Background: Heart failure with midrange ejection fraction (HFmrEF) represents a heterogeneous category where phenotype, as well as prognostic assessment, remains still debated. The present study explores a specific HFmrEF subset, namely those who recovered from a reduced EF (rec-HFmrEF) and, particularly, it focuses on the possible additive prognostic role of cardiopulmonary exercise testing (CPET). Methods and results: We analyzed data of 4,535 HF with reduced EF (HFrEF) and 1,176 rec-HFmrEF outpatients from the Metabolic Exercise combined with Cardiac and Kidney Indexes (MECKI) database. The end-point was cardiovascular death at 5 years. The median follow-up was 1,343 days (25th-75th range, 627-2,403 days). Cardiovascular death occurred in 552 HFrEF and 61 rec-HFmrEF patients. The multivariate analysis confirmed an independent role of the MECKI score's variables in HFrEF (C-index=0.744) whereas, in the rec-HFmrEF group, only age and peak oxygen uptake (pVO2) remained associated to the end-point (C-index=0.745). A pVO2 ≤55% of predicted and a ventilatory efficiency ≥31 resulted as the most accurate cut-off values in the outcome prediction. Conclusions: Present data support the CPET and, particularly, the pVO2, as a useful tool in the rec-HFmrEF prognostic assessment. Peak VO2≤55% predicted and ventilatory efficiency ≥31 might help to identify a high risk rec-HFmrEF subgroup.
Cardiovascular death risk in recovered mid-range ejection fraction heart failure: insights from cardiopulmonary exercise test / D. Magrì, M. Piepoli, U. Corrà, G. Gallo, A. Maruotti, C. Vignati, E. Salvioni, M. Mapelli, S. Paolillo, P. Filardi, D. Girola, M. Metra, A. Scardovi, R. Lagioia, G. Limongelli, M. Senni, D. Scrutinio, M. Emdin, C. Passino, C. Lombardi, G. Cattadori, G. Parati, M. Cicoira, M. Correale, M. Frigerio, F. Clemenza, M. Bussotti, M. Guazzi, R. Badagliacca, S. Sciomer, A. Lenarda, A. Maggioni, G. Sinagra, M. Volpe, P. Agostoni. - In: JOURNAL OF CARDIAC FAILURE. - ISSN 1071-9164. - 26:11(2020 Nov), pp. 932-943.
|Titolo:||Cardiovascular death risk in recovered mid-range ejection fraction heart failure: insights from cardiopulmonary exercise test|
AGOSTONI, PIERGIUSEPPE (Corresponding)
|Parole Chiave:||Heart failure; MECKI score; cardiopulmonary exercise test; prognosis|
|Settore Scientifico Disciplinare:||Settore MED/11 - Malattie dell'Apparato Cardiovascolare|
|Data di pubblicazione:||nov-2020|
|Data ahead of print / Data di stampa:||16-mag-2020|
|Digital Object Identifier (DOI):||http://dx.doi.org/10.1016/j.cardfail.2020.04.021|
|Appare nelle tipologie:||01 - Articolo su periodico|