Exercise testing with concurrent beta-blocker usage: is it useful? What do we learn?

Cardiopulmonary exercise testing (CPET) has been used for the assessment of severity of heart failure (HF), secondary to left ventricular systolic dysfunction. Initial studies determined that oxygen consumption (VO2) during exercise, as a measure of functional capacity, correlated well with the hemodynamic responses related to chronic HF. These studies led to the use of peak VO2 as a prognostic indicator in chronic HF. In addition, the use of several ventilatory parameters, eg, minute ventilation/carbon dioxide production during submaximal and peak exercise, were shown to have additive and (in some studies) superior prognostic value in patients with chronic HF. However, most of these studies were performed before beta-adrenergic blockade became the main focus of therapy in chronic HF. Unlike other drugs used in the treatment of HF, these drugs do not consistently improve exercise capacity as measured by peak VO2. Several retrospective studies and one prospective study have examined the effect of long-term beta-blocker therapy on the prognostic value of CPET in patients with chronic HF. These studies indicate that patients on beta-blockers have improved overall cardiovascular outcomes compared with patients not on these drugs. In addition, peak exercise VO2 still has prognostic value in beta-blocked patients; however, the thresholds for increased risk and need for transplantation have to be lower than in patients not on these drugs. There appears to be a real demand for a comprehensive survival score tool that includes the use of beta-blockade, along with CPET performance.