Cardiovascular Death Risk in Recovered Mid-Range Ejection Fraction Heart Failure: Insights From Cardiopulmonary Exercise Test

D. MAGRÌ, M. PIEPOLI, U.G.O. CORRÀ, G. GALLO, A. MARUOTTI, C. VIGNATI, E. SALVIONI, M. MAPELLI, S. PAOLILLO, P. PERRONE FILARDI, D. GIROLA, M. METRA, A.B. SCARDOVI, R. LAGIOIA, G. LIMONGELLI, M. SENNI, D. SCRUTINIO, M. EMDIN, C. PASSINO, C. LOMBARDIG.A.I.A. CATTADORI, G. PARATI, M. CICOIRA, M. CORREALE, M. FRIGERIO, F. CLEMENZA, M. BUSSOTTI, M. GUAZZI, R. BADAGLIACCA, S. SCIOMER, A. DI LENARDA, A.L.D.O. MAGGIONI, G. SINAGRA, M. VOLPE, P. AGOSTONI, MECKI score Research Group (see appendix)

Research output: Contribution to journalArticlepeer-review

Abstract



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.
Original languageEnglish
Pages (from-to)932-943
Number of pages12
JournalJournal of Cardiac Failure
Volume26
Issue number11
DOIs
Publication statusPublished - 2020

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