We analyzed 381 iDCM patients who consecutively performed CPET. The study end-point was a composite of cardiovascular death/urgent heart transplantation (CVD/HTx). In the overall population the average values of peak oxygen consumption (peak VO2/kg) and percent-predicted peak VO2 (peak VO2%) were 17.1 ± 5.1 ml/kg/min and 59 ± 15%, respectively. Mean VE/VCO2 slope was 29.8 ± 6.1. During a median follow-up of 47 months (interquartile range 23–84), 83 patients experienced CVD/HTx. Peak VO2% (Area Under the Curve [AUC] 0.74; 95% CI 0.71–0.85, p < 0.001) and VE/VCO2 slope (AUC 0.78; 95% CI 0.74–0.84, p < 0.001) were more accurate in predicting CVD/HTx compared to peak VO2/kg (AUC 0.60; 95% CI 0.54–0.68, p = 0.003) (p < 0.001 for both comparisons). The most accurate threshold values for outcome prediction in our iDCM cohort were < 60% for peak VO2% and > 29 for VE/VCO2 slope. At multivariable analysis peak VO2% and VE/VCO2 slope were the strongest predictors of CVD/HTx, either as continuous and categorical variables, whereas peak VO2/kg was not independently related with prognosis.
In a large population of iDCM patients peak VO2% and VE/VCO2 slope emerged as the strongest prognostic CPET variables. Prospective studies will be necessary to confirm these data.
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