TY - JOUR
T1 - Cardiovascular Death Risk in Recovered Mid-Range Ejection Fraction Heart Failure
T2 - Insights From Cardiopulmonary Exercise Test
AU - MECKI Score Research Group (see Appendix)
AU - MagrÌ, Damiano
AU - Piepoli, Massimo
AU - CorrÀ, Ugo
AU - Gallo, Giovanna
AU - Maruotti, Antonello
AU - Vignati, Carlo
AU - Salvioni, Elisabetta
AU - Mapelli, Massimo
AU - Paolillo, Stefania
AU - Perrone Filardi, Pasquale
AU - Girola, Davide
AU - Metra, Marco
AU - Scardovi, Angela B
AU - Lagioia, Rocco
AU - Limongelli, Giuseppe
AU - Senni, Michele
AU - Scrutinio, Domenico
AU - Emdin, Michele
AU - Passino, Claudio
AU - Lombardi, Carlo
AU - Cattadori, Gaia
AU - Parati, Gianfranco
AU - Cicoira, Mariantonietta
AU - Correale, Michele
AU - Frigerio, Maria
AU - Clemenza, Francesco
AU - Bussotti, Maurizio
AU - Guazzi, Marco
AU - Badagliacca, Roberto
AU - Sciomer, Susanna
AU - DI Lenarda, Andrea
AU - Maggioni, Aldo
AU - Sinagra, Gianfranco
AU - Volpe, Massimo
AU - Agostoni, Piergiuseppe
N1 - Copyright © 2020 Elsevier Inc. All rights reserved.
PY - 2020/5/17
Y1 - 2020/5/17
N2 - BACKGROUND: Heart failure with midrange ejection fraction (HFmrEF) represents a heterogeneous category where phenotype, as well as prognostic assessment, remains 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.METHODS AND RESULTS: We analyzed data from 4535 patients with HFrEF and 1176 patients with rec-HFmrEF from the Metabolic Exercise combined with Cardiac and Kidney Indexes database. The end point was cardiovascular death at 5 years. The median follow-up was 1343 days (25th-75th range 627-2403 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 peak oxygen uptake of ≤55% of predicted and a ventilatory efficiency of ≥31 resulted as the most accurate cut-off values in the outcome prediction.CONCLUSIONS: Present data support the cardiopulmonary exercise test and, particularly, the peak oxygen uptake, as a useful tool in the rec-HFmrEF prognostic assessment. A peak VO2 of ≤55% predicted and ventilatory efficiency of ≥31 might help to identify a high-risk rec-HFmrEF subgroup.
AB - BACKGROUND: Heart failure with midrange ejection fraction (HFmrEF) represents a heterogeneous category where phenotype, as well as prognostic assessment, remains 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.METHODS AND RESULTS: We analyzed data from 4535 patients with HFrEF and 1176 patients with rec-HFmrEF from the Metabolic Exercise combined with Cardiac and Kidney Indexes database. The end point was cardiovascular death at 5 years. The median follow-up was 1343 days (25th-75th range 627-2403 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 peak oxygen uptake of ≤55% of predicted and a ventilatory efficiency of ≥31 resulted as the most accurate cut-off values in the outcome prediction.CONCLUSIONS: Present data support the cardiopulmonary exercise test and, particularly, the peak oxygen uptake, as a useful tool in the rec-HFmrEF prognostic assessment. A peak VO2 of ≤55% predicted and ventilatory efficiency of ≥31 might help to identify a high-risk rec-HFmrEF subgroup.
U2 - 10.1016/j.cardfail.2020.04.021
DO - 10.1016/j.cardfail.2020.04.021
M3 - Article
C2 - 32428671
JO - Journal of Cardiac Failure
JF - Journal of Cardiac Failure
SN - 1071-9164
ER -