Congestive heart failure exercise stress testing: Difference between revisions

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| [[File:Siren.gif|30px|link= Heart failure resident survival guide]]|| <br> || <br>
| [[Heart failure resident survival guide|'''Resident'''<br>'''Survival'''<br>'''Guide''']]
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{{Congestive heart failure}}
{{Congestive heart failure}}
{{CMG}}; {{AOEIC}} {{LG}}
{{CMG}}; {{AOEIC}} {{Sara.Zand}} {{LG}} {{EdzelCo}}
 
==Overview==
[[Exercise stress testing]] with an assessment of [[oxygen]] consumption is useful in assessing the [[functional capacity]] of the [[heart failure ]] [[patient]].
[[Cardiopulmonary exercise testing]] is considered to optimize prescription of [[exercise]] training.


== Overview==
Exercise stress testing with an assessment of oxygen consumption is useful in assessing the functional capacity of the heart failure patient, angiography can exclude the presence of an ischemic basis for the disease, cardiac catheterization can evaluate hemodynamic basis of heart failure and the response to drug, and myocardial viability studies can determine whether hypocontractile myocardium is viable but just hibernating, and could therefore benefit from revascularization.
==Exercise Stress Testing==
==Exercise Stress Testing==
Exercise stress testing is useful in measuring the "functional capacity" of heart failure patients. It is also helpful to assess the efficacy of congestive heart failure treatment.
[[Exercise stress testing]] is useful in measuring the [[functional capacity]] of [[heart failure]] [[patients]]. It is also helpful to assess the efficacy of [[congestive heart failure]] treatment.
 
===2021 European Society of Cardiology Guidelines (DO NOT EDIT) <ref name="pmid34447992">{{cite journal |vauthors=McDonagh TA, Metra M, Adamo M, Gardner RS, Baumbach A, Böhm M, Burri H, Butler J, Čelutkienė J, Chioncel O, Cleland JGF, Coats AJS, Crespo-Leiro MG, Farmakis D, Gilard M, Heymans S, Hoes AW, Jaarsma T, Jankowska EA, Lainscak M, Lam CSP, Lyon AR, McMurray JJV, Mebazaa A, Mindham R, Muneretto C, Francesco Piepoli M, Price S, Rosano GMC, Ruschitzka F, Kathrine Skibelund A |title=2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure |journal=Eur Heart J |volume=42 |issue=36 |pages=3599–3726 |date=September 2021 |pmid=34447992 |doi=10.1093/eurheartj/ehab368 |url=}}</ref>===
 
{|class="wikitable" style="width:80%"
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| colspan="1" style="text-align:center; background:LemonChiffon"| [[ESC guidelines classification scheme#Classification of Recommendations|Class I]]
 
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| bgcolor="LemonChiffon"|<nowiki>"</nowiki>  [[Cardiopulmonary exercise testing]] is recommended as a part of the evaluation for [[heart transplantation]] and /or [[mechanical circulatory support]]. ''([[ESC guidelines classification scheme#Level of Evidence|Level of Evidence: C]])'' <nowiki>"</nowiki>
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| colspan="1" style="text-align:center; background:LemonChiffon"| [[ESC guidelines classification scheme#Classification of Recommendations|Class IIa]]
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| bgcolor="LemonChiffon"|<nowiki>"</nowiki>[[Cardiopulmonary exercise testing]] should be considered to optimize prescription of [[exercise]] training. ''([[ESC guidelines classification scheme#Level of Evidence|Level of Evidence: C]])'' <nowiki>"</nowiki>
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| bgcolor="LemonChiffon"|<nowiki>"</nowiki> [[Cardiopulmonary exercise testing]] should be considered to identify the cause of unexplained [[dyspnea]] and/or [[exercise intolerance]].''([[ESC guidelines classification scheme#Level of Evidence|Level of Evidence: C]])'' <nowiki>"</nowiki>
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===Exercise and Functional Capacity Testing 2022 AHA/ACC/HFSA Heart Failure Guideline (DO NOT EDIT) <ref name="pmid35363500">{{cite journal| author=Heidenreich PA, Bozkurt B, Aguilar D, Allen LA, Byun JJ, Colvin MM | display-authors=etal| title=2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure: Executive Summary: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. | journal=Circulation | year= 2022 | volume= 145 | issue= 18 | pages= e876-e894 | pmid=35363500 | doi=10.1161/CIR.0000000000001062 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=35363500  }} </ref> ===
 
{|class="wikitable" style="width:80%"
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|colspan="1" style="text-align:center; background:LightGreen"| [[ACC AHA guidelines classification scheme#Classification of Recommendations|Class I]]
 
|-
| bgcolor="LightGreen"|<nowiki>"</nowiki>'''1.''' In [[patients]] with [[HF]], assessment and documentation of [[NYHA]] functional classification are recommended to determine eligibility for [[treatments]]. <ref name="pmid16442912">{{cite journal| author=Ahmed A, Aronow WS, Fleg JL| title=Higher New York Heart Association classes and increased mortality and hospitalization in patients with heart failure and preserved left ventricular function. | journal=Am Heart J | year= 2006 | volume= 151 | issue= 2 | pages= 444-50 | pmid=16442912 | doi=10.1016/j.ahj.2005.03.066 | pmc=2771182 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16442912  }} </ref><ref name="pmid12445535">{{cite journal| author=Muntwyler J, Abetel G, Gruner C, Follath F| title=One-year mortality among unselected outpatients with heart failure. | journal=Eur Heart J | year= 2002 | volume= 23 | issue= 23 | pages= 1861-6 | pmid=12445535 | doi=10.1053/euhj.2002.3282 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12445535  }} </ref> ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C-LD]])'' <nowiki>"</nowiki>
 
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| bgcolor="LightGreen"|<nowiki>"</nowiki>'''2.''' In selected [[ambulatory]] [[patients]] with [[HF]], [[cardiopulmonary exercise testing]] ([[CPET]]) is recommended to determine appropriateness of advanced [[treatments]] (eg, LVAD, [[heart transplant]]). <ref name="pmid26067685">{{cite journal| author=Brawner CA, Shafiq A, Aldred HA, Ehrman JK, Leifer ES, Selektor Y | display-authors=etal| title=Comprehensive analysis of cardiopulmonary exercise testing and mortality in patients with systolic heart failure: the Henry Ford Hospital cardiopulmonary exercise testing (FIT-CPX) project. | journal=J Card Fail | year= 2015 | volume= 21 | issue= 9 | pages= 710-8 | pmid=26067685 | doi=10.1016/j.cardfail.2015.06.001 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26067685  }} </ref><ref name="pmid21450614">{{cite journal| author=Corrà U, Giordano A, Mezzani A, Gnemmi M, Pistono M, Caruso R | display-authors=etal| title=Cardiopulmonary exercise testing and prognosis in heart failure due to systolic left ventricular dysfunction: a validation study of the European Society of Cardiology Guidelines and Recommendations (2008) and further developments. | journal=Eur J Prev Cardiol | year= 2012 | volume= 19 | issue= 1 | pages= 32-40 | pmid=21450614 | doi=10.1177/1741826710393994 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21450614  }} </ref><ref name="pmid23352391">{{cite journal| author=Feldman D, Pamboukian SV, Teuteberg JJ, Birks E, Lietz K, Moore SA | display-authors=etal| title=The 2013 International Society for Heart and Lung Transplantation Guidelines for mechanical circulatory support: executive summary. | journal=J Heart Lung Transplant | year= 2013 | volume= 32 | issue= 2 | pages= 157-87 | pmid=23352391 | doi=10.1016/j.healun.2012.09.013 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23352391  }} </ref><ref name="pmid1999029">{{cite journal| author=Mancini DM, Eisen H, Kussmaul W, Mull R, Edmunds LH, Wilson JR| title=Value of peak exercise oxygen consumption for optimal timing of cardiac transplantation in ambulatory patients with heart failure. | journal=Circulation | year= 1991 | volume= 83 | issue= 3 | pages= 778-86 | pmid=1999029 | doi=10.1161/01.cir.83.3.778 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1999029  }} </ref><ref name="pmid26776864">{{cite journal| author=Mehra MR, Canter CE, Hannan MM, Semigran MJ, Uber PA, Baran DA | display-authors=etal| title=The 2016 International Society for Heart Lung Transplantation listing criteria for heart transplantation: A 10-year update. | journal=J Heart Lung Transplant | year= 2016 | volume= 35 | issue= 1 | pages= 1-23 | pmid=26776864 | doi=10.1016/j.healun.2015.10.023 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26776864  }} </ref>''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C-LD]])'' <nowiki>"</nowiki>
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{|class="wikitable" style="width:80%"
|-
|colspan="1" style="text-align:center; background:LemonChiffon"| [[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIa]]
 
|-
| bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''3.''' In [[ambulatory]] [[patients]] with [[HF]], performing a [[CPET]] or 6-minute [[walk test]] is reasonable to assess [[functional capacity]]. <ref name="pmid26067685">{{cite journal| author=Brawner CA, Shafiq A, Aldred HA, Ehrman JK, Leifer ES, Selektor Y | display-authors=etal| title=Comprehensive analysis of cardiopulmonary exercise testing and mortality in patients with systolic heart failure: the Henry Ford Hospital cardiopulmonary exercise testing (FIT-CPX) project. | journal=J Card Fail | year= 2015 | volume= 21 | issue= 9 | pages= 710-8 | pmid=26067685 | doi=10.1016/j.cardfail.2015.06.001 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26067685  }} </ref><ref name="pmid21450614">{{cite journal| author=Corrà U, Giordano A, Mezzani A, Gnemmi M, Pistono M, Caruso R | display-authors=etal| title=Cardiopulmonary exercise testing and prognosis in heart failure due to systolic left ventricular dysfunction: a validation study of the European Society of Cardiology Guidelines and Recommendations (2008) and further developments. | journal=Eur J Prev Cardiol | year= 2012 | volume= 19 | issue= 1 | pages= 32-40 | pmid=21450614 | doi=10.1177/1741826710393994 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21450614  }} </ref><ref name="pmid19254672">{{cite journal| author=Alahdab MT, Mansour IN, Napan S, Stamos TD| title=Six minute walk test predicts long-term all-cause mortality and heart failure rehospitalization in African-American patients hospitalized with acute decompensated heart failure. | journal=J Card Fail | year= 2009 | volume= 15 | issue= 2 | pages= 130-5 | pmid=19254672 | doi=10.1016/j.cardfail.2008.10.006 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19254672  }} </ref><ref name="pmid8411500">{{cite journal| author=Bittner V, Weiner DH, Yusuf S, Rogers WJ, McIntyre KM, Bangdiwala SI | display-authors=etal| title=Prediction of mortality and morbidity with a 6-minute walk test in patients with left ventricular dysfunction. SOLVD Investigators. | journal=JAMA | year= 1993 | volume= 270 | issue= 14 | pages= 1702-7 | pmid=8411500 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8411500  }} </ref><ref name="pmid20887617">{{cite journal| author=Boxer R, Kleppinger A, Ahmad A, Annis K, Hager D, Kenny A| title=The 6-minute walk is associated with frailty and predicts mortality in older adults with heart failure. | journal=Congest Heart Fail | year= 2010 | volume= 16 | issue= 5 | pages= 208-13 | pmid=20887617 | doi=10.1111/j.1751-7133.2010.00151.x | pmc=3027222 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20887617  }} </ref><ref name="pmid23177293">{{cite journal| author=Forman DE, Fleg JL, Kitzman DW, Brawner CA, Swank AM, McKelvie RS | display-authors=etal| title=6-min walk test provides prognostic utility comparable to cardiopulmonary exercise testing in ambulatory outpatients with systolic heart failure. | journal=J Am Coll Cardiol | year= 2012 | volume= 60 | issue= 25 | pages= 2653-61 | pmid=23177293 | doi=10.1016/j.jacc.2012.08.1010 | pmc=3766897 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23177293  }} </ref><ref name="pmid32677748">{{cite journal| author=Grundtvig M, Eriksen-Volnes T, Ørn S, Slind EK, Gullestad L| title=6 min walk test is a strong independent predictor of death in outpatients with heart failure. | journal=ESC Heart Fail | year= 2020 | volume= 7 | issue= 5 | pages= 2904-2911 | pmid=32677748 | doi=10.1002/ehf2.12900 | pmc=7524091 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=32677748  }} </ref><ref name="pmid26892413">{{cite journal| author=Keteyian SJ, Patel M, Kraus WE, Brawner CA, McConnell TR, Piña IL | display-authors=etal| title=Variables Measured During Cardiopulmonary Exercise Testing as Predictors of Mortality in Chronic Systolic Heart Failure. | journal=J Am Coll Cardiol | year= 2016 | volume= 67 | issue= 7 | pages= 780-9 | pmid=26892413 | doi=10.1016/j.jacc.2015.11.050 | pmc=4761107 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26892413  }} </ref><ref name="pmid28551310">{{cite journal| author=McCabe N, Butler J, Dunbar SB, Higgins M, Reilly C| title=Six-minute walk distance predicts 30-day readmission after acute heart failure hospitalization. | journal=Heart Lung | year= 2017 | volume= 46 | issue= 4 | pages= 287-292 | pmid=28551310 | doi=10.1016/j.hrtlng.2017.04.001 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28551310  }} </ref><ref name="pmid31369636">{{cite journal| author=Ramalho SHR, Cipriano Junior G, Vieira PJC, Nakano EY, Winkelmann ER, Callegaro CC | display-authors=etal| title=Inspiratory muscle strength and six-minute walking distance in heart failure: Prognostic utility in a 10 years follow up cohort study. | journal=PLoS One | year= 2019 | volume= 14 | issue= 8 | pages= e0220638 | pmid=31369636 | doi=10.1371/journal.pone.0220638 | pmc=6675323 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=31369636  }} </ref> ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C-LD]])'' <nowiki>"</nowiki>


==ACC/AHA Guidelines- Exercise Stress Testing Recommendation <ref name="Hunt"> Hunt SA, Abraham WT, Chin MH, Feldman AM, Francis GS, Ganiats TG, Jessup M, Konstam MA, Mancini DM, Michl K, Oates JA, Rahko PS, Silver MA, Stevenson LW, Yancy CW, Antman EM, Smith SC Jr, Adams CD, Anderson JL, Faxon DP, Fuster V, Halperin JL, Hiratzka LF, Jacobs AK, Nishimura R, Ornato JP, Page RL, Riegel B; American College of Cardiology; American Heart Association Task Force on Practice Guidelines; American College of Chest Physicians; International Society for Heart and Lung Transplantation; Heart Rhythm Society. ACC/AHA 2005 Guideline Update for the Diagnosis and Management of Chronic Heart Failure in the Adult: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Update the 2001 Guidelines for the Evaluation and Management of Heart Failure): developed in collaboration with the American College of Chest Physicians and the International Society for Heart and Lung Transplantation: endorsed by the Heart Rhythm Society. Circulation. 2005 Sep 20; 112(12): e154-235. Epub 2005 Sep 13. PMID 16160202</ref><ref name="pmid19324967">Jessup M, Abraham WT, Casey DE, Feldman AM, Francis GS, Ganiats TG et al. (2009) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=19324967 2009 focused update: ACCF/AHA Guidelines for the Diagnosis and Management of Heart Failure in Adults: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines: developed in collaboration with the International Society for Heart and Lung Transplantation.] ''Circulation'' 119 (14):1977-2016. [http://dx.doi.org/10.1161/CIRCULATIONAHA.109.192064 DOI:10.1161/CIRCULATIONAHA.109.192064] PMID: [http://pubmed.gov/19324967 19324967]</ref>==
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{{cquote| 
| bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''4.''' In [[ambulatory]] [[patients]] with unexplained [[dyspnea]], [[CPET]] is reasonable to evaluate the cause of [[dyspnea]]. <ref name="pmid22336677">{{cite journal| author=Parshall MB, Schwartzstein RM, Adams L, Banzett RB, Manning HL, Bourbeau J | display-authors=etal| title=An official American Thoracic Society statement: update on the mechanisms, assessment, and management of dyspnea. | journal=Am J Respir Crit Care Med | year= 2012 | volume= 185 | issue= 4 | pages= 435-52 | pmid=22336677 | doi=10.1164/rccm.201111-2042ST | pmc=5448624 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22336677  }} </ref><ref name="pmid29803552">{{cite journal| author=Reddy YNV, Olson TP, Obokata M, Melenovsky V, Borlaug BA| title=Hemodynamic Correlates and Diagnostic Role of Cardiopulmonary Exercise Testing in Heart Failure With Preserved Ejection Fraction. | journal=JACC Heart Fail | year= 2018 | volume= 6 | issue= 8 | pages= 665-675 | pmid=29803552 | doi=10.1016/j.jchf.2018.03.003 | pmc=6076329 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=29803552  }} </ref>''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C-LD]])'' <nowiki>"</nowiki>
===[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIa]]===
'''1.''' Maximal [[Exercise stress testing|exercise testing]] with or without measurement of [[respiratory gas exchange]] and/or [[blood oxygen saturation]] is reasonable in patients presenting with [[heart failure]] to help determine whether [[heart failure]] is the cause of exercise limitation when the contribution of [[heart failure]] is uncertain. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''


'''2.''' Maximal [[Exercise stress testing|exercise testing]] with measurement of [[respiratory gas exchange]] is reasonable to identify high-risk patients presenting with [[heart failure]] who are candidates for [[cardiac transplantation]] or other advanced treatments. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])''}}


==Related chapters==
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*[[Exercise stress testing]]


==Vote on and Suggest Revisions to the Current Guidelines==
{|class="wikitable" style="width:80%"
*[[The Living Guidelines: Diagnosis and Management of Chronic Heart Failure | The CHF Living Guidelines: Vote on current recommendations and suggest revisions to the guidelines]]
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|colspan="1" style="text-align:center; background:LemonChiffon"| [[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIb]]


==Guidelines Resources==
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*[http://circ.ahajournals.org/content/112/12/e154.full.pdf The ACC/AHA 2005 Guideline Update for the Diagnosis and Management of Chronic Heart Failure in the Adult] <ref name="Hunt"> Hunt SA, Abraham WT, Chin MH, Feldman AM, Francis GS, Ganiats TG, Jessup M, Konstam MA, Mancini DM, Michl K, Oates JA, Rahko PS, Silver MA, Stevenson LW, Yancy CW, Antman EM, Smith SC Jr, Adams CD, Anderson JL, Faxon DP, Fuster V, Halperin JL, Hiratzka LF, Jacobs AK, Nishimura R, Ornato JP, Page RL, Riegel B; American College of Cardiology; American Heart Association Task Force on Practice Guidelines; American College of Chest Physicians; International Society for Heart and Lung Transplantation; Heart Rhythm Society. ACC/AHA 2005 Guideline Update for the Diagnosis and Management of Chronic Heart Failure in the Adult: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Update the 2001 Guidelines for the Evaluation and Management of Heart Failure): developed in collaboration with the American College of Chest Physicians and the International Society for Heart and Lung Transplantation: endorsed by the Heart Rhythm Society. Circulation. 2005 Sep 20; 112(12): e154-235. Epub 2005 Sep 13. PMID 16160202</ref>
| bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''7.''' In [[patients]] with [[HF]] and [[coronary artery disease]] ([[CAD]]) who are candidates for [[coronary revascularization]], noninvasive [[stress imaging]] ([[stress echocardiography]], [[single-photon emission CT]] [SPECT], CMR, or [[positron emission tomography]] [PET] may be considered for detection of [[myocardial ischemia]] to help guide [[coronary revascularization]]. <ref name="pmid11923039">{{cite journal| author=Allman KC, Shaw LJ, Hachamovitch R, Udelson JE| title=Myocardial viability testing and impact of revascularization on prognosis in patients with coronary artery disease and left ventricular dysfunction: a meta-analysis. | journal=J Am Coll Cardiol | year= 2002 | volume= 39 | issue= 7 | pages= 1151-8 | pmid=11923039 | doi=10.1016/s0735-1097(02)01726-6 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11923039  }} </ref><ref name="pmid19761983">{{cite journal| author=D'Egidio G, Nichol G, Williams KA, Guo A, Garrard L, deKemp R | display-authors=etal| title=Increasing benefit from revascularization is associated with increasing amounts of myocardial hibernation: a substudy of the PARR-2 trial. | journal=JACC Cardiovasc Imaging | year= 2009 | volume= 2 | issue= 9 | pages= 1060-8 | pmid=19761983 | doi=10.1016/j.jcmg.2009.02.017 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19761983  }} </ref><ref name="pmid23595888">{{cite journal| author=Ling LF, Marwick TH, Flores DR, Jaber WA, Brunken RC, Cerqueira MD | display-authors=etal| title=Identification of therapeutic benefit from revascularization in patients with left ventricular systolic dysfunction: inducible ischemia versus hibernating myocardium. | journal=Circ Cardiovasc Imaging | year= 2013 | volume= 6 | issue= 3 | pages= 363-72 | pmid=23595888 | doi=10.1161/CIRCIMAGING.112.000138 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23595888  }} </ref><ref name="pmid25617608">{{cite journal| author=Orlandini A, Castellana N, Pascual A, Botto F, Cecilia Bahit M, Chacon C | display-authors=etal| title=Myocardial viability for decision-making concerning revascularization in patients with left ventricular dysfunction and coronary artery disease: a meta-analysis of non-randomized and randomized studies. | journal=Int J Cardiol | year= 2015 | volume= 182 | issue=  | pages= 494-9 | pmid=25617608 | doi=10.1016/j.ijcard.2015.01.025 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25617608  }} </ref><ref name="pmid16198841">{{cite journal| author=Desideri A, Cortigiani L, Christen AI, Coscarelli S, Gregori D, Zanco P | display-authors=etal| title=The extent of perfusion-F18-fluorodeoxyglucose positron emission tomography mismatch determines mortality in medically treated patients with chronic ischemic left ventricular dysfunction. | journal=J Am Coll Cardiol | year= 2005 | volume= 46 | issue= 7 | pages= 1264-9 | pmid=16198841 | doi=10.1016/j.jacc.2005.06.057 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16198841  }} </ref> ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:B-NR]])'' <nowiki>"</nowiki>


*[http://content.onlinejacc.org/cgi/reprint/53/15/1343.pdf 2009 focused update: ACCF/AHA Guidelines for the Diagnosis and Management of Heart Failure in Adults: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines: developed in collaboration with the International Society for Heart and Lung Transplantation] <ref name="pmid19324967">Jessup M, Abraham WT, Casey DE, Feldman AM, Francis GS, Ganiats TG et al. (2009) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=19324967 2009 focused update: ACCF/AHA Guidelines for the Diagnosis and Management of Heart Failure in Adults: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines: developed in collaboration with the International Society for Heart and Lung Transplantation.] ''Circulation'' 119 (14):1977-2016. [http://dx.doi.org/10.1161/CIRCULATIONAHA.109.192064 DOI:10.1161/CIRCULATIONAHA.109.192064] PMID: [http://pubmed.gov/19324967 19324967]</ref>
|}
 
 
==External Links==
*[https://www.ahajournals.org/doi/epub/10.1161/CIR.0000000000001063.full.pdf 2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines]<ref name="pmid35363499">{{cite journal |vauthors=Heidenreich PA, Bozkurt B, Aguilar D, Allen LA, Byun JJ, Colvin MM, Deswal A, Drazner MH, Dunlay SM, Evers LR, Fang JC, Fedson SE, Fonarow GC, Hayek SS, Hernandez AF, Khazanie P, Kittleson MM, Lee CS, Link MS, Milano CA, Nnacheta LC, Sandhu AT, Stevenson LW, Vardeny O, Vest AR, Yancy CW |title=2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines |journal=Circulation |volume=145 |issue=18 |pages=e895–e1032 |date=May 2022 |pmid=35363499 |doi=10.1161/CIR.0000000000001063 |url=}} </ref>


==References==
==References==
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Latest revision as of 20:47, 22 June 2022
Resident
Survival
Guide
Congestive Heart Failure Microchapters

Home

Patient Information

Overview

Historical Perspective

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Pathophysiology

Systolic Dysfunction
Diastolic Dysfunction
HFpEF
HFrEF

Causes

Differentiating Congestive heart failure from other Diseases

Epidemiology and Demographics

Risk Factors

Screening

Natural History, Complications and Prognosis

Diagnosis

Clinical Assessment

History and Symptoms

Physical Examination

Laboratory Findings

Electrocardiogram

Chest X Ray

Cardiac MRI

Echocardiography

Exercise Stress Test

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Cardiac Catheterization

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Treatment

Invasive Hemodynamic Monitoring

Medical Therapy:

Summary
Acute Pharmacotherapy
Chronic Pharmacotherapy in HFpEF
Chronic Pharmacotherapy in HFrEF
Diuretics
ACE Inhibitors
Angiotensin receptor blockers
Aldosterone Antagonists
Beta Blockers
Ca Channel Blockers
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Hydralazine
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Angiotensin Receptor-Neprilysin Inhibitor
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Nutritional Supplements
Hormonal Therapies
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Treatment of underlying causes
Associated conditions

Exercise Training

Surgical Therapy:

Biventricular Pacing or Cardiac Resynchronization Therapy (CRT)
Implantation of Intracardiac Defibrillator
Ultrafiltration
Cardiac Surgery
Left Ventricular Assist Devices (LVADs)
Cardiac Transplantation

ACC/AHA Guideline Recommendations

Initial and Serial Evaluation of the HF Patient
Hospitalized Patient
Patients With a Prior MI
Sudden Cardiac Death Prevention
Surgical/Percutaneous/Transcather Interventional Treatments of HF
Patients at high risk for developing heart failure (Stage A)
Patients with cardiac structural abnormalities or remodeling who have not developed heart failure symptoms (Stage B)
Patients with current or prior symptoms of heart failure (Stage C)
Patients with refractory end-stage heart failure (Stage D)
Coordinating Care for Patients With Chronic HF
Quality Metrics/Performance Measures

Implementation of Practice Guidelines

Congestive heart failure end-of-life considerations

Specific Groups:

Special Populations
Patients who have concomitant disorders
Obstructive Sleep Apnea in the Patient with CHF
NSTEMI with Heart Failure and Cardiogenic Shock

Congestive heart failure exercise stress testing On the Web

Most recent articles

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Directions to Hospitals Treating Congestive heart failure exercise stress testing

Risk calculators and risk factors for Congestive heart failure exercise stress testing

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-In-Chief: Sara Zand, M.D.[2] Lakshmi Gopalakrishnan, M.B.B.S. [3] Edzel Lorraine Co, DMD, MD[4]

Overview

Exercise stress testing with an assessment of oxygen consumption is useful in assessing the functional capacity of the heart failure patient. Cardiopulmonary exercise testing is considered to optimize prescription of exercise training.

Exercise Stress Testing

Exercise stress testing is useful in measuring the functional capacity of heart failure patients. It is also helpful to assess the efficacy of congestive heart failure treatment.

2021 European Society of Cardiology Guidelines (DO NOT EDIT) [1]

Class I
" Cardiopulmonary exercise testing is recommended as a part of the evaluation for heart transplantation and /or mechanical circulatory support. (Level of Evidence: C) "
Class IIa
"Cardiopulmonary exercise testing should be considered to optimize prescription of exercise training. (Level of Evidence: C) "
" Cardiopulmonary exercise testing should be considered to identify the cause of unexplained dyspnea and/or exercise intolerance.(Level of Evidence: C) "

Exercise and Functional Capacity Testing 2022 AHA/ACC/HFSA Heart Failure Guideline (DO NOT EDIT) [2]

Class I
"1. In patients with HF, assessment and documentation of NYHA functional classification are recommended to determine eligibility for treatments. [3][4] (Level of Evidence: C-LD) "
"2. In selected ambulatory patients with HF, cardiopulmonary exercise testing (CPET) is recommended to determine appropriateness of advanced treatments (eg, LVAD, heart transplant). [5][6][7][8][9](Level of Evidence: C-LD) "
Class IIa
"3. In ambulatory patients with HF, performing a CPET or 6-minute walk test is reasonable to assess functional capacity. [5][6][10][11][12][13][14][15][16][17] (Level of Evidence: C-LD) "
"4. In ambulatory patients with unexplained dyspnea, CPET is reasonable to evaluate the cause of dyspnea. [18][19](Level of Evidence: C-LD) "


Class IIb
"7. In patients with HF and coronary artery disease (CAD) who are candidates for coronary revascularization, noninvasive stress imaging (stress echocardiography, single-photon emission CT [SPECT], CMR, or positron emission tomography [PET] may be considered for detection of myocardial ischemia to help guide coronary revascularization. [20][21][22][23][24] (Level of Evidence:B-NR) "


External Links

References

  1. ↑ McDonagh TA, Metra M, Adamo M, Gardner RS, Baumbach A, Böhm M, Burri H, Butler J, Čelutkienė J, Chioncel O, Cleland J, Coats A, Crespo-Leiro MG, Farmakis D, Gilard M, Heymans S, Hoes AW, Jaarsma T, Jankowska EA, Lainscak M, Lam C, Lyon AR, McMurray J, Mebazaa A, Mindham R, Muneretto C, Francesco Piepoli M, Price S, Rosano G, Ruschitzka F, Kathrine Skibelund A (September 2021). "2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure". Eur Heart J. 42 (36): 3599–3726. doi:10.1093/eurheartj/ehab368. PMID 34447992 Check |pmid= value (help). Vancouver style error: initials (help)
  2. ↑ Heidenreich PA, Bozkurt B, Aguilar D, Allen LA, Byun JJ, Colvin MM; et al. (2022). "2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure: Executive Summary: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines". Circulation. 145 (18): e876–e894. doi:10.1161/CIR.0000000000001062. PMID 35363500 Check |pmid= value (help).
  3. ↑ Ahmed A, Aronow WS, Fleg JL (2006). "Higher New York Heart Association classes and increased mortality and hospitalization in patients with heart failure and preserved left ventricular function". Am Heart J. 151 (2): 444–50. doi:10.1016/j.ahj.2005.03.066. PMC 2771182. PMID 16442912.
  4. ↑ Muntwyler J, Abetel G, Gruner C, Follath F (2002). "One-year mortality among unselected outpatients with heart failure". Eur Heart J. 23 (23): 1861–6. doi:10.1053/euhj.2002.3282. PMID 12445535.
  5. ↑ 5.0 5.1 Brawner CA, Shafiq A, Aldred HA, Ehrman JK, Leifer ES, Selektor Y; et al. (2015). "Comprehensive analysis of cardiopulmonary exercise testing and mortality in patients with systolic heart failure: the Henry Ford Hospital cardiopulmonary exercise testing (FIT-CPX) project". J Card Fail. 21 (9): 710–8. doi:10.1016/j.cardfail.2015.06.001. PMID 26067685.
  6. ↑ 6.0 6.1 Corrà U, Giordano A, Mezzani A, Gnemmi M, Pistono M, Caruso R; et al. (2012). "Cardiopulmonary exercise testing and prognosis in heart failure due to systolic left ventricular dysfunction: a validation study of the European Society of Cardiology Guidelines and Recommendations (2008) and further developments". Eur J Prev Cardiol. 19 (1): 32–40. doi:10.1177/1741826710393994. PMID 21450614.
  7. ↑ Feldman D, Pamboukian SV, Teuteberg JJ, Birks E, Lietz K, Moore SA; et al. (2013). "The 2013 International Society for Heart and Lung Transplantation Guidelines for mechanical circulatory support: executive summary". J Heart Lung Transplant. 32 (2): 157–87. doi:10.1016/j.healun.2012.09.013. PMID 23352391.
  8. ↑ Mancini DM, Eisen H, Kussmaul W, Mull R, Edmunds LH, Wilson JR (1991). "Value of peak exercise oxygen consumption for optimal timing of cardiac transplantation in ambulatory patients with heart failure". Circulation. 83 (3): 778–86. doi:10.1161/01.cir.83.3.778. PMID 1999029.
  9. ↑ Mehra MR, Canter CE, Hannan MM, Semigran MJ, Uber PA, Baran DA; et al. (2016). "The 2016 International Society for Heart Lung Transplantation listing criteria for heart transplantation: A 10-year update". J Heart Lung Transplant. 35 (1): 1–23. doi:10.1016/j.healun.2015.10.023. PMID 26776864.
  10. ↑ Alahdab MT, Mansour IN, Napan S, Stamos TD (2009). "Six minute walk test predicts long-term all-cause mortality and heart failure rehospitalization in African-American patients hospitalized with acute decompensated heart failure". J Card Fail. 15 (2): 130–5. doi:10.1016/j.cardfail.2008.10.006. PMID 19254672.
  11. ↑ Bittner V, Weiner DH, Yusuf S, Rogers WJ, McIntyre KM, Bangdiwala SI; et al. (1993). "Prediction of mortality and morbidity with a 6-minute walk test in patients with left ventricular dysfunction. SOLVD Investigators". JAMA. 270 (14): 1702–7. PMID 8411500.
  12. ↑ Boxer R, Kleppinger A, Ahmad A, Annis K, Hager D, Kenny A (2010). "The 6-minute walk is associated with frailty and predicts mortality in older adults with heart failure". Congest Heart Fail. 16 (5): 208–13. doi:10.1111/j.1751-7133.2010.00151.x. PMC 3027222. PMID 20887617.
  13. ↑ Forman DE, Fleg JL, Kitzman DW, Brawner CA, Swank AM, McKelvie RS; et al. (2012). "6-min walk test provides prognostic utility comparable to cardiopulmonary exercise testing in ambulatory outpatients with systolic heart failure". J Am Coll Cardiol. 60 (25): 2653–61. doi:10.1016/j.jacc.2012.08.1010. PMC 3766897. PMID 23177293.
  14. ↑ Grundtvig M, Eriksen-Volnes T, Ørn S, Slind EK, Gullestad L (2020). "6 min walk test is a strong independent predictor of death in outpatients with heart failure". ESC Heart Fail. 7 (5): 2904–2911. doi:10.1002/ehf2.12900. PMC 7524091 Check |pmc= value (help). PMID 32677748 Check |pmid= value (help).
  15. ↑ Keteyian SJ, Patel M, Kraus WE, Brawner CA, McConnell TR, Piña IL; et al. (2016). "Variables Measured During Cardiopulmonary Exercise Testing as Predictors of Mortality in Chronic Systolic Heart Failure". J Am Coll Cardiol. 67 (7): 780–9. doi:10.1016/j.jacc.2015.11.050. PMC 4761107. PMID 26892413.
  16. ↑ McCabe N, Butler J, Dunbar SB, Higgins M, Reilly C (2017). "Six-minute walk distance predicts 30-day readmission after acute heart failure hospitalization". Heart Lung. 46 (4): 287–292. doi:10.1016/j.hrtlng.2017.04.001. PMID 28551310.
  17. ↑ Ramalho SHR, Cipriano Junior G, Vieira PJC, Nakano EY, Winkelmann ER, Callegaro CC; et al. (2019). "Inspiratory muscle strength and six-minute walking distance in heart failure: Prognostic utility in a 10 years follow up cohort study". PLoS One. 14 (8): e0220638. doi:10.1371/journal.pone.0220638. PMC 6675323 Check |pmc= value (help). PMID 31369636.
  18. ↑ Parshall MB, Schwartzstein RM, Adams L, Banzett RB, Manning HL, Bourbeau J; et al. (2012). "An official American Thoracic Society statement: update on the mechanisms, assessment, and management of dyspnea". Am J Respir Crit Care Med. 185 (4): 435–52. doi:10.1164/rccm.201111-2042ST. PMC 5448624. PMID 22336677.
  19. ↑ Reddy YNV, Olson TP, Obokata M, Melenovsky V, Borlaug BA (2018). "Hemodynamic Correlates and Diagnostic Role of Cardiopulmonary Exercise Testing in Heart Failure With Preserved Ejection Fraction". JACC Heart Fail. 6 (8): 665–675. doi:10.1016/j.jchf.2018.03.003. PMC 6076329. PMID 29803552.
  20. ↑ Allman KC, Shaw LJ, Hachamovitch R, Udelson JE (2002). "Myocardial viability testing and impact of revascularization on prognosis in patients with coronary artery disease and left ventricular dysfunction: a meta-analysis". J Am Coll Cardiol. 39 (7): 1151–8. doi:10.1016/s0735-1097(02)01726-6. PMID 11923039.
  21. ↑ D'Egidio G, Nichol G, Williams KA, Guo A, Garrard L, deKemp R; et al. (2009). "Increasing benefit from revascularization is associated with increasing amounts of myocardial hibernation: a substudy of the PARR-2 trial". JACC Cardiovasc Imaging. 2 (9): 1060–8. doi:10.1016/j.jcmg.2009.02.017. PMID 19761983.
  22. ↑ Ling LF, Marwick TH, Flores DR, Jaber WA, Brunken RC, Cerqueira MD; et al. (2013). "Identification of therapeutic benefit from revascularization in patients with left ventricular systolic dysfunction: inducible ischemia versus hibernating myocardium". Circ Cardiovasc Imaging. 6 (3): 363–72. doi:10.1161/CIRCIMAGING.112.000138. PMID 23595888.
  23. ↑ Orlandini A, Castellana N, Pascual A, Botto F, Cecilia Bahit M, Chacon C; et al. (2015). "Myocardial viability for decision-making concerning revascularization in patients with left ventricular dysfunction and coronary artery disease: a meta-analysis of non-randomized and randomized studies". Int J Cardiol. 182: 494–9. doi:10.1016/j.ijcard.2015.01.025. PMID 25617608.
  24. ↑ Desideri A, Cortigiani L, Christen AI, Coscarelli S, Gregori D, Zanco P; et al. (2005). "The extent of perfusion-F18-fluorodeoxyglucose positron emission tomography mismatch determines mortality in medically treated patients with chronic ischemic left ventricular dysfunction". J Am Coll Cardiol. 46 (7): 1264–9. doi:10.1016/j.jacc.2005.06.057. PMID 16198841.
  25. ↑ Heidenreich PA, Bozkurt B, Aguilar D, Allen LA, Byun JJ, Colvin MM, Deswal A, Drazner MH, Dunlay SM, Evers LR, Fang JC, Fedson SE, Fonarow GC, Hayek SS, Hernandez AF, Khazanie P, Kittleson MM, Lee CS, Link MS, Milano CA, Nnacheta LC, Sandhu AT, Stevenson LW, Vardeny O, Vest AR, Yancy CW (May 2022). "2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines". Circulation. 145 (18): e895–e1032. doi:10.1161/CIR.0000000000001063. PMID 35363499 Check |pmid= value (help).

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