Pub Date : 2025-12-01DOI: 10.1016/j.cjco.2025.09.001
Natalie Wiebe RN, MSc , Cathy A. Eastwood RN, PhD , Seungwon Lee PhD , Elliot A. Martin PhD , Robin L. Walker PhD , Alexander Ah-Chi Leung MD, MPH , Jonathan Howlett MD , Hude Quan MD, PhD
Background
Heart failure (HF) readmission rates have been a significant concern for healthcare systems globally. Accurate predictive models are essential to identify patients at high readmission risk and implement timely interventions. Current models often lack comprehensive variables that reflect both clinical and patient and/or caregiver perspectives. We aimed to develop a consensus-driven approach to identify essential variables for inclusion in HF hospital readmission risk prediction algorithms.
Methods
A Delphi panel comprised of clinicians and patient and/or caregiver partners was assembled. The Delphi panelists were recruited from the province of Alberta, Canada. The panel consisted of 13 individuals, including 9 healthcare providers and 4 patients and/or caregivers. The review panel was provided with a list of variables from a previously completed systematic literature review. Three rounds were conducted. The panel also determined the directionality of the association.
Results
A total of 99 variables were identified through literature and physician input. Panelists reached a consensus on 61 variables, which were deemed to be associated with the risk of readmission for any cause within 30 days of discharge after HF hospitalization. Clinician ratings on consensus were consistently higher than those of nonclinicians.
Conclusions
This study successfully identified 61 variables associated with HF readmission risk through a modified Delphi process, incorporating both clinician and patient and/or caregiver perspectives. These findings provide a foundation for future research and the development of more comprehensive and accurate risk prediction models. Including diverse stakeholder input highlights the importance of integrating medical expertise and patient experiences in improving HF management and reducing readmission rates.
{"title":"Heart Failure Readmission Risk Factors: A Modified Delphi Panel Study","authors":"Natalie Wiebe RN, MSc , Cathy A. Eastwood RN, PhD , Seungwon Lee PhD , Elliot A. Martin PhD , Robin L. Walker PhD , Alexander Ah-Chi Leung MD, MPH , Jonathan Howlett MD , Hude Quan MD, PhD","doi":"10.1016/j.cjco.2025.09.001","DOIUrl":"10.1016/j.cjco.2025.09.001","url":null,"abstract":"<div><h3>Background</h3><div>Heart failure (HF) readmission rates have been a significant concern for healthcare systems globally. Accurate predictive models are essential to identify patients at high readmission risk and implement timely interventions. Current models often lack comprehensive variables that reflect both clinical and patient and/or caregiver perspectives. We aimed to develop a consensus-driven approach to identify essential variables for inclusion in HF hospital readmission risk prediction algorithms.</div></div><div><h3>Methods</h3><div>A Delphi panel comprised of clinicians and patient and/or caregiver partners was assembled. The Delphi panelists were recruited from the province of Alberta, Canada. The panel consisted of 13 individuals, including 9 healthcare providers and 4 patients and/or caregivers. The review panel was provided with a list of variables from a previously completed systematic literature review. Three rounds were conducted. The panel also determined the directionality of the association.</div></div><div><h3>Results</h3><div>A total of 99 variables were identified through literature and physician input. Panelists reached a consensus on 61 variables, which were deemed to be associated with the risk of readmission for any cause within 30 days of discharge after HF hospitalization. Clinician ratings on consensus were consistently higher than those of nonclinicians.</div></div><div><h3>Conclusions</h3><div>This study successfully identified 61 variables associated with HF readmission risk through a modified Delphi process, incorporating both clinician and patient and/or caregiver perspectives. These findings provide a foundation for future research and the development of more comprehensive and accurate risk prediction models. Including diverse stakeholder input highlights the importance of integrating medical expertise and patient experiences in improving HF management and reducing readmission rates.</div></div>","PeriodicalId":36924,"journal":{"name":"CJC Open","volume":"7 12","pages":"Pages 1584-1591"},"PeriodicalIF":2.5,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145765685","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-01DOI: 10.1016/j.cjco.2025.07.010
Zhe Li PhD , Danielle Marion MS , Jessica Blair PhD , Elsayed Z. Soliman MD , David Gladstone MD, PhD , Hooman Kamel MD , David Birnie MD , Doug Manuel MD , Frederick W. Unverzagt PhD , Virginia J. Howard PhD , Jodi D. Edwards PhD
Background
Clinical atrial fibrillation (AF) is often preceded by substantive structural and electrical remodelling, termed atrial cardiopathy. This cohort study aims to investigate associations between markers of atrial cardiopathy and the risk of cognitive impairment among aging adults without a suggestive history or documentation of AF.
Methods
This analysis included 21,856 participants from the REasons for Geographic and Racial Differences in Stroke (REGARDS) study who were free of AF and cognitive impairment (2003-2007). Markers of atrial cardiopathy included atrial premature complexes (APCs) and N-terminal pro-brain natriuretic peptide (NT-proBNP). Cognitive status was measured using the 6-item screener. Cox proportional hazards regression was used to examine the association between markers of atrial cardiopathy and risk of cognitive impairment (primary outcome) and stroke during the follow-up period (secondary outcomes), separately.
Results
During a mean follow-up of 9.9 years, 6058 participants had incident cognitive impairment, and 876 had a stroke. APCs increased the hazard of cognitive impairment by 8% (hazard ratio [HR], 1.08, 95% confidence interval [CI]: 1.01-1.15) and stroke by 10% (HR, 1.10, 95% CI: 1.04-1.17). The highest NTpro-BNP-level quintile ( > 235.2 pg/mL) increased the hazard of cognitive impairment by 53% (HR, 1.53, 95% CI: 1.36-1.72) and stroke by 54% (HR, 1.54, 95% CI: 1.39-1.71).
Conclusions
Markers of left atrial cardiopathy, including presence of APCs and a high level of NT-proBNP, may be associated with an increased risk of cognitive impairment and stroke with no suggestive history or documentation of AF.
{"title":"Association Between Markers of Atrial Cardiopathy and Cognitive Impairment Risk Among Adults with No Suggestive History of Atrial Fibrillation","authors":"Zhe Li PhD , Danielle Marion MS , Jessica Blair PhD , Elsayed Z. Soliman MD , David Gladstone MD, PhD , Hooman Kamel MD , David Birnie MD , Doug Manuel MD , Frederick W. Unverzagt PhD , Virginia J. Howard PhD , Jodi D. Edwards PhD","doi":"10.1016/j.cjco.2025.07.010","DOIUrl":"10.1016/j.cjco.2025.07.010","url":null,"abstract":"<div><h3>Background</h3><div>Clinical atrial fibrillation (AF) is often preceded by substantive structural and electrical remodelling, termed atrial cardiopathy. This cohort study aims to investigate associations between markers of atrial cardiopathy and the risk of cognitive impairment among aging adults without a suggestive history or documentation of AF.</div></div><div><h3>Methods</h3><div>This analysis included 21,856 participants from the REasons for Geographic and Racial Differences in Stroke (REGARDS) study who were free of AF and cognitive impairment (2003-2007). Markers of atrial cardiopathy included atrial premature complexes (APCs) and N-terminal pro-brain natriuretic peptide (NT-proBNP). Cognitive status was measured using the 6-item screener. Cox proportional hazards regression was used to examine the association between markers of atrial cardiopathy and risk of cognitive impairment (primary outcome) and stroke during the follow-up period (secondary outcomes), separately.</div></div><div><h3>Results</h3><div>During a mean follow-up of 9.9 years, 6058 participants had incident cognitive impairment, and 876 had a stroke. APCs increased the hazard of cognitive impairment by 8% (hazard ratio [HR], 1.08, 95% confidence interval [CI]: 1.01-1.15) and stroke by 10% (HR, 1.10, 95% CI: 1.04-1.17). The highest NTpro-BNP-level quintile ( > 235.2 pg/mL) increased the hazard of cognitive impairment by 53% (HR, 1.53, 95% CI: 1.36-1.72) and stroke by 54% (HR, 1.54, 95% CI: 1.39-1.71).</div></div><div><h3>Conclusions</h3><div>Markers of left atrial cardiopathy, including presence of APCs and a high level of NT-proBNP, may be associated with an increased risk of cognitive impairment and stroke with no suggestive history or documentation of AF.</div></div>","PeriodicalId":36924,"journal":{"name":"CJC Open","volume":"7 12","pages":"Pages 1539-1548"},"PeriodicalIF":2.5,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145765777","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
This study investigated the association between health-related quality of life (HRQOL), sedentary time, and physical function in hospitalized patients with cardiovascular disease (CVD) undergoing phase I cardiac rehabilitation (CR).
Methods
This observational study enrolled CVD patients between October 2020 and September 2024. Participants were classified into low-HRQOL ( < 0.83) and high-HRQOL ( ≥ 0.83) groups based on the median EuroQol 5-Dimensions 5-Levels score. Clinical characteristics, physical function measures, and sedentary time were compared between groups. Multiple regression analysis was performed with the score as the dependent variable to identify predictors of HRQOL.
Results
The final analysis included 544 patients (mean age: 69.1 years; male: 74.8%), of whom 49.0% were classified into the low-HRQOL group. Patients with low HRQOL showed significantly longer sedentary time and poorer physical function. Multiple regression identified employment status (unstandardized coefficient [B] = 0.068, 95% confidence interval [CI]: 0.007-0.130, P = 0.030), angiotensin-converting enzyme inhibitor and/pr angiotensin II receptor blocker use (B = 0.076, 95% CI: 0.026-0.126, P = 0.003), gait speed (B = 0.233, 95% CI: 0.109-0.358, P <0.001), and sedentary time (B = –0.0004, 95% CI: –0.0005to –0.0003, P <0.001) as significant predictors of HRQOL.
Conclusions
Excessive sedentary time during hospitalization was significantly associated with lower HRQOL in CVD patients undergoing phase I CR. Reducing sedentary time, along with formulating functional and clinical strategies, may be vital for improving HRQOL in inpatient CR programs. These findings highlight the need for future studies to explore personalized CR interventions to improve long-term outcomes.
本研究旨在探讨心血管疾病（CVD）住院患者接受I期心脏康复（CR）的健康相关生活质量（HRQOL）、久坐时间和身体功能之间的关系。方法本观察性研究纳入了2020年10月至2024年9月期间的CVD患者。根据EuroQol 5-Dimensions 5-Levels的中位数得分，将参与者分为低hrqol （< 0.83）和高hrqol（≥0.83）组。比较两组患者的临床特征、身体功能指标和久坐时间。以评分为因变量进行多元回归分析，确定HRQOL的预测因子。结果共纳入544例患者，平均年龄69.1岁，男性74.8%，其中49.0%归为低hrqol组。低HRQOL患者久坐时间较长，身体功能较差。多元回归发现，就业状况（非标准化系数[B] = 0.068, 95%可信区间[CI]: 0.007-0.130, P = 0.030）、血管紧张素转换酶抑制剂和/pr血管紧张素II受体阻滞剂的使用（B = 0.076, 95% CI: 0.026-0.126, P = 0.003）、步态速度（B = 0.233, 95% CI: 0.109-0.358, P <0.001）和久坐时间（B = -0.0004, 95% CI: - 0.0005 - -0.0003, P <0.001）是HRQOL的显著预测因子。结论住院期间久坐时间过长与心血管疾病I期CR患者HRQOL降低显著相关，减少久坐时间，同时制定功能和临床策略，可能对改善住院CR患者HRQOL至关重要。这些发现强调了未来研究探索个性化CR干预措施以改善长期结果的必要性。
{"title":"Impact of Sedentary Time and Physical Function on Health-Related Quality of Life in Hospitalized Patients with Cardiovascular Disease","authors":"Kazuhiro P. Izawa PT, PhD, MSc , Masahiro Kitamura PT, PhD, MSc , Asami Ogura PT, PhD, MSc , Ikko Kubo PT, PhD, MSc , Kodai Ishihara PT, PhD, MSc , Yuji Kanejima PT, PhD, MSc , Koichiro Oka PhD, MSc , Shinichi Noto PhD, MSc , Koichi Naito PhD, MSc , Peter H. Brubaker PhD, MSc , Hitomi Nagashima PT , Hideto Tawa MD , Daisuke Matsumoto MD , Ikki Shimizu MD, PhD","doi":"10.1016/j.cjco.2025.08.004","DOIUrl":"10.1016/j.cjco.2025.08.004","url":null,"abstract":"<div><h3>Background</h3><div>This study investigated the association between health-related quality of life (HRQOL), sedentary time, and physical function in hospitalized patients with cardiovascular disease (CVD) undergoing phase I cardiac rehabilitation (CR).</div></div><div><h3>Methods</h3><div>This observational study enrolled CVD patients between October 2020 and September 2024. Participants were classified into low-HRQOL ( < 0.83) and high-HRQOL ( ≥ 0.83) groups based on the median EuroQol 5-Dimensions 5-Levels score. Clinical characteristics, physical function measures, and sedentary time were compared between groups. Multiple regression analysis was performed with the score as the dependent variable to identify predictors of HRQOL.</div></div><div><h3>Results</h3><div>The final analysis included 544 patients (mean age: 69.1 years; male: 74.8%), of whom 49.0% were classified into the low-HRQOL group. Patients with low HRQOL showed significantly longer sedentary time and poorer physical function. Multiple regression identified employment status (unstandardized coefficient [B] = 0.068, 95% confidence interval [CI]: 0.007-0.130, <em>P</em> = 0.030), angiotensin-converting enzyme inhibitor and/pr angiotensin II receptor blocker use (B = 0.076, 95% CI: 0.026-0.126, <em>P</em> = 0.003), gait speed (B = 0.233, 95% CI: 0.109-0.358, <em>P</em> <0.001), and sedentary time (B = –0.0004, 95% CI: –0.0005to –0.0003, <em>P</em> <0.001) as significant predictors of HRQOL.</div></div><div><h3>Conclusions</h3><div>Excessive sedentary time during hospitalization was significantly associated with lower HRQOL in CVD patients undergoing phase I CR. Reducing sedentary time, along with formulating functional and clinical strategies, may be vital for improving HRQOL in inpatient CR programs. These findings highlight the need for future studies to explore personalized CR interventions to improve long-term outcomes.</div></div>","PeriodicalId":36924,"journal":{"name":"CJC Open","volume":"7 11","pages":"Pages 1524-1532"},"PeriodicalIF":2.5,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145555421","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-11-01DOI: 10.1016/j.cjco.2025.06.009
Nicholas Grubic MSc , Salwa Nihal MBBS, MPhil, MSc , Julia E. Herr MSc , Tomislav Jelic MD , Steven J. Montague MD, MSc , Natasha Aleksova MD, MSc , Gillian Nesbitt MD, FRCPC , Omid Kiamanesh MD, FRCPC , Daniel J. Belliveau MD , Linden Kolbenson MD , Zakhar Kanyuka MD , Sharon L. Mulvagh MD, FRCPC, FACC, FASE, FAHA , Barkha Sirwani MPH , Amer M. Johri MD, MSc, FRCPC, FASE
Background
Disparities in access to postgraduate cardiopulmonary point-of-care ultrasound (POCUS) training have limited uptake by nonspecialists in remote care centres. This multicentre pre-post study evaluated the skill improvement of learners after they participated in a longitudinal and virtual POCUS training program.
Methods
Nonexpert POCUS users were recruited at urban teaching hospitals and geographically remote hospitals/nursing stations across 4 Canadian provinces. The 3-week educational program consisted of e-learning, independent imaging practice, and point-of-care tele-ultrasound (tele-POCUS) consultations with experts during clinical encounters. Standardized assessments were used to evaluate skill improvement in image acquisition, image quality, and image interpretation for cardiac and lung/pleura POCUS (as measured on a 5-point Likert scale) after program completion and receipt of remotely delivered guidance via tele-POCUS.
Results
Among 29 learners, 17 (41% female) completed the training program, of whom 7 practiced in remote hospitals/nursing stations. For cardiac POCUS, pre- and post-training assessments revealed improvements in image acquisition (mean scores: 3.02 to 4.48, P < 0.01), quality (2.49 to 4.06, P < 0.01), and interpretation (3.03 to 4.44, P < 0.01). Improvements in image acquisition (3.27 to 4.63, P < 0.01), quality (3.25 to 4.53, P < 0.01), and interpretation (3.35 to 4.65, P < 0.01) also occurred for lung/pleura POCUS. A total of 153 tele-POCUS consultations (77 cardiac and 76 lung/pleura) were performed. Image acquisition improved after remote guidance was provided to learners using tele-POCUS (all P < 0.01). Results were similar in analyses stratified by geographic setting.
Conclusions
Cardiopulmonary POCUS can be taught successfully to learners in diverse geographic settings using a virtual training format and tele-POCUS.
{"title":"Training Nonexpert Users in Cardiopulmonary Point-of-Care Ultrasound Using a Virtual Curriculum and a Teleconsultation Model: A Multicentre Study","authors":"Nicholas Grubic MSc , Salwa Nihal MBBS, MPhil, MSc , Julia E. Herr MSc , Tomislav Jelic MD , Steven J. Montague MD, MSc , Natasha Aleksova MD, MSc , Gillian Nesbitt MD, FRCPC , Omid Kiamanesh MD, FRCPC , Daniel J. Belliveau MD , Linden Kolbenson MD , Zakhar Kanyuka MD , Sharon L. Mulvagh MD, FRCPC, FACC, FASE, FAHA , Barkha Sirwani MPH , Amer M. Johri MD, MSc, FRCPC, FASE","doi":"10.1016/j.cjco.2025.06.009","DOIUrl":"10.1016/j.cjco.2025.06.009","url":null,"abstract":"<div><h3>Background</h3><div>Disparities in access to postgraduate cardiopulmonary point-of-care ultrasound (POCUS) training have limited uptake by nonspecialists in remote care centres. This multicentre pre-post study evaluated the skill improvement of learners after they participated in a longitudinal and virtual POCUS training program.</div></div><div><h3>Methods</h3><div>Nonexpert POCUS users were recruited at urban teaching hospitals and geographically remote hospitals/nursing stations across 4 Canadian provinces. The 3-week educational program consisted of e-learning, independent imaging practice, and point-of-care tele-ultrasound (tele-POCUS) consultations with experts during clinical encounters. Standardized assessments were used to evaluate skill improvement in image acquisition, image quality, and image interpretation for cardiac and lung/pleura POCUS (as measured on a 5-point Likert scale) after program completion and receipt of remotely delivered guidance via tele-POCUS.</div></div><div><h3>Results</h3><div>Among 29 learners, 17 (41% female) completed the training program, of whom 7 practiced in remote hospitals/nursing stations. For cardiac POCUS, pre- and post-training assessments revealed improvements in image acquisition (mean scores: 3.02 to 4.48, <em>P</em> < 0.01), quality (2.49 to 4.06, <em>P</em> < 0.01), and interpretation (3.03 to 4.44, <em>P</em> < 0.01). Improvements in image acquisition (3.27 to 4.63, <em>P</em> < 0.01), quality (3.25 to 4.53, <em>P</em> < 0.01), and interpretation (3.35 to 4.65, <em>P</em> < 0.01) also occurred for lung/pleura POCUS. A total of 153 tele-POCUS consultations (77 cardiac and 76 lung/pleura) were performed. Image acquisition improved after remote guidance was provided to learners using tele-POCUS (all <em>P</em> < 0.01). Results were similar in analyses stratified by geographic setting.</div></div><div><h3>Conclusions</h3><div>Cardiopulmonary POCUS can be taught successfully to learners in diverse geographic settings using a virtual training format and tele-POCUS.</div></div>","PeriodicalId":36924,"journal":{"name":"CJC Open","volume":"7 11","pages":"Pages 1512-1523"},"PeriodicalIF":2.5,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145555420","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-11-01DOI: 10.1016/j.cjco.2025.07.009
Holden Lowes BSc, MSc , Ingrid Brenner BPHE, BScN, BSc, MSc, PhD , Kirsten Woodend BScN, MSc, RN, PhD , Sarah West BPHE, MSc, PhD , Manjot Sunner BSc, MD , Barinder Khehra BSc, MD , Ani Orchanian-Cheff BA, MISt , Juan Jose Rodriguez Arias PhD, MD , Farid Foroutan BSc, PhD , Chun Po S. Fan BSc, MSc, PhD , Eduard Rodenas-Alesina MSc, MD , Juan Duero Posada MSc, MD , Heather J. Ross MHSc, DSc, MD , Yasbanoo Moayedi MHSc, MD
Background
The prognostic utility of cardiopulmonary exercise testing (CPET) in heart failure (HF) is well established; however, whether optimal CPET parameter thresholds differ across HF etiologies remains unclear. This systematic review aimed to determine how CPET-derived parameters and their prognostic threshold values differ, and their association with adverse outcomes, in patients with ischemic vs nonischemic cardiomyopathy.
Methods
Eligible studies assessed adult HF patients and reported outcomes of all-cause mortality, left ventricular assist device implantation, heart transplantation, or hospitalization. CPET parameters and associated threshold values were extracted, and risk of bias was assessed using the Joanna Briggs Institute checklist for cohort studies.
Results
Four studies comprising 491 ischemic and 218 nonischemic HF patients were included. Peak oxygen consumption (pVO2) was the only CPET parameter unanimously reported. In ischemic HF, the optimal pVO2 thresholds, in mL/kg/min, were ≤ 14.10 (hazard ratio [HR] 3.3; confidence interval [CI]: 1.9-5.8), ≤ 10.0 (HR 0.76; CI: 0.59-0.98), ≤ 15.20, and ≤ 14.0 (used in one study as a guideline comparator), yielding a mean threshold of ≤ 13.33 mL/kg/min ( ± 2.28). In nonischemic HF, optimal thresholds in mL/kg/min were ≤ 14.60 (HR 4.30 [CI: 2.10-8.90]) and ≤ 14.0, yielding a mean of ≤ 14.30 mL/kg/min ( ± 0.42).
Conclusions
Significant heterogeneity was present in study design, patient populations, and CPET variables assessed. The few consistently assessed prognostic thresholds were similar across HF etiologies. Peak oxygen consumption (pVO2) remains a robust prognostic marker in both ischemic and nonischemic cardiomyopathy. Although patients with ischemic cardiomyopathy generally have worse clinical profiles, this review suggests that no meaningful differences occur in a few key CPET prognostic thresholds, namely pVO2, across etiologies. These findings support continued use of established guideline-recommended thresholds for risk stratification, irrespective of HF subtype, but require further confirmation.
{"title":"A Systematic Review of the Prognostic Value of Cardiopulmonary Exercise Testing in Patients with Ischemic and Nonischemic Cardiomyopathy","authors":"Holden Lowes BSc, MSc , Ingrid Brenner BPHE, BScN, BSc, MSc, PhD , Kirsten Woodend BScN, MSc, RN, PhD , Sarah West BPHE, MSc, PhD , Manjot Sunner BSc, MD , Barinder Khehra BSc, MD , Ani Orchanian-Cheff BA, MISt , Juan Jose Rodriguez Arias PhD, MD , Farid Foroutan BSc, PhD , Chun Po S. Fan BSc, MSc, PhD , Eduard Rodenas-Alesina MSc, MD , Juan Duero Posada MSc, MD , Heather J. Ross MHSc, DSc, MD , Yasbanoo Moayedi MHSc, MD","doi":"10.1016/j.cjco.2025.07.009","DOIUrl":"10.1016/j.cjco.2025.07.009","url":null,"abstract":"<div><h3>Background</h3><div>The prognostic utility of cardiopulmonary exercise testing (CPET) in heart failure (HF) is well established; however, whether optimal CPET parameter thresholds differ across HF etiologies remains unclear. This systematic review aimed to determine how CPET-derived parameters and their prognostic threshold values differ, and their association with adverse outcomes, in patients with ischemic vs nonischemic cardiomyopathy.</div></div><div><h3>Methods</h3><div>Eligible studies assessed adult HF patients and reported outcomes of all-cause mortality, left ventricular assist device implantation, heart transplantation, or hospitalization. CPET parameters and associated threshold values were extracted, and risk of bias was assessed using the Joanna Briggs Institute checklist for cohort studies.</div></div><div><h3>Results</h3><div>Four studies comprising 491 ischemic and 218 nonischemic HF patients were included. Peak oxygen consumption (pVO<sub>2</sub>) was the only CPET parameter unanimously reported. In ischemic HF, the optimal pVO<sub>2</sub> thresholds, in mL/kg/min, were ≤ 14.10 (hazard ratio [HR] 3.3; confidence interval [CI]: 1.9-5.8), ≤ 10.0 (HR 0.76; CI: 0.59-0.98), ≤ 15.20, and ≤ 14.0 (used in one study as a guideline comparator), yielding a mean threshold of ≤ 13.33 mL/kg/min ( ± 2.28). In nonischemic HF, optimal thresholds in mL/kg/min were ≤ 14.60 (HR 4.30 [CI: 2.10-8.90]) and ≤ 14.0, yielding a mean of ≤ 14.30 mL/kg/min ( ± 0.42).</div></div><div><h3>Conclusions</h3><div>Significant heterogeneity was present in study design, patient populations, and CPET variables assessed. The few consistently assessed prognostic thresholds were similar across HF etiologies. Peak oxygen consumption (pVO<sub>2</sub>) remains a robust prognostic marker in both ischemic and nonischemic cardiomyopathy. Although patients with ischemic cardiomyopathy generally have worse clinical profiles, this review suggests that no meaningful differences occur in a few key CPET prognostic thresholds, namely pVO<sub>2</sub>, across etiologies. These findings support continued use of established guideline-recommended thresholds for risk stratification, irrespective of HF subtype, but require further confirmation.</div></div>","PeriodicalId":36924,"journal":{"name":"CJC Open","volume":"7 11","pages":"Pages 1441-1450"},"PeriodicalIF":2.5,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145555424","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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