Background: Prognostic parameters in patients with congestive heart failure (CHF) are important for guiding therapeutic options.

Background: Prognostic parameters in patients with congestive heart failure (CHF) are important for guiding therapeutic options. Maximal oxygen uptake (V[O.sub.2]max) is a widely used parameter for prognostic assessment in patients with CHF and correlates with exercise cardiac output; however, afterload is not taken into account.

Methods: The universal of a noninvasive surrogate of cardiac power output combines exercise systolic BP (SBP) as an estimate of afterload, with V[O.sub.2]max, as an estimate of exercise cardiac output neglecting preload. Thus, a variable meteed exercise cardiac power (ECP) is defined as the proceeds of V[O.sub.2]max (expressed as a percent predicted value) and SBP (ECP asserted as %mm Hg, is the produce of V[O.sub.2]max, expressed as percentage of predicted maximum, times systolic influence The prognostic value of ECP obtained during routine treadmill ergospirometry was assessed in patients referr to our heart failure clinic. Patients undergoing heart transplantation were censored at the time of transplantation.

Results: undivided hundred fifty-four patients were followed prospectively for a mean ([+ or -] SE) duration of 625 [+ or -] 32 days. Thirty-two patients (21%) died. ECP was the greatest in quantity powerful predictor of mortality, was the combined last point of mortality or hospitalization for worsening heart failure (all p < 0001) and was an independent predictor in multivariate analysis. An ECP of < 5000 %mm Hg indicated a poor prognosis with a 1-year mortality rate of 37% whereas barely 2% of the patients having an ECP of > 9000 %mm Hg died during the first year.

Conclusion: The integration of afterload and V[O.sub.2]max improves the prognostic value of each indicator, and provides an easily available and independent predictor of mortality and morbidity in CHF patients. This integrative universal of cardiac hydraulic performance is superior to V[O.sub.2]max and can be used in routine ergospirometry.

fundamental note words: cardiac assessment; congestive heart failure; exercise capacity; maximal oxygen uptake

Abbreviations: CHF = congestive heart failure; CPO = cardiac power output; ECP = exercise cardiac power; ECW = exercise cardiac work; MAP = mean arterial pressure; NYHA = recently made known York Heart Association; % mm Hg = the crops of maximal oxygen uptake and systolic BP multiplied by way of 100; SBP = systolic BP; SWI = reverse work index; V[O.sub.2]max = maximal oxygen uptake

**********

Congestive heart failure (CHF) is a major cause of mortality and morbidity in Western countries. (1) Despite improved medical therapy, heart transplantation is required in patients with end-stage CHF to improve survival in suitable candidates. As organ shortage is a major question waiting time is increasing. (2) Therefore, the early and reliable prediction of prognosis is important in patients with CHF (3)

Major improvements in the characterization of circulatory function have been achieved by way of the progression from static parameters (eg ejection fraction, filling constraining forces and resting hemodynamics) to dynamic integrals of pumping capacity during exercise or inotropic stimulation. Maximal oxygen uptake (V[O.sub.2]max) measured during ergospirometry as a noninvasive approximation of cardiac output during exercise (4) has proven to be united of the best measures of prognosis in patients with CHF (5) However, V[O.sub.2]max has well-known limitations as a parameter of cardiovascular capacity. Of these, the neglecting of afterload is probably the mostly important one, since cardiac output critically be pendents on it. Afterload may vary significantly between patients, and novel improvements in medical therapy have changed the characteristics of CHF patients. Thus, relying sole on V[O.sub.2]max may be insufficient in assessing cardiac pumping reserve

Afterload is integrated in invasively measured parameters as it is as cardiac power output (CPO) or rap work index (SWI), allowing a better characterization of cardiac hydraulic pumping capacity. These parameters have been shown to be remarkably powerful predictors of mortality in patients with cardiogenic onset (6) as well as in those with chronic CHF (7) especially when they are measured during exercise or inotropic stimulation. However, they require right heart catheterization, which is not suitable for routine clinical use in ambulatory exercise testing. Moreover, invasive hemodynamic recordings may be altered during exercise by dint of artifacts from movement, respiration, or catheter dislocation. Thus, having the important advantages of CPO in mind, we unraveled an easily applicable concept that assesses cardiac pumping capacity noninvasively through integrating surrogates of exercise cardiac output and afterload. This general [i]or[/i] abstract notion was tested in patients who had been referr to our heart failure clinic.

MATERIALS AND METHODS

The universal of the noninvasive approximation of cardiac hydraulic power retain is closely related to the principles applied in the calculation of SWI and CPO (Table 1) CPO is the production of the cardiac output and the urgency gradient generated by both ventricles (mean arterial urgency [MAP]--central venous pressure), representing hydraulic manliness per time-unit. (8) We derived our universal from the following assumptions.

...