by using multi-factor Logistic regression analysis in HFpEF patients.The predictive value of independent factors and combined predictive factors to poor prognosis were analyzed through drawing receiver operating characteristic(ROC)curve.Results During follow-up period(median=27 months),there 27 cases of MACE(2 with cardiac death,25 re-hospitalized due to exacerbated heart failure),and NT-proBNP was significantly higher in poor prognosis group than that in good prognosis group(P<0.05).Among CPET parameters,the peak oxygen uptake(peak VO2),percentage of peak oxygen uptake to predicted value(peak VO2%pred),percentage of peak heart rate to predicted value(peak HR%pred),1-min heart rate recovery(HRR1)and peak end-tidal carbon dioxide partial pressure(peak PETCO2)were significantly lower(P<0.05),and slope of carbon dioxide ventilation equivalent(VE/VCO2 slope)was significantly higher(P<0.05)in poor prognosis group than those in good prognosis group.The results of multi-factor Logistic regression analysis showed that decreased peak VO2%pred and increased NT-proBNP and VE/VCO2 slope were independent risk factors of poor prognosis in HFpEF patients(P<0.05).The results of ROC curve analysis showed that,in predicting poor prognosis,AUC of VE/VCO2 slope was 0.756,AUC of peak VO2%pred was 0.682,AUC of NT-proBNP was 0.817 and AUC of combined predictive factors was 0.870,and the optimal threshold value was,respectively,35.50 pg/ml,69.50%pg/ml,754.00 pg/ml and 2685.25.Conclusion VE/VCO2 slope,peak VO2%pred and NT-proBNP are independent predictive factors of poor prognosis,and combination of them had a higher predictive efficacy in HFpEF patients.
Keywords：Heart failure with preserved ejection fractionCardiopulmonary exercise testingN-terminal pro-brain natriuretic peptide
Publication Date：2024-02-28
Online Publishing Date：2025-08-15(First online date of this platform, not the publication date of the document)
Pages：6( 167-172 )