Prediction of severe cardiovascular events by VE/VCO2 slope vs. Peak VO2 in systolic heart failure: A meta-analysis of the published literature

POGGIO R; COHEN ARAZI H; GIORGI MA; MIRIUKA SG

AMERICAN HEART JOURNAL, THE

MOSBY-ELSEVIER

Lugar: Philadelphia; Año: 2010

0002-8703

Background: PeakVO2 has traditionally been used for prognostic evaluation in systolic heart failure. However, in the past years VE/VCO2 slope has been shown to be similar or even superior in many studies. We performed a systematic review and a meta-analysis of diagnostic studies of VE/VCO2 slope in order to assess its ability to predict cardiovascular events in systolic heart failure. Methods: We searched the published literature in PubMed and ISI Web of Science for VE/VCO2 slope in heart failure, and performed a systematic review and a meta-analysis of diagnostic studies in papers fulfilling previously established selection criteria. Endpoints were serious cardiovascular events defined as death or the combined end-point of death, ventricular assist device implantation or heart transplant. A sub-analysis was also performed with those papers providing enough data to compare VE/VCO2 slope prognostic ability to that of PeakVO2. Results: 491 papers potentially relevant were identified, and 12 studies were selected based on our pre-defined criteria. No heterogeneity or evidence of publication bias was found. The 12 studies included a total of 2628 patients with a mean follow up time of 31 (95%CI 16-46) months. The combined event rate at one year was 11.2% (95%CI 7.8-14.6). Diagnostic odds ratio and area under the curve for serious cardiovascular events were 5.02 (95%CI: 4.06-6.21) and 0.75 (95%CI: 0.72-0.78), respectively. Six studies provided sufficient data for VE/VCO2 slope and PeakVO2 comparison. Both variables showed similar performance, although VE/VCO2 did present a trend to superiority. Conclusions: In this meta-analysis, VE/VCO2 slope represents a reasonable ability to predict serious cardiovascular events in systolic heart failure, and is at least as effective as PeakVO2.