Background Oxygen uptake at the anaerobic threshold (VO(2)AT), a submaximal exercise-derived variable, independent of patients' motivation, is a marker of outcome in heart failure (HF). However, previous evidence of VO(2)AT values paradoxically higher in HF patients with permanent atrial fibrillation (AF) than in those with sinus rhythm (SR) raised uncertainties. Design We tested the prognostic role of VO(2)AT in a large cohort of systolic HF patients, focusing on possible differences between SR and AF. Methods Altogether 2976 HF patients (2578 with SR and 398 with AF) were prospectively followed. Besides a clinical examination, each patient underwent a maximal cardiopulmonary exercise test (CPET). Results The follow-up was analysed for up to 1500 days. Cardiovascular death or urgent cardiac transplantation occurred in 303 patients (250 (9.6%) patients with SR and 53 (13.3%) patients with AF, p=0.023). In the entire population, multivariate analysis including peak oxygen uptake (VO2) showed a prognostic capacity (C-index) similar to that obtained including VO(2)AT (0.76 vs 0.72). Also, left ventricular ejection fraction, ventilation vs carbon dioxide production slope, -blocker and digoxin therapy proved to be significant prognostic indexes. The receiver-operating characteristic (ROC) curves analysis showed that the best predictive VO(2)AT cut-off for the SR group was 11.7ml/kg/min, while it was 12.8ml/kg/min for the AF group. Conclusions VO(2)AT, a submaximal CPET-derived parameter, is reliable for long-term cardiovascular mortality prognostication in stable systolic HF. However, different VO(2)AT cut-off values between SR and AF HF patients should be adopted.
Deceptive meaning of oxygen uptake measured at the anaerobic threshold in patients with systolic heart failure and atrial fibrillation / D. Magrì, P. Agostoni, U. Corrà, C. Passino, D. Scrutinio, P. Perrone-Filardi, M. Correale, G. Cattadori, M. Metra, D. Girola, M.F. Piepoli, A. Iorio, M. Emdin, R. Raimondo, F. Re, M. Cicoira, R. Belardinelli, M. Guazzi, G. Limongelli, F. Clemenza, G. Parati, M. Frigerio, M. Casenghi, A.B. Scardovi, A. Ferraironi, A. Di Lenarda, M. Bussotti, A. Apostolo, S. Paolillo, R. La Gioia, P. Gargiulo, P. Palermo, C. Minà, S. Farina, E. Battaia, A. Maruotti, G. Pacileo, M. Contini, F. Oliva, R. Ricci, G. Sinagra. - In: EUROPEAN JOURNAL OF PREVENTIVE CARDIOLOGY. - ISSN 2047-4873. - 22:8(2015 Aug), pp. 1046-1055.
|Titolo:||Deceptive meaning of oxygen uptake measured at the anaerobic threshold in patients with systolic heart failure and atrial fibrillation|
AGOSTONI, PIERGIUSEPPE (Secondo)
|Parole Chiave:||Heart failure; prognosis; atrial fibrillation; exercise; anaerobic threshold|
|Settore Scientifico Disciplinare:||Settore MED/11 - Malattie dell'Apparato Cardiovascolare|
|Data di pubblicazione:||ago-2015|
|Data ahead of print / Data di stampa:||26-set-2014|
|Digital Object Identifier (DOI):||http://dx.doi.org/10.1177/2047487314551546|
|Appare nelle tipologie:||01 - Articolo su periodico|
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