Papel de la determinación del poder cardíaco como factor pronóstico en pacientes con insuficiencia cardíaca crónica

work objective to evaluate the predictive value of a new variable obtained through the cardiopulmonary exercise test, the maximum cardiac power (cpmx) during peak exercise. research design and methods a group of heart failure patients were prospectively evaluated through the assessment of vo2 mx, cpmx (oxygen pulse × mean arterial tension) and cardiac reserve (cr) (cpmx - cpbasal). the values were compared according to the presence of events (heart failure, hospitalization or death). the incremental value through roc curves and the association of their cut-points with events (log-rank test and cox regression) were evaluated. combined end point: admission for worsening hf and/or death. results sample of 157 patients, 83.4% men, aged 59±10 years, functional class iii/iv: 22.3%. severe lv systolic dysfunction 56.7%, events 22.9%, average follow up: 9 months. patients with events showed lower values of vo2 mx (11.8 vs. 14.9 ml/kg/min, p< 0.001), cpmx (831 vs. 1079 watts, p = 0.003) and cr (465 vs. 676 watts, p = 0.002); roc areas: (vo2 mx: 0.73; cpmx 0.68; cr 0.68, p = 0.34 between areas). risk of events: for vo2 mx< 14 ml/kg/min hr 3.93 (95% ci 1.89-8.20) p< 0.001; cpmx< 780 hr 2.78 (ci 1.42-5.43), p = 0.003 and cr< 350 hr 2.75 (95% ci 1.42-5.35) p = 0.003. the incidence of events was of 8.5% in patients with normal vo2 and cp, 30.3% with only one altered index: hr 3.1 (95% ci 1.16-8.25) p = 0.024, and 45.2% with both altered indexes hr 5 (95% ci 1.81-13.75) p = 0.002. conclusions cpmx is another variable to determine in the cardiopulmonary exercise test which could give incremental predictive value, added to other classical parameters.