Anaerobic Threshold and Respiratory Compensation Point Identification During Cardiopulmonary Exercise Tests in Chronic Heart Failure

Cosimo Carriere, Ugo Corrà, Massimo Piepoli, Alice Bonomi, Marco Merlo, Simone Barbieri, Elisabetta Salvioni, Simone Binno, Massimo Mapelli, Francesca Righini, Susanna Sciomer, Carlo Vignati, Federica Moscucci, Fabrizio Veglia, Gianfranco Sinagra, Piergiuseppe Agostoni

Research output: Contribution to journalArticle

Abstract

BACKGROUND: We evaluated the prognostic meaning of the simple presence or absence of identifiable anaerobic threshold (AT) and respiratory compensation point (RCP) at cardiopulmonary exercise tests (CPETs) performed with a maximal incremental exercise protocol.

METHODS: In the present multicenter study, we retrospectively analyzed data in 1,995 patients with heart failure with reduced ejection fraction (HFrEF). All underwent clinical and laboratory evaluation, echocardiography, and maximal CPET at baseline. The analysis was performed according to absence of identified AT and RCP (group 1: n = 292; 15%), presence of AT but absence of identified RCP (group 2: n = 920; 46%), and presence of both AT and RCP (group 3: n = 783; 39%). The study end point was the composite of cardiovascular mortality, urgent heart transplant, and left ventricular assist device implantation.

RESULTS: Median follow-up was 2.97 years (interquartile range, 1.50-5.35 years). Eighty-seven (30%), 169 (18%), and 111 (14%) events were observed in groups 1, 2, and 3, respectively (P = .025). Compared with results in group 3 (patients with the best survival), the likelihood of reaching the study end point increased 2.7 times when neither AT nor RCP were identified (hazard ratio, 2.74) and 1.4 times when only AT was identified (hazard ratio, 1.4). Moreover, adding the presence or absence of identified AT and RCP improved the prognostic power of peak oxygen uptake because a significant reclassification was obtained.

CONCLUSIONS: AT and RCP identification has a potential role in the prognostic stratification of HFrEF.

Original languageEnglish
Pages (from-to)338-347
Number of pages10
JournalChest
Volume156
Issue number2
DOIs
Publication statusPublished - Aug 2019

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Anaerobic Threshold
Exercise Test
Heart Failure
Heart-Assist Devices
Multicenter Studies
Echocardiography
Exercise
Oxygen
Transplants
Survival
Mortality

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Anaerobic Threshold and Respiratory Compensation Point Identification During Cardiopulmonary Exercise Tests in Chronic Heart Failure. / Carriere, Cosimo; Corrà, Ugo; Piepoli, Massimo; Bonomi, Alice; Merlo, Marco; Barbieri, Simone; Salvioni, Elisabetta; Binno, Simone; Mapelli, Massimo; Righini, Francesca; Sciomer, Susanna; Vignati, Carlo; Moscucci, Federica; Veglia, Fabrizio; Sinagra, Gianfranco; Agostoni, Piergiuseppe.

In: Chest, Vol. 156, No. 2, 08.2019, p. 338-347.

Research output: Contribution to journalArticle

Carriere, Cosimo ; Corrà, Ugo ; Piepoli, Massimo ; Bonomi, Alice ; Merlo, Marco ; Barbieri, Simone ; Salvioni, Elisabetta ; Binno, Simone ; Mapelli, Massimo ; Righini, Francesca ; Sciomer, Susanna ; Vignati, Carlo ; Moscucci, Federica ; Veglia, Fabrizio ; Sinagra, Gianfranco ; Agostoni, Piergiuseppe. / Anaerobic Threshold and Respiratory Compensation Point Identification During Cardiopulmonary Exercise Tests in Chronic Heart Failure. In: Chest. 2019 ; Vol. 156, No. 2. pp. 338-347.
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abstract = "BACKGROUND: We evaluated the prognostic meaning of the simple presence or absence of identifiable anaerobic threshold (AT) and respiratory compensation point (RCP) at cardiopulmonary exercise tests (CPETs) performed with a maximal incremental exercise protocol.METHODS: In the present multicenter study, we retrospectively analyzed data in 1,995 patients with heart failure with reduced ejection fraction (HFrEF). All underwent clinical and laboratory evaluation, echocardiography, and maximal CPET at baseline. The analysis was performed according to absence of identified AT and RCP (group 1: n = 292; 15{\%}), presence of AT but absence of identified RCP (group 2: n = 920; 46{\%}), and presence of both AT and RCP (group 3: n = 783; 39{\%}). The study end point was the composite of cardiovascular mortality, urgent heart transplant, and left ventricular assist device implantation.RESULTS: Median follow-up was 2.97 years (interquartile range, 1.50-5.35 years). Eighty-seven (30{\%}), 169 (18{\%}), and 111 (14{\%}) events were observed in groups 1, 2, and 3, respectively (P = .025). Compared with results in group 3 (patients with the best survival), the likelihood of reaching the study end point increased 2.7 times when neither AT nor RCP were identified (hazard ratio, 2.74) and 1.4 times when only AT was identified (hazard ratio, 1.4). Moreover, adding the presence or absence of identified AT and RCP improved the prognostic power of peak oxygen uptake because a significant reclassification was obtained.CONCLUSIONS: AT and RCP identification has a potential role in the prognostic stratification of HFrEF.",
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T1 - Anaerobic Threshold and Respiratory Compensation Point Identification During Cardiopulmonary Exercise Tests in Chronic Heart Failure

AU - Carriere, Cosimo

AU - Corrà, Ugo

AU - Piepoli, Massimo

AU - Bonomi, Alice

AU - Merlo, Marco

AU - Barbieri, Simone

AU - Salvioni, Elisabetta

AU - Binno, Simone

AU - Mapelli, Massimo

AU - Righini, Francesca

AU - Sciomer, Susanna

AU - Vignati, Carlo

AU - Moscucci, Federica

AU - Veglia, Fabrizio

AU - Sinagra, Gianfranco

AU - Agostoni, Piergiuseppe

N1 - Copyright © 2019. Published by Elsevier Inc.

PY - 2019/8

Y1 - 2019/8

N2 - BACKGROUND: We evaluated the prognostic meaning of the simple presence or absence of identifiable anaerobic threshold (AT) and respiratory compensation point (RCP) at cardiopulmonary exercise tests (CPETs) performed with a maximal incremental exercise protocol.METHODS: In the present multicenter study, we retrospectively analyzed data in 1,995 patients with heart failure with reduced ejection fraction (HFrEF). All underwent clinical and laboratory evaluation, echocardiography, and maximal CPET at baseline. The analysis was performed according to absence of identified AT and RCP (group 1: n = 292; 15%), presence of AT but absence of identified RCP (group 2: n = 920; 46%), and presence of both AT and RCP (group 3: n = 783; 39%). The study end point was the composite of cardiovascular mortality, urgent heart transplant, and left ventricular assist device implantation.RESULTS: Median follow-up was 2.97 years (interquartile range, 1.50-5.35 years). Eighty-seven (30%), 169 (18%), and 111 (14%) events were observed in groups 1, 2, and 3, respectively (P = .025). Compared with results in group 3 (patients with the best survival), the likelihood of reaching the study end point increased 2.7 times when neither AT nor RCP were identified (hazard ratio, 2.74) and 1.4 times when only AT was identified (hazard ratio, 1.4). Moreover, adding the presence or absence of identified AT and RCP improved the prognostic power of peak oxygen uptake because a significant reclassification was obtained.CONCLUSIONS: AT and RCP identification has a potential role in the prognostic stratification of HFrEF.

AB - BACKGROUND: We evaluated the prognostic meaning of the simple presence or absence of identifiable anaerobic threshold (AT) and respiratory compensation point (RCP) at cardiopulmonary exercise tests (CPETs) performed with a maximal incremental exercise protocol.METHODS: In the present multicenter study, we retrospectively analyzed data in 1,995 patients with heart failure with reduced ejection fraction (HFrEF). All underwent clinical and laboratory evaluation, echocardiography, and maximal CPET at baseline. The analysis was performed according to absence of identified AT and RCP (group 1: n = 292; 15%), presence of AT but absence of identified RCP (group 2: n = 920; 46%), and presence of both AT and RCP (group 3: n = 783; 39%). The study end point was the composite of cardiovascular mortality, urgent heart transplant, and left ventricular assist device implantation.RESULTS: Median follow-up was 2.97 years (interquartile range, 1.50-5.35 years). Eighty-seven (30%), 169 (18%), and 111 (14%) events were observed in groups 1, 2, and 3, respectively (P = .025). Compared with results in group 3 (patients with the best survival), the likelihood of reaching the study end point increased 2.7 times when neither AT nor RCP were identified (hazard ratio, 2.74) and 1.4 times when only AT was identified (hazard ratio, 1.4). Moreover, adding the presence or absence of identified AT and RCP improved the prognostic power of peak oxygen uptake because a significant reclassification was obtained.CONCLUSIONS: AT and RCP identification has a potential role in the prognostic stratification of HFrEF.

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JO - Chest

JF - Chest

SN - 0012-3692

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ER -