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Revista Española de Cardiología (English Edition) Revista Española de Cardiología (English Edition)
Rev Esp Cardiol. 2018;71:250-6 - Vol. 71 Num.04 DOI: 10.1016/j.rec.2017.05.022

Peak Exercise Oxygen Uptake Predicts Recurrent Admissions in Heart Failure With Preserved Ejection Fraction

Patricia Palau a,, Eloy Domínguez a, Eduardo Núñez b, José María Ramón b, Laura López c, Joana Melero a, Juan Sanchis b,d, Alejandro Bellver a, Enrique Santas b, Antoni Bayes-Genis d,e, Francisco J. Chorro b, Julio Núñez b,d

a Servicio de Cardiología, Hospital General Universitario de Castellón, Universitat Jaume I, Castellón, Spain
b Servicio de Cardiología, Hospital Clínico Universitario, INCLIVA, Universitat de València, Valencia, Spain
c Departamento de Fisioterapia, Universitat de València, Valencia, Spain
d CIBER Cardiovascular, Madrid, Spain
e Servicio de Cardiología, Hospital Universitari Germans Trias i Pujol, Badalona, Departamento de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain

Refers to


Heart failure with preserved ejection fraction. Prognosis. Recurrent hospitalizations. Exercise capacity.


Introduction and objectives

Heart failure with preserved ejection fraction (HFpEF) is a highly prevalent syndrome with an elevated risk of morbidity and mortality. To date, there is scarce evidence on the role of peak exercise oxygen uptake (peak VO2) for predicting the morbidity burden in HFpEF. We sought to evaluate the association between peak VO2 and the risk of recurrent hospitalizations in patients with HFpEF.


A total of 74 stable symptomatic patients with HFpEF underwent a cardiopulmonary exercise test between June 2012 and May 2016. A negative binomial regression method was used to determine the association between the percentage of predicted peak VO2 (pp-peak VO2) and recurrent hospitalizations. Risk estimates are reported as incidence rate ratios.


The mean age was 72.5 ± 9.1 years, 53% were women, and all patients were in New York Heart Association functional class II to III. Mean peak VO2 and median pp-peak VO2 were 10 ± 2.8 mL/min/kg and 60% (range, 47-67), respectively. During a median follow-up of 276 days [interquartile range, 153-1231], 84 all-cause hospitalizations in 31 patients (41.9%) were registered. A total of 15 (20.3%) deaths were also recorded. On multivariate analysis, accounting for mortality as a terminal event, pp-peak VO2 was independently and linearly associated with the risk of recurrent admission. Thus, and modeled as continuous, a 10% decrease of pp-peak VO2 increased the risk of recurrent hospitalizations by 32% (IRR, 1.32; 95%CI, 1.03-1.68; P = .028).


In symptomatic elderly patients with HFpEF, pp-peak VO2 predicts all-cause recurrent admission.

1885-5857/© 2018 Sociedad Española de Cardiología. Published by Elsevier España, S.L.U. All rights reserved