Exercise oscillatory ventilation and prognosis in heart failure patients with reduced and mid-range ejection fraction

on behalf of the MECKI Score Research Group (see Appendix 1)

Research output: Contribution to journalArticle

Abstract

Aims: Exercise oscillatory ventilation (EOV) is a pivotal cardiopulmonary exercise test parameter for the prognostic evaluation of patients with chronic heart failure (HF). It has been described in patients with HF with reduced ejection fraction (<40%, HFrEF) and with HF with preserved ejection fraction (>50%, HFpEF), but no data are available for patients with HF with mid-range ejection fraction (40–49%, HFmrEF). The aim of the study was to evaluate the prognostic role of EOV in HFmrEF patients. Methods and results: We analysed 1239 patients with HFmrEF and 4482 patients with HFrEF, enrolled in the MECKI score database, with a 2-year follow-up. The study endpoint was the composite of cardiovascular death, urgent heart transplant, and ventricular assist device implantation. We identified EOV in 968 cases (16% and 17% of cases in HFmrEF and HFrEF,. respectively). HFrEF EOV+ patients were significantly older, and their parameters suggested a more severe HF than HFrEF EOV− patients. A similar behaviour was found in HFmrEF EOV+ vs. EOV− patients. Kaplan–Meier analysis, irrespective of ejection fraction, showed that EOV is associated with a worse survival, and that patients with HFrEF and HFmrEF EOV+ had a significantly worse outcome than the EOV− of the same ejection fraction groups. EOV-associated survival differences in HFmrEF patients started after 18 months of follow-up. Conclusion: Exercise oscillatory ventilation has a similar prevalence and ominous prognostic value in both HFmrEF and HFrEF patients, indicating a group of patients in need of a more intensive follow-up and a more aggressive therapy. In HFmrEF, the survival curves between EOV+ and EOV− patients diverged only after 18 months.

Original languageEnglish
Pages (from-to)1586-1595
Number of pages10
JournalEuropean Journal of Heart Failure
Volume21
Issue number12
DOIs
Publication statusPublished - Dec 1 2019

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Ventilation
Heart Failure
Exercise
Heart-Assist Devices
Survival
Exercise Test
Databases
Transplants

Keywords

  • Cardiopulmonary exercise test
  • Exercise oscillatory ventilation
  • Heart failure with mid-range ejection fraction
  • Prognosis

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Exercise oscillatory ventilation and prognosis in heart failure patients with reduced and mid-range ejection fraction. / on behalf of the MECKI Score Research Group (see Appendix 1).

In: European Journal of Heart Failure, Vol. 21, No. 12, 01.12.2019, p. 1586-1595.

Research output: Contribution to journalArticle

on behalf of the MECKI Score Research Group (see Appendix 1). / Exercise oscillatory ventilation and prognosis in heart failure patients with reduced and mid-range ejection fraction. In: European Journal of Heart Failure. 2019 ; Vol. 21, No. 12. pp. 1586-1595.
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abstract = "Aims: Exercise oscillatory ventilation (EOV) is a pivotal cardiopulmonary exercise test parameter for the prognostic evaluation of patients with chronic heart failure (HF). It has been described in patients with HF with reduced ejection fraction (<40{\%}, HFrEF) and with HF with preserved ejection fraction (>50{\%}, HFpEF), but no data are available for patients with HF with mid-range ejection fraction (40–49{\%}, HFmrEF). The aim of the study was to evaluate the prognostic role of EOV in HFmrEF patients. Methods and results: We analysed 1239 patients with HFmrEF and 4482 patients with HFrEF, enrolled in the MECKI score database, with a 2-year follow-up. The study endpoint was the composite of cardiovascular death, urgent heart transplant, and ventricular assist device implantation. We identified EOV in 968 cases (16{\%} and 17{\%} of cases in HFmrEF and HFrEF,. respectively). HFrEF EOV+ patients were significantly older, and their parameters suggested a more severe HF than HFrEF EOV− patients. A similar behaviour was found in HFmrEF EOV+ vs. EOV− patients. Kaplan–Meier analysis, irrespective of ejection fraction, showed that EOV is associated with a worse survival, and that patients with HFrEF and HFmrEF EOV+ had a significantly worse outcome than the EOV− of the same ejection fraction groups. EOV-associated survival differences in HFmrEF patients started after 18 months of follow-up. Conclusion: Exercise oscillatory ventilation has a similar prevalence and ominous prognostic value in both HFmrEF and HFrEF patients, indicating a group of patients in need of a more intensive follow-up and a more aggressive therapy. In HFmrEF, the survival curves between EOV+ and EOV− patients diverged only after 18 months.",
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T1 - Exercise oscillatory ventilation and prognosis in heart failure patients with reduced and mid-range ejection fraction

AU - on behalf of the MECKI Score Research Group (see Appendix 1)

AU - Rovai, Sara

AU - Corrà, Ugo

AU - Piepoli, Massimo

AU - Vignati, Carlo

AU - Salvioni, Elisabetta

AU - Bonomi, Alice

AU - Mattavelli, Irene

AU - Arcari, Luca

AU - Scardovi, Angela B.

AU - Perrone Filardi, Pasquale

AU - Lagioia, Rocco

AU - Paolillo, Stefania

AU - Magrì, Damiano

AU - Limongelli, Giuseppe

AU - Metra, Marco

AU - Senni, Michele

AU - Scrutinio, Domenico

AU - Raimondo, Rosa

AU - Emdin, Michele

AU - Lombardi, Carlo

AU - Cattadori, Gaia

AU - Parati, Gianfranco

AU - Re, Federica

AU - Cicoira, Mariantonietta

AU - Villani, Giovanni Q.

AU - Minà, Chiara

AU - Correale, Michele

AU - Frigerio, Maria

AU - Perna, Enrico

AU - Mapelli, Massimo

AU - Magini, Alessandra

AU - Clemenza, Francesco

AU - Bussotti, Maurizio

AU - Battaia, Elisa

AU - Guazzi, Marco

AU - Bandera, Francesco

AU - Badagliacca, Roberto

AU - Di Lenarda, Andrea

AU - Pacileo, Giuseppe

AU - Maggioni, Aldo

AU - Passino, Claudio

AU - Sciomer, Susanna

AU - Sinagra, Gianfranco

AU - Agostoni, Piergiuseppe

PY - 2019/12/1

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N2 - Aims: Exercise oscillatory ventilation (EOV) is a pivotal cardiopulmonary exercise test parameter for the prognostic evaluation of patients with chronic heart failure (HF). It has been described in patients with HF with reduced ejection fraction (<40%, HFrEF) and with HF with preserved ejection fraction (>50%, HFpEF), but no data are available for patients with HF with mid-range ejection fraction (40–49%, HFmrEF). The aim of the study was to evaluate the prognostic role of EOV in HFmrEF patients. Methods and results: We analysed 1239 patients with HFmrEF and 4482 patients with HFrEF, enrolled in the MECKI score database, with a 2-year follow-up. The study endpoint was the composite of cardiovascular death, urgent heart transplant, and ventricular assist device implantation. We identified EOV in 968 cases (16% and 17% of cases in HFmrEF and HFrEF,. respectively). HFrEF EOV+ patients were significantly older, and their parameters suggested a more severe HF than HFrEF EOV− patients. A similar behaviour was found in HFmrEF EOV+ vs. EOV− patients. Kaplan–Meier analysis, irrespective of ejection fraction, showed that EOV is associated with a worse survival, and that patients with HFrEF and HFmrEF EOV+ had a significantly worse outcome than the EOV− of the same ejection fraction groups. EOV-associated survival differences in HFmrEF patients started after 18 months of follow-up. Conclusion: Exercise oscillatory ventilation has a similar prevalence and ominous prognostic value in both HFmrEF and HFrEF patients, indicating a group of patients in need of a more intensive follow-up and a more aggressive therapy. In HFmrEF, the survival curves between EOV+ and EOV− patients diverged only after 18 months.

AB - Aims: Exercise oscillatory ventilation (EOV) is a pivotal cardiopulmonary exercise test parameter for the prognostic evaluation of patients with chronic heart failure (HF). It has been described in patients with HF with reduced ejection fraction (<40%, HFrEF) and with HF with preserved ejection fraction (>50%, HFpEF), but no data are available for patients with HF with mid-range ejection fraction (40–49%, HFmrEF). The aim of the study was to evaluate the prognostic role of EOV in HFmrEF patients. Methods and results: We analysed 1239 patients with HFmrEF and 4482 patients with HFrEF, enrolled in the MECKI score database, with a 2-year follow-up. The study endpoint was the composite of cardiovascular death, urgent heart transplant, and ventricular assist device implantation. We identified EOV in 968 cases (16% and 17% of cases in HFmrEF and HFrEF,. respectively). HFrEF EOV+ patients were significantly older, and their parameters suggested a more severe HF than HFrEF EOV− patients. A similar behaviour was found in HFmrEF EOV+ vs. EOV− patients. Kaplan–Meier analysis, irrespective of ejection fraction, showed that EOV is associated with a worse survival, and that patients with HFrEF and HFmrEF EOV+ had a significantly worse outcome than the EOV− of the same ejection fraction groups. EOV-associated survival differences in HFmrEF patients started after 18 months of follow-up. Conclusion: Exercise oscillatory ventilation has a similar prevalence and ominous prognostic value in both HFmrEF and HFrEF patients, indicating a group of patients in need of a more intensive follow-up and a more aggressive therapy. In HFmrEF, the survival curves between EOV+ and EOV− patients diverged only after 18 months.

KW - Cardiopulmonary exercise test

KW - Exercise oscillatory ventilation

KW - Heart failure with mid-range ejection fraction

KW - Prognosis

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