Aims: Exercise-derived parameters, specifically peak exercise oxygen uptake (peak VO 2 ) and minute ventilation/carbon dioxide relationship slope (VE/VCO 2 slope), have a pivotal prognostic value in heart failure (HF). It is unknown how the prognostic threshold of peak VO 2 and VE/VCO 2 slope has changed over the last 20 years in parallel with HF prognosis improvement. Methods and results: Data from 6083 HF patients (81% male, age 61 ± 13 years), enrolled in the MECKI score database between 1993 and 2015, were retrospectively analysed. By enrolment year, four groups were generated: group 1 1993–2000 (n = 440), group 2 2001–2005 (n = 1288), group 3 2006–2010 (n = 2368), and group 4 2011–2015 (n = 1987). We compared the 10-year survival of groups and analysed how the overall risk (cardiovascular death, urgent heart transplantation, or left ventricular assist device implantation) changed over time according to peak VO 2 and VE/VCO 2 slope and to major clinical and therapeutic variables. At 10 years, a progressively higher survival from group 1 to group 3 was observed, with no further improvement afterwards. A 20% risk for peak VO 2 15 mL/min/kg (95% confidence interval 16–13), 9 (11–8), 4 (4–2) and 5 (7–4) was observed in group 1, 2, 3, and 4, respectively, while the VE/VCO 2 slope value for a 20% risk was 32 (37–29), 47 (51–43), 59 (64–55), and 57 (63–52), respectively. Conclusions: Heart failure prognosis improved over time up to 2010 in a HF population followed by experienced centres. The peak VO 2 and VE/VCO 2 slope cut-offs identifying a definite risk progressively decreased and increased over time, respectively. The prognostic threshold of peak VO 2 and VE/VCO 2 slope must be updated whenever HF prognosis improves.

Heart failure prognosis over time: how the prognostic role of oxygen consumption and ventilatory efficiency during exercise has changed in the last 20 years / S. Paolillo, F. Veglia, E. Salvioni, U. Corrà, M. Piepoli, R. Lagioia, G. Limongelli, G. Sinagra, G. Cattadori, A.B. Scardovi, M. Metra, M. Senni, A. Bonomi, D. Scrutinio, R. Raimondo, M. Emdin, D. Magrì, G. Parati, F. Re, M. Cicoira, C. Minà, M. Correale, M. Frigerio, M. Bussotti, E. Battaia, M. Guazzi, R. Badagliacca, A. Di Lenarda, A. Maggioni, C. Passino, S. Sciomer, G. Pacileo, M. Mapelli, C. Vignati, F. Clemenza, S. Binno, C. Lombardi, P.P. Filardi, P. Agostoni, A. Apostolo, P. Palermo, M. Contini, S. Farina, V. Mantegazza, E. Spadafora, M.S. Lattarulo, A. Giordano, A. Mezzani, R. Ricci, A. Ferraironi, V. Carubelli, F. Pietrucci, G. Malfatto, S. Caravita, E. Viganò, F. Valente, R. Vastarella, R. Gravino, T. Roselli, A. Buono, R. De Maria, A. Passantino, D. Santoro, S. Campanale, D. Caputo, D. Bertipaglia, M. Confalonieri, P. Gentile, E. Zambon, M. Morosin, C. Carriere, A. Ferraretti, G. Marchese, A. Iorio, L. Pastormerlo, P. Gargiulo, G.Q. Villani, F. Oliva, E. Perna. - In: EUROPEAN JOURNAL OF HEART FAILURE. - ISSN 1388-9842. - 21:2(2019 Feb), pp. 208-217. [10.1002/ejhf.1364]

Heart failure prognosis over time: how the prognostic role of oxygen consumption and ventilatory efficiency during exercise has changed in the last 20 years

F. Veglia;M. Piepoli;G. Cattadori;M. Guazzi;M. Mapelli;C. Vignati;P. Agostoni;S. Farina;V. Mantegazza;E. Spadafora;G. Malfatto;G. Marchese;
2019

Abstract

Aims: Exercise-derived parameters, specifically peak exercise oxygen uptake (peak VO 2 ) and minute ventilation/carbon dioxide relationship slope (VE/VCO 2 slope), have a pivotal prognostic value in heart failure (HF). It is unknown how the prognostic threshold of peak VO 2 and VE/VCO 2 slope has changed over the last 20 years in parallel with HF prognosis improvement. Methods and results: Data from 6083 HF patients (81% male, age 61 ± 13 years), enrolled in the MECKI score database between 1993 and 2015, were retrospectively analysed. By enrolment year, four groups were generated: group 1 1993–2000 (n = 440), group 2 2001–2005 (n = 1288), group 3 2006–2010 (n = 2368), and group 4 2011–2015 (n = 1987). We compared the 10-year survival of groups and analysed how the overall risk (cardiovascular death, urgent heart transplantation, or left ventricular assist device implantation) changed over time according to peak VO 2 and VE/VCO 2 slope and to major clinical and therapeutic variables. At 10 years, a progressively higher survival from group 1 to group 3 was observed, with no further improvement afterwards. A 20% risk for peak VO 2 15 mL/min/kg (95% confidence interval 16–13), 9 (11–8), 4 (4–2) and 5 (7–4) was observed in group 1, 2, 3, and 4, respectively, while the VE/VCO 2 slope value for a 20% risk was 32 (37–29), 47 (51–43), 59 (64–55), and 57 (63–52), respectively. Conclusions: Heart failure prognosis improved over time up to 2010 in a HF population followed by experienced centres. The peak VO 2 and VE/VCO 2 slope cut-offs identifying a definite risk progressively decreased and increased over time, respectively. The prognostic threshold of peak VO 2 and VE/VCO 2 slope must be updated whenever HF prognosis improves.
Cardiopulmonary exercise test; Heart failure; Peak oxygen uptake; Prognosis; VE/VCO 2 slope ; Cardiology and Cardiovascular Medicine
Settore MED/11 - Malattie dell'Apparato Cardiovascolare
feb-2019
http://onlinelibrary.wiley.com/journal/10.1002/(ISSN)1879-0844
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