{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,28]],"date-time":"2026-07-28T16:58:55Z","timestamp":1785257935282,"version":"3.55.0"},"reference-count":22,"publisher":"MDPI AG","issue":"8","license":[{"start":{"date-parts":[[2026,7,28]],"date-time":"2026-07-28T00:00:00Z","timestamp":1785196800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J. Cardiovasc. Dev. Dis.","JCDD"],"abstract":"<jats:p>Background: Cardiopulmonary exercise testing (CPET) is widely used for prognostic assessment and risk stratification in patients with heart failure (HF). However, its feasibility and clinical utility in patients with advanced HF requiring intravenous inotropic support remain unclear. Methods: This observational study included hospitalized patients with HF who received intravenous inotropic therapy and underwent CPET during index hospitalization. The primary outcome was a composite of HF rehospitalization or cardiovascular death. Results: A total of 528 patients hospitalized for HF required intravenous inotropic therapy; 50 patients were included. CPET was safely completed in all patients without exercise-related adverse events. The median peak VO2 was 12.5 mL\/kg\/min, and the median VE\/VCO2 slope was 38.3. During a median follow-up of 762 days, 12 primary events occurred. In univariable analysis, the VE\/VCO2 slope, O2 pulse, and maximal workload were significantly associated with the primary outcome, whereas peak VO2 was not. A VE\/VCO2 slope &gt; 38.2 was associated with a significantly higher 3-year event rate compared with a slope \u2264 38.2 (40% vs. 8%, p = 0.021). Conclusions: CPET is feasible and safe in highly selected patients with advanced HF requiring inotropic support, and the VE\/VCO2 slope was associated with clinical outcomes in exploratory univariable analyses.<\/jats:p>","DOI":"10.3390\/jcdd13080354","type":"journal-article","created":{"date-parts":[[2026,7,28]],"date-time":"2026-07-28T15:57:28Z","timestamp":1785254248000},"page":"354","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["The Efficacy and Safety of Cardiopulmonary Exercise Testing in Advanced Heart Failure Receiving Intravenous Inotropes"],"prefix":"10.3390","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4765-9593","authenticated-orcid":false,"given":"Masaki","family":"Nakagaito","sequence":"first","affiliation":[{"name":"Second Department of Internal Medicine, University of Toyama, Toyama 930-0194, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7294-7637","authenticated-orcid":false,"given":"Teruhiko","family":"Imamura","sequence":"additional","affiliation":[{"name":"Second Department of Internal Medicine, University of Toyama, Toyama 930-0194, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuki","family":"Hida","sequence":"additional","affiliation":[{"name":"Second Department of Internal Medicine, University of Toyama, Toyama 930-0194, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2703-2523","authenticated-orcid":false,"given":"Toshihide","family":"Izumida","sequence":"additional","affiliation":[{"name":"Second Department of Internal Medicine, University of Toyama, Toyama 930-0194, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4543-596X","authenticated-orcid":false,"given":"Ryuichi","family":"Ushijima","sequence":"additional","affiliation":[{"name":"Second Department of Internal Medicine, University of Toyama, Toyama 930-0194, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9604-5603","authenticated-orcid":false,"given":"Makiko","family":"Nakamura","sequence":"additional","affiliation":[{"name":"Second Department of Internal Medicine, University of Toyama, Toyama 930-0194, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Koichiro","family":"Kinugawa","sequence":"additional","affiliation":[{"name":"Second Department of Internal Medicine, University of Toyama, Toyama 930-0194, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,7,28]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"492","DOI":"10.1016\/j.cardfail.2016.01.012","article-title":"The Added Value of Exercise Variables in Heart Failure Prognosis","volume":"22","author":"Alba","year":"2016","journal-title":"J. Card. Fail."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"929","DOI":"10.1002\/ejhf.156","article-title":"Cardiopulmonary exercise testing in systolic heart failure in 2014: The evolving prognostic role: A position paper from the committee on exercise physiology and training of the heart failure association of the ESC","volume":"16","author":"Piepoli","year":"2014","journal-title":"Eur. J. Heart Fail."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"3599","DOI":"10.1093\/eurheartj\/ehab368","article-title":"2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure","volume":"42","author":"McDonagh","year":"2021","journal-title":"Eur. Heart J."},{"key":"ref_4","first-page":"e895","article-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","volume":"145","author":"Heidenreich","year":"2022","journal-title":"Circulation"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"778","DOI":"10.1161\/01.CIR.83.3.778","article-title":"Value of peak exercise oxygen consumption for optimal timing of cardiac transplantation in ambulatory patients with heart failure","volume":"83","author":"Mancini","year":"1991","journal-title":"Circulation"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.healun.2015.10.023","article-title":"The 2016 International Society for Heart Lung Transplantation listing criteria for heart transplantation: A 10-year update","volume":"35","author":"Mehra","year":"2016","journal-title":"J. Heart Lung Transplant."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"1282","DOI":"10.1016\/j.jacc.2007.04.099","article-title":"Improved survival of patients with end-stage heart failure listed for heart transplantation: Analysis of organ procurement and transplantation network\/U.S. United Network of Organ Sharing data, 1990 to 2005","volume":"50","author":"Lietz","year":"2007","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"1585","DOI":"10.1016\/S0735-1097(97)00078-8","article-title":"Clinical correlates and prognostic significance of the ventilatory response to exercise in chronic heart failure","volume":"29","author":"Chua","year":"1997","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1002\/ejhf.979","article-title":"Role of cardiopulmonary exercise testing in clinical stratification in heart failure. A position paper from the Committee on Exercise Physiology and Training of the Heart Failure Association of the European Society of Cardiology","volume":"20","author":"Agostoni","year":"2018","journal-title":"Eur. J. Heart Fail."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"35","DOI":"10.1016\/j.hfc.2024.09.001","article-title":"Cardiopulmonary Exercise Testing in Advanced Heart Failure Management","volume":"21","author":"Landsteiner","year":"2025","journal-title":"Heart Fail. Clin."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"226","DOI":"10.1016\/j.jchf.2020.11.008","article-title":"Predictive Value of Cardiopulmonary Exercise Testing Parameters in Ambulatory Advanced Heart Failure","volume":"9","author":"Lala","year":"2021","journal-title":"JACC Heart Fail."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"191","DOI":"10.1161\/CIR.0b013e3181e52e69","article-title":"Clinician\u2019s Guide to cardiopulmonary exercise testing in adults: A scientific statement from the American Heart Association","volume":"122","author":"Balady","year":"2010","journal-title":"Circulation"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"oeab006","DOI":"10.1093\/ehjopen\/oeab006","article-title":"Short physical performance battery vs. 6-minute walking test in hospitalized elderly patients with heart failure","volume":"1","author":"Kitai","year":"2021","journal-title":"Eur. Heart J. Open"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"177","DOI":"10.1016\/S0002-9149(83)80032-0","article-title":"Failure of dobutamine to increase exercise capacity despite hemodynamic improvement in severe chronic heart failure","volume":"51","author":"Maskin","year":"1983","journal-title":"Am. J. Cardiol."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"1308","DOI":"10.1016\/0002-9149(84)90085-7","article-title":"Impaired skeletal muscle nutritive flow during exercise in patients with congestive heart failure: Role of cardiac pump dysfunction as determined by the effect of dobutamine","volume":"53","author":"Wilson","year":"1984","journal-title":"Am. J. Cardiol."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"133","DOI":"10.1002\/ehf2.12047","article-title":"Levosimendan improves exercise performance in patients with advanced chronic heart failure","volume":"2","author":"Mushtaq","year":"2015","journal-title":"ESC Heart Fail."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"2410","DOI":"10.1161\/CIRCULATIONAHA.107.686576","article-title":"Development of a ventilatory classification system in patients with heart failure","volume":"115","author":"Arena","year":"2007","journal-title":"Circulation"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"354","DOI":"10.1016\/j.ahj.2003.07.014","article-title":"Peak VO2 and VE\/VCO2 slope in patients with heart failure: A prognostic comparison","volume":"147","author":"Arena","year":"2004","journal-title":"Am. Heart J."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"154","DOI":"10.1053\/euhj.1999.1863","article-title":"Cardiopulmonary exercise testing for prognosis in chronic heart failure: Continuous and independent prognostic value from VE\/VCO2slope and peak VO2","volume":"21","author":"Francis","year":"2000","journal-title":"Eur. Heart J."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"2411","DOI":"10.1161\/01.CIR.100.24.2411","article-title":"Ventilatory and heart rate responses to exercise: Better predictors of heart failure mortality than peak oxygen consumption","volume":"100","author":"Robbins","year":"1999","journal-title":"Circulation"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"589","DOI":"10.1016\/j.healun.2005.11.448","article-title":"Determining the best ventilatory efficiency measure to predict mortality in patients with heart failure","volume":"25","author":"Bard","year":"2006","journal-title":"J. Heart Lung Transplant."},{"key":"ref_22","doi-asserted-by":"crossref","unstructured":"Pugliatti, P., Trimarchi, G., Barocelli, F., Pizzino, F., Di Spigno, F., Tedeschi, A., Piccione, M.C., Irrera, P., Aschieri, D., and Niccoli, G. (2024). Advancing Cardiac Amyloidosis Care Through Insights from Cardiopulmonary Exercise Testing. J. Clin. Med., 13.","DOI":"10.3390\/jcm13237285"}],"container-title":["Journal of Cardiovascular Development and Disease"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2308-3425\/13\/8\/354\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,28]],"date-time":"2026-07-28T16:02:03Z","timestamp":1785254523000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2308-3425\/13\/8\/354"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7,28]]},"references-count":22,"journal-issue":{"issue":"8","published-online":{"date-parts":[[2026,8]]}},"alternative-id":["jcdd13080354"],"URL":"https:\/\/doi.org\/10.3390\/jcdd13080354","relation":{},"ISSN":["2308-3425"],"issn-type":[{"value":"2308-3425","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7,28]]}}}