Prognostic value of resting end-tidal carbon dioxide in patients with heart failure

Background Cardiopulmonary exercise testing (CPET) variables provide valuable prognostic information in the heart failure (HF) population. The purpose of the present study is to assess the ability of resting end-tidal carbon dioxide partial pressure (PETCO2) to predict cardiac-related events in patients with HF. Methods 121 subjects diagnosed with compensated HF underwent CPET on an outpatient basis. Mean age and ejection fraction were 49.3 years (± 14.7) and 28.4% (± 13.4), respectively. Resting PETCO2 was determined immediately prior to the exercise test in the seated position. Peak oxygen consumption (VO2) and the minute ventilation-carbon dioxide production (VE/VCO2) slope were also acquired during CPET. Results There were 41 cardiac-related hospitalizations and 9 cardiac-related deaths in the year following CPET. Mean resting PETCO2, peak VO2 and VE/VCO2 slope were 34.1 mmHg (± 4.6), 14.5 ml•kg− 1•min− 1 (± 5.1) and 35.9 (± 8.7) respectively. Univariate Cox regression analysis revealed that resting PETCO2 (Chi-square = 28.4, p < 0.001), peak VO2 (Chi-square = 21.6, p < 0.001) and VE/VCO2 slope (Chi-square = 54.9, p < 0.001) were all significant predictors of cardiac related events. Multivariate Cox regression analysis revealed resting PETCO2 added to the prognostic value of VE/VCO2 slope in predicting cardiac related events (residual Chi-square = 4.4, p = 0.04). Peak VO2 did not add additional value and was removed (residual Chi-square = 3.2, p = 0.08). Conclusions These results indicate a resting ventilatory expired gas variable possesses prognostic value independently and in combination with an established prognostic marker from the CPET. Resting PETCO2 may therefore be a valuable objective measure to obtain during both non-exercise and exercise evaluations in patients with HF.