Standing the test of time: exercise testing for heart failure prognosis in the beta-blocker era

Heart failure is a major world health problem. Despite many treatments, mortality and hospitalizations remain high. Prognosis can be quite difficult, particularly regarding the interaction of multiple therapies on our diagnostic tools. Therefore, it is imperative that we periodically revisit the utility of prognostic markers to ensure that that our interpretation of testing results remain clinically relevant. Cardiopulmonary exercise testing is a prime example of this conundrum. Originally popularized for the prediction of outcomes in systolic heart failure prior to the beta-blocker era, it remains widely utilized particularly in assessing severity of heart failure in patients considered for heart transplant. Since this time, beta-blockers have been shown to significantly improve outcomes in heart failure, as have other treatments including angiotensin receptor blockers, aldosterone receptor blockers, implantable defibrillators for primary prevention of sudden death, and cardiac resynchronization devices.
In this issue of Archives of the Turkish Society of Cardiology, Dufay-bougon, et al. evaluate the prognostic value of cardiopulmonary exercise testing in systolic heart failure patients on chronic beta-blocker therapy in a large retrospective study.