What is considered a poor prognosis in heart failure based on VO2 max during CPET?

In the context of heart failure, a VO2 max measurement during cardiopulmonary exercise testing (CPET) is a critical indicator of functional capacity and prognosis. A VO2 max of less than 14 mL/kg/min is recognized as a threshold indicating a poor prognosis in heart failure patients. This low level suggests significantly impaired cardiovascular efficiency and an inability to sustain physical activity, which correlates with an increased risk of morbidity and mortality. Patients with such low exercise capacity often demonstrate severe symptoms and limitations, reinforcing the need for close monitoring and potentially more aggressive management of their heart failure condition.

In contrast, higher values, such as those above 20 mL/kg/min, indicate a better functional capacity and a more favorable prognosis. Values between 18 and 20 mL/kg/min and those less than 25 mL/kg/min are considered areas of moderate to fair prognosis but do not reflect the critical threshold that signifies poor outcomes, making them less indicative of severe heart failure severity compared to the value of less than 14 mL/kg/min.