Gender and age normalization and ventilation efficiency during exercise in heart failure with reduced ejection fraction

ESC Heart Failure

卷:7

MECKI score research group¹  Maurizio Bussotti²  Giuseppe Pacileo³  Giuseppe Limongelli³  Ugo Corrà⁴  Angela B. Scardovi⁵  Federica Re⁶  Francesco Bandera⁷  Marco Guazzi⁷  Marco Metra⁸  Carlo Lombardi⁸  Andrea Di Lenarda⁹  Gianfranco Sinagra¹⁰  Giuseppe Vitale¹¹  Piergiuseppe Agostoni¹²  Laura Fusini¹²  Alessandra Magini¹²  Pietro Palermo¹²  Anna Apostolo¹²  Carlo Vignati¹²  Mauro Contini¹²  Federico Boggio¹²  Elisabetta Salvioni¹²  Alice Bonomi¹²  Massimo Mapelli¹²  Beatrice Pezzuto¹²  Sara Rovai¹²  Lorenzo Cangiano¹²  Francesco Clemenza¹³  Stefania Paolillo¹⁴  Pasquale Perrone Filardi¹⁴  Lucrezia Piccioli¹⁴  Elisa Battaia¹⁵  Michele Correale¹⁶  Damiano Magrì¹⁷  Giovanna Gallo¹⁷  Sergio Caravita¹⁸  Gianfranco Parati¹⁸  Maria Frigerio¹⁹  Roberto Badagliacca²⁰  Susanna Sciomer²⁰  Mario Pasquali²¹  Giuseppe Ambrosio²²  Rocco Lagioia²³  Domenico Scrutinio²³  Claudio Passino²⁴  Michele Emdin²⁴  Rosa Raimondo²⁵  Mariantonietta Cicoira²⁶  Massimo Piepoli²⁷  Gaia Cattadori²⁸ 

[1] ;

[2] Cardiac Rehabilitation Unit, Fondazione Salvatore Maugeri IRCCS, Scientific Institute of Milan Milan Italy;

[3] Cardiologia SUN, Ospedale Monaldi (Azienda dei Colli) Seconda Università di Napoli Napoli Italy;

[4] Cardiology Department, Istituti Clinici Scientifici Maugeri IRCCS, Veruno Institute Veruno Italy;

[5] Cardiology Division Santo Spirito Hospital Roma Italy;

[6] Cardiology Division, Cardiac Arrhythmia Center and Cardiomyopathies Unit San Camillo‐Forlanini Hospital Roma Italy;

[7] Cardiology University Department, Heart Failure Unit and Cardiopulmonary Laboratory IRCCS Policlinico San Donato San Donato Milanese Italy;

[8] Cardiology, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health University of Brescia Brescia Italy;

[9] Cardiovascular Center, Health Authority no. 1 University of Trieste Trieste Italy;

[10] Cardiovascular Department Ospedali Riuniti and University of Trieste Trieste Italy;

[11] Cardiovascular Rehabilitation Unit Buccheri La Ferla Fatebenefratelli Hospital Palermo Italy;

[12] Centro Cardiologico Monzino IRCCS Via Parea 4 Milan 20138 Italy;

[13] Department for the Treatment and Study of Cardiothoracic Diseases and Cardiothoracic Transplantation IRCCS–ISMETT Palermo Italy;

[14] Department of Advanced Biomedical Sciences Federico II University of Naples Naples Italy;

[15] Department of Cardiology S. Chiara Hospital Trento Italy;

[16] Department of Cardiology University of Foggia Foggia Italy;

[17] Department of Clinical and Molecular Medicine, Azienda Ospedaliera Sant'Andrea “Sapienza” Università degli Studi di Roma Roma Italy;

[18] Department of Medicine and Surgery University of Milano‐Bicocca Milan Italy;

[19] Dipartimento Cardiologico “A. De Gasperis” Ospedale Cà Granda‐A.O. Niguarda Milano Italy;

[20] Dipartimento di Scienze Cardiovascolari, Respiratorie, Nefrologiche, Anestesiologiche e Geriatriche, “Sapienza” Rome University Rome Italy;

[21] Dipartimento di medicina e scienze dell'invecchiamento Università G. D'Annunzio Chieti Italy;

[22] Division of Cardiology University of Perugia School of Medicine Perugia Italy;

[23] Division of Cardiology, “S. Maugeri” Foundation IRCCS, Institute of Cassano Murge Bari Italy;

[24] Fondazione Gabriele Monasterio CNR‐Regione Toscana Pisa Italy;

[25] Fondazione Salvatore Maugeri IRCCS, Istituto Scientifico di Tradate Tradate Italy;

[26] Section of Cardiology, Department of Medicine University of Verona Verona Italy;

[27] UOC Cardiologia G da Saliceto Hospital Piacenza Italy;

[28] Unità Operativa Cardiologia Riabilitativa Multimedica IRCCS Milano Italy;

关键词: Cardiopulmonary exercise test;    Prognosis;    Ventilation efficiency;    Heart failure;   

DOI  :  10.1002/ehf2.12582

来源: DOAJ

【 摘 要 】

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%, peakVO2 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 (peakVO2 < 14 mL/min/kg, n = 2919, 61.1 events/1000 pts/year) or moderate (peakVO2 ≥ 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 × Age + 23.808 (r = 0.192); male, VE/VCO2 = 0.095 × 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 peakVO2 < 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.

【 授权许可】

Unknown