Published Online
on October 14, 2008

A more recent version of this article appeared on November 1, 2008

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Original Article

The absence of exercise capacity improvement after exercise training program: a strong prognostic factor in patients with chronic heart failure

Jean-Yves Tabet^1,3; Philippe Meurin; Florence Beauvais; Helene Weber; Nathalie Renaud; Gabriel Thabut²; Alain Cohen Solal; Damien Logeart and Ahmed Ben Driss

¹ Centre de Réadaptation Cardiaque de la Brie (CRCB) and Lariboisiere Hospital;
² Bichat Hospital

³ E-mail: jtabet{at}free.fr

Background—Exercise training is established as adjuvant therapy for chronic heart failure (CHF), but the prognostic value of improvement in exercise capacity after exercise training has never been evaluated.

Methods and Results—In this prospective bicentric study, all CHF patients with left-ventricular ejection fraction (LVEF)<45% who underwent an exercise training program in a cardiac rehabilitation center between January 2004 and September 2006 were consecutively included. Improvement in exercise capacity was assessed by change in peak oxygen consumption (PVO₂) and in PVO₂ expressed as a percentage of predicted PVO₂ (%PPVO₂) measured before and after the training program. We included 155 patients (54±12 years old, male 81%, LVEF= 29.5±7.1%). Patients underwent 19±9 training sessions. PVO₂ and %PPVO₂ were significantly increased after the training program (14% and 13%, respectively, p<0.001 for both). After 16±6 months follow-up, 27 patients had a cardiac event (death [n=12], cardiac transplantation [n=5], hospitalization for acute heart failure [n=10]). Univariate analysis revealed that among 17 significant predictors of cardiac events, the two more powerful ones were level of B-type natriuretic peptide (BNP) at baseline (p<0.0001) and improvement in exercise capacity as assessed by PVO₂ and %PPVO₂ (p<0.0001). Multivariate analysis revealed BNP level and %PPVO₂ as only independent predictive factors of outcome (p=0.01). The risk ratio of cardiac events for nonresponse versus response to the training program (defined as median %PPVO₂<6%) was 8.2 (p=0.0006).

Conclusions—Among patients with CHF, the lack of improvement in exercise capacity after an exercise training program has strong prognostic value for adverse cardiac events independent of classical predictive factors such as LVEF, NYHA class and BNP level.

Key Words: exercise • heart failure