TY - JOUR
T1 - Cardiovascular Death Risk in Recovered Mid-Range Ejection Fraction Heart Failure
T2 - Insights From Cardiopulmonary Exercise Test
AU - MAGRÌ, D.
AU - PIEPOLI, M.
AU - CORRÀ, U.G.O.
AU - GALLO, G.
AU - MARUOTTI, A.
AU - VIGNATI, C.
AU - SALVIONI, E.
AU - MAPELLI, M.
AU - PAOLILLO, S.
AU - PERRONE FILARDI, P.
AU - GIROLA, D.
AU - METRA, M.
AU - SCARDOVI, A.B.
AU - LAGIOIA, R.
AU - LIMONGELLI, G.
AU - SENNI, M.
AU - SCRUTINIO, D.
AU - EMDIN, M.
AU - PASSINO, C.
AU - LOMBARDI, C.
AU - CATTADORI, G.A.I.A.
AU - PARATI, G.
AU - CICOIRA, M.
AU - CORREALE, M.
AU - FRIGERIO, M.
AU - CLEMENZA, F.
AU - BUSSOTTI, M.
AU - GUAZZI, M.
AU - BADAGLIACCA, R.
AU - SCIOMER, S.
AU - DI LENARDA, A.
AU - MAGGIONI, A.L.D.O.
AU - SINAGRA, G.
AU - VOLPE, M.
AU - AGOSTONI, P.
AU - appendix), MECKI score Research Group (see
N1 - Cited By :2
Export Date: 27 December 2020
PY - 2020
Y1 - 2020
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.Keywords: Heart failure; MECKI score; cardiopulmonary exercise test; prognosis.
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.Keywords: Heart failure; MECKI score; cardiopulmonary exercise test; prognosis.
U2 - 10.1016/j.cardfail.2020.04.021
DO - 10.1016/j.cardfail.2020.04.021
M3 - Article
VL - 26
SP - 932
EP - 943
JO - Journal of Cardiac Failure
JF - Journal of Cardiac Failure
SN - 1071-9164
IS - 11
ER -