Prediction of left ventricular reverse remodeling in patients with heart failure with reduced ejection fraction using cardiopulmonary exercise testing.

Background: With advances in the treatment of heart failure with reduced ejection fraction (HFrEF), the prediction of left ventricular reverse remodeling (LVRR) has become increasingly important. Cardiopulmonary exercise testing (CPET) is a non-invasive test recommended for prognostic risk assessment in HFrEF; however, it is not known whether it predicts LVRR. We aimed to investigate whether the parameters obtained from CPET are useful in predicting LVRR in HFrEF.

Methods: We retrospectively evaluated 230 consecutive patients with HFrEF [left ventricular ejection fraction (LVEF) ≤40 %] hospitalized for acute heart failure (59 ± 14 years, 78 % males) who underwent CPET before discharge. We investigated whether the CPET parameters, peak oxygen consumption (VO), and the minute ventilation (VE) vs. carbon dioxide production (VCO) slope could predict LVRR within 1 year (LVEF >50 %).

Results: Among 230 patients, 89 (39 %) exhibited LVRR. In multivariable logistic analysis, higher peak VO [odds ratio (OR): 1.13, 95 % confidence interval (CI): 1.05-1.22, p < 0.001] and lower VE vs. VCO slope (OR: 0.95, 95 % CI: 0.91-0.98, p < 0.001) were independently associated with LVRR. In receiver operating characteristic curve analysis, peak VO [area under the curve (AUC): 0.657, p < 0.001, optimal cut-off: 15.5 mL/min/kg] and VE vs. VCO slope (AUC: 0.663, p < 0.001, optimal cut-off: 35.8) were significant predictors of LVRR. Moreover, combining the peak VO and VE vs. VCO slope improved the predictive value (AUC: 0.682).

Conclusions: CPET is a valuable test for the non-invasive detection of LVRR. The combination of peak VO and the VE vs. VCO slope is useful for predicting LVRR among hospitalized patients with HFrEF receiving pharmacological treatment.