Development of a ventilatory classification system in patients with heart failure

Ross Arena, Jonathan Myers, Joshua Abella, Mary Ann Peberdy, Daniel Bensimhon, Paul Chase, Marco Guazzi

Research output: Contribution to journalArticlepeer-review


BACKGROUND - Ventilatory efficiency, commonly assessed by the minute ventilation (V̇E)-carbon dioxide production (V̇CO2) slope, is a powerful prognostic marker in the heart failure population. The purpose of the present study is to refine the prognostic power of the V̇E/V̇CO 2 slope by developing a ventilatory class system that correlates V̇E/V̇CO2 cut points to cardiac-related events. METHODS AND RESULTS - Four hundred forty-eight subjects diagnosed with heart failure were included in this analysis. The V̇E/V̇CO2 slope was determined via cardiopulmonary exercise testing. Subjects were tracked for major cardiac events (mortality, transplantation, or left ventricular assist device implantation) for 2 years after cardiopulmonary exercise testing. There were 81 cardiac-related events (64 deaths, 10 heart transplants, and 7 left ventricular assist device implantations) during the 2-year tracking period. Receiver operating characteristic curve analysis revealed the overall V̇E/V̇CO2 slope classification scheme was significant (area under the curve: 0.78 [95% CI, 0.73 to 0.83], P2 slope stratifies the burden of risk for the entire spectrum of heart failure severity. Application of this classification is therefore proposed to improve clinical decision making in heart failure.

Original languageEnglish
Pages (from-to)2410-2417
Number of pages8
Issue number18
Publication statusPublished - May 2007


  • Exercise
  • Heart failure
  • Prognosis
  • Ventilation

ASJC Scopus subject areas

  • Physiology
  • Cardiology and Cardiovascular Medicine


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