Aims Ventilation vs. carbon dioxide production (VE/VCO2) is among the strongest cardiopulmonary exercise testing prognostic parameters in heart failure (HF). It is usually reported as an absolute value. The current definition of normal VE/VCO2 slope values is inadequate, since it was built from small groups of subjects with a particularly limited number of women and elderly. We aimed to define VE/VCO2 slope prediction formulas in a sizable population and to test whether the prognostic power of VE/VCO2 slope in HF was different if expressed as a percentage of the predicted value or as an absolute value. Methods and results We calculated the linear regressions between age and VE/VCO2 slope in 1136 healthy subjects (68% male, age 44.9 +/- 14.5, range 13-83 years). We then applied age-adjusted and sex-adjusted formulas to predict VE/VCO2 slope to HF patients included in the metabolic exercise test data combined with cardiac and kidney indexes score database, which counts 6112 patients (82% male, age 61.4 +/- 12.8, left ventricular ejection fraction 33.2 +/- 10.5%, peakVO(2) 14.8 +/- 4.9, mL/min/kg, VE/VCO2 slope 32.7 +/- 7.7) from 24 HF centres. Finally, we evaluated whether the use of absolute values vs. percentages of predicted VE/VCO2 affected HF prognosis prediction (composite of cardiovascular mortality + urgent transplant or left ventricular assist device). We did so in the entire cardiac and kidney indexes score population and separately in HF patients with severe (peakVO(2) < 14 mL/min/kg, n = 2919, 61.1 events/1000 pts/year) or moderate (peakVO(2) >= 14 mL/min/kg, n = 3183, 19.9 events/1000 pts/year) HF. In the healthy population, we obtained the following equations: female, VE/VCO2 = 0.052 x Age + 23.808 (r = 0.192); male, VE/VCO2 = 0.095 x Age + 20.227 (r = 0.371) (P = 0.007). We applied these formulas to calculate the percentages of predicted VE/VCO2 values. The 2-year survival prognostic power of VE/VCO2 slope was strong, and it was similar if expressed as absolute value or as a percentage of predicted value (AUCs 0.686 and 0.690, respectively). In contrast, in severe HF patients, AUCs significantly differed between absolute values (0.637) and percentages of predicted values (0.650, P = 0.0026). Moreover, VE/VCO2 slope expressed as a percentage of predicted value allowed to reclassify 6.6% of peakVO(2) < 14 mL/min/kg patients (net reclassification improvement = 0.066, P = 0.0015). Conclusions The percentage of predicted VE/VCO2 slope value strengthens the prognostic power of VE/VCO2 in severe HF patients, and it should be preferred over the absolute value for HF prognostication. Furthermore, the widespread use of VE/VCO2 slope expressed as percentage of predicted value can improve our ability to identify HF patients at high risk, which is a goal of utmost clinical relevance.
Gender and age normalization and ventilation efficiency during exercise in heart failure with reduced ejection fraction / E. Salvioni, U. Corrà, M. Piepoli, S. Rovai, M. Correale, S. Paolillo, M. Pasquali, D. Magrì, G. Vitale, L. Fusini, M. Mapelli, C. Vignati, R. Lagioia, R. Raimondo, G. Sinagra, F. Boggio, L. Cangiano, G. Gallo, A. Magini, M. Contini, P. Palermo, A. Apostolo, B. Pezzuto, A. Bonomi, A.B. Scardovi, P.P. Filardi, G. Limongelli, M. Metra, D. Scrutinio, M. Emdin, L. Piccioli, C. Lombardi, G. Cattadori, G. Parati, S. Caravita, F. Re, M. Cicoira, M. Frigerio, F. Clemenza, M. Bussotti, E. Battaia, M. Guazzi, F. Bandera, R. Badagliacca, A. Di Lenarda, G. Pacileo, C. Passino, S. Sciomer, G. Ambrosio, P. Agostoni. - In: ESC HEART FAILURE. - ISSN 2055-5822. - (2020). [Epub ahead of print]
Gender and age normalization and ventilation efficiency during exercise in heart failure with reduced ejection fraction
E. Salvioni;M. Piepoli;L. Fusini;M. Mapelli;C. Vignati;A. Magini;G. Cattadori;M. Guazzi;F. Bandera;P. Agostoni
Ultimo
2020
Abstract
Aims Ventilation vs. carbon dioxide production (VE/VCO2) is among the strongest cardiopulmonary exercise testing prognostic parameters in heart failure (HF). It is usually reported as an absolute value. The current definition of normal VE/VCO2 slope values is inadequate, since it was built from small groups of subjects with a particularly limited number of women and elderly. We aimed to define VE/VCO2 slope prediction formulas in a sizable population and to test whether the prognostic power of VE/VCO2 slope in HF was different if expressed as a percentage of the predicted value or as an absolute value. Methods and results We calculated the linear regressions between age and VE/VCO2 slope in 1136 healthy subjects (68% male, age 44.9 +/- 14.5, range 13-83 years). We then applied age-adjusted and sex-adjusted formulas to predict VE/VCO2 slope to HF patients included in the metabolic exercise test data combined with cardiac and kidney indexes score database, which counts 6112 patients (82% male, age 61.4 +/- 12.8, left ventricular ejection fraction 33.2 +/- 10.5%, peakVO(2) 14.8 +/- 4.9, mL/min/kg, VE/VCO2 slope 32.7 +/- 7.7) from 24 HF centres. Finally, we evaluated whether the use of absolute values vs. percentages of predicted VE/VCO2 affected HF prognosis prediction (composite of cardiovascular mortality + urgent transplant or left ventricular assist device). We did so in the entire cardiac and kidney indexes score population and separately in HF patients with severe (peakVO(2) < 14 mL/min/kg, n = 2919, 61.1 events/1000 pts/year) or moderate (peakVO(2) >= 14 mL/min/kg, n = 3183, 19.9 events/1000 pts/year) HF. In the healthy population, we obtained the following equations: female, VE/VCO2 = 0.052 x Age + 23.808 (r = 0.192); male, VE/VCO2 = 0.095 x Age + 20.227 (r = 0.371) (P = 0.007). We applied these formulas to calculate the percentages of predicted VE/VCO2 values. The 2-year survival prognostic power of VE/VCO2 slope was strong, and it was similar if expressed as absolute value or as a percentage of predicted value (AUCs 0.686 and 0.690, respectively). In contrast, in severe HF patients, AUCs significantly differed between absolute values (0.637) and percentages of predicted values (0.650, P = 0.0026). Moreover, VE/VCO2 slope expressed as a percentage of predicted value allowed to reclassify 6.6% of peakVO(2) < 14 mL/min/kg patients (net reclassification improvement = 0.066, P = 0.0015). Conclusions The percentage of predicted VE/VCO2 slope value strengthens the prognostic power of VE/VCO2 in severe HF patients, and it should be preferred over the absolute value for HF prognostication. Furthermore, the widespread use of VE/VCO2 slope expressed as percentage of predicted value can improve our ability to identify HF patients at high risk, which is a goal of utmost clinical relevance.File | Dimensione | Formato | |
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