Heart failure prognosis over time: how the prognostic role of oxygen consumption and ventilatory efficiency during exercise has changed in the last 20 years

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

Research output: Contribution to journalArticle

4 Citations (Scopus)

Abstract

Aims: Exercise-derived parameters, specifically peak exercise oxygen uptake (peak VO2) and minute ventilation/carbon dioxide relationship slope (VE/VCO2 slope), have a pivotal prognostic value in heart failure (HF). It is unknown how the prognostic threshold of peak VO2 and VE/VCO2 slope has changed over the last 20 years in parallel with HF prognosis improvement. Methods and results: Data from 6083 HF patients (81% male, age 61 ± 13 years), enrolled in the MECKI score database between 1993 and 2015, were retrospectively analysed. By enrolment year, four groups were generated: group 1 1993–2000 (n = 440), group 2 2001–2005 (n = 1288), group 3 2006–2010 (n = 2368), and group 4 2011–2015 (n = 1987). We compared the 10-year survival of groups and analysed how the overall risk (cardiovascular death, urgent heart transplantation, or left ventricular assist device implantation) changed over time according to peak VO2 and VE/VCO2 slope and to major clinical and therapeutic variables. At 10 years, a progressively higher survival from group 1 to group 3 was observed, with no further improvement afterwards. A 20% risk for peak VO2 15 mL/min/kg (95% confidence interval 16–13), 9 (11–8), 4 (4–2) and 5 (7–4) was observed in group 1, 2, 3, and 4, respectively, while the VE/VCO2 slope value for a 20% risk was 32 (37–29), 47 (51–43), 59 (64–55), and 57 (63–52), respectively. Conclusions: Heart failure prognosis improved over time up to 2010 in a HF population followed by experienced centres. The peak VO2 and VE/VCO2 slope cut-offs identifying a definite risk progressively decreased and increased over time, respectively. The prognostic threshold of peak VO2 and VE/VCO2 slope must be updated whenever HF prognosis improves.

Original languageEnglish
JournalEuropean Journal of Heart Failure
DOIs
Publication statusAccepted/In press - Jan 1 2019

Fingerprint

Oxygen Consumption
Heart Failure
Exercise
Heart-Assist Devices
Survival
Heart Transplantation
Carbon Dioxide
Ventilation
Databases
Confidence Intervals
Oxygen
Population

Keywords

  • Cardiopulmonary exercise test
  • Heart failure
  • Peak oxygen uptake
  • Prognosis
  • VE/VCO slope

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Heart failure prognosis over time : how the prognostic role of oxygen consumption and ventilatory efficiency during exercise has changed in the last 20 years. / on behalf of the MECKI Score Research Group (see Appendix).

In: European Journal of Heart Failure, 01.01.2019.

Research output: Contribution to journalArticle

@article{230e1b19ec714e2383394227de1f11e2,
title = "Heart failure prognosis over time: how the prognostic role of oxygen consumption and ventilatory efficiency during exercise has changed in the last 20 years",
abstract = "Aims: Exercise-derived parameters, specifically peak exercise oxygen uptake (peak VO2) and minute ventilation/carbon dioxide relationship slope (VE/VCO2 slope), have a pivotal prognostic value in heart failure (HF). It is unknown how the prognostic threshold of peak VO2 and VE/VCO2 slope has changed over the last 20 years in parallel with HF prognosis improvement. Methods and results: Data from 6083 HF patients (81{\%} male, age 61 ± 13 years), enrolled in the MECKI score database between 1993 and 2015, were retrospectively analysed. By enrolment year, four groups were generated: group 1 1993–2000 (n = 440), group 2 2001–2005 (n = 1288), group 3 2006–2010 (n = 2368), and group 4 2011–2015 (n = 1987). We compared the 10-year survival of groups and analysed how the overall risk (cardiovascular death, urgent heart transplantation, or left ventricular assist device implantation) changed over time according to peak VO2 and VE/VCO2 slope and to major clinical and therapeutic variables. At 10 years, a progressively higher survival from group 1 to group 3 was observed, with no further improvement afterwards. A 20{\%} risk for peak VO2 15 mL/min/kg (95{\%} confidence interval 16–13), 9 (11–8), 4 (4–2) and 5 (7–4) was observed in group 1, 2, 3, and 4, respectively, while the VE/VCO2 slope value for a 20{\%} risk was 32 (37–29), 47 (51–43), 59 (64–55), and 57 (63–52), respectively. Conclusions: Heart failure prognosis improved over time up to 2010 in a HF population followed by experienced centres. The peak VO2 and VE/VCO2 slope cut-offs identifying a definite risk progressively decreased and increased over time, respectively. The prognostic threshold of peak VO2 and VE/VCO2 slope must be updated whenever HF prognosis improves.",
keywords = "Cardiopulmonary exercise test, Heart failure, Peak oxygen uptake, Prognosis, VE/VCO slope",
author = "{on behalf of the MECKI Score Research Group (see Appendix)} and Stefania Paolillo and Fabrizio Veglia and Elisabetta Salvioni and Ugo Corr{\`a} and Massimo Piepoli and Rocco Lagioia and Giuseppe Limongelli and Gianfranco Sinagra and Gaia Cattadori and Scardovi, {Angela B.} and Marco Metra and Michele Senni and Alice Bonomi and Domenico Scrutinio and Rosa Raimondo and Michele Emdin and Damiano Magr{\`i} and Gianfranco Parati and Federica Re and Mariantonietta Cicoira and Chiara Min{\`a} and Michele Correale and Maria Frigerio and Maurizio Bussotti and Elisa Battaia and Marco Guazzi and Roberto Badagliacca and {Di Lenarda}, Andrea and Aldo Maggioni and Claudio Passino and Susanna Sciomer and Giuseppe Pacileo and Massimo Mapelli and Carlo Vignati and Francesco Clemenza and Simone Binno and Piergiuseppe Agostoni and Anna Apostolo and Pietro Palermo and Mauro Contini and Stefania Farina and Valentina Mantegazza and Emanuele Spadafora and Andrea Giordano and Alessandro Mezzani and Gabriella Malfatto and Sergio Caravita and Andrea Passantino and Daniela Santoro and Paola Gargiulo",
year = "2019",
month = "1",
day = "1",
doi = "10.1002/ejhf.1364",
language = "English",
journal = "European Journal of Heart Failure",
issn = "1388-9842",
publisher = "John Wiley & Sons, Ltd",

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TY - JOUR

T1 - Heart failure prognosis over time

T2 - how the prognostic role of oxygen consumption and ventilatory efficiency during exercise has changed in the last 20 years

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

AU - Paolillo, Stefania

AU - Veglia, Fabrizio

AU - Salvioni, Elisabetta

AU - Corrà, Ugo

AU - Piepoli, Massimo

AU - Lagioia, Rocco

AU - Limongelli, Giuseppe

AU - Sinagra, Gianfranco

AU - Cattadori, Gaia

AU - Scardovi, Angela B.

AU - Metra, Marco

AU - Senni, Michele

AU - Bonomi, Alice

AU - Scrutinio, Domenico

AU - Raimondo, Rosa

AU - Emdin, Michele

AU - Magrì, Damiano

AU - Parati, Gianfranco

AU - Re, Federica

AU - Cicoira, Mariantonietta

AU - Minà, Chiara

AU - Correale, Michele

AU - Frigerio, Maria

AU - Bussotti, Maurizio

AU - Battaia, Elisa

AU - Guazzi, Marco

AU - Badagliacca, Roberto

AU - Di Lenarda, Andrea

AU - Maggioni, Aldo

AU - Passino, Claudio

AU - Sciomer, Susanna

AU - Pacileo, Giuseppe

AU - Mapelli, Massimo

AU - Vignati, Carlo

AU - Clemenza, Francesco

AU - Binno, Simone

AU - Agostoni, Piergiuseppe

AU - Apostolo, Anna

AU - Palermo, Pietro

AU - Contini, Mauro

AU - Farina, Stefania

AU - Mantegazza, Valentina

AU - Spadafora, Emanuele

AU - Giordano, Andrea

AU - Mezzani, Alessandro

AU - Malfatto, Gabriella

AU - Caravita, Sergio

AU - Passantino, Andrea

AU - Santoro, Daniela

AU - Gargiulo, Paola

PY - 2019/1/1

Y1 - 2019/1/1

N2 - Aims: Exercise-derived parameters, specifically peak exercise oxygen uptake (peak VO2) and minute ventilation/carbon dioxide relationship slope (VE/VCO2 slope), have a pivotal prognostic value in heart failure (HF). It is unknown how the prognostic threshold of peak VO2 and VE/VCO2 slope has changed over the last 20 years in parallel with HF prognosis improvement. Methods and results: Data from 6083 HF patients (81% male, age 61 ± 13 years), enrolled in the MECKI score database between 1993 and 2015, were retrospectively analysed. By enrolment year, four groups were generated: group 1 1993–2000 (n = 440), group 2 2001–2005 (n = 1288), group 3 2006–2010 (n = 2368), and group 4 2011–2015 (n = 1987). We compared the 10-year survival of groups and analysed how the overall risk (cardiovascular death, urgent heart transplantation, or left ventricular assist device implantation) changed over time according to peak VO2 and VE/VCO2 slope and to major clinical and therapeutic variables. At 10 years, a progressively higher survival from group 1 to group 3 was observed, with no further improvement afterwards. A 20% risk for peak VO2 15 mL/min/kg (95% confidence interval 16–13), 9 (11–8), 4 (4–2) and 5 (7–4) was observed in group 1, 2, 3, and 4, respectively, while the VE/VCO2 slope value for a 20% risk was 32 (37–29), 47 (51–43), 59 (64–55), and 57 (63–52), respectively. Conclusions: Heart failure prognosis improved over time up to 2010 in a HF population followed by experienced centres. The peak VO2 and VE/VCO2 slope cut-offs identifying a definite risk progressively decreased and increased over time, respectively. The prognostic threshold of peak VO2 and VE/VCO2 slope must be updated whenever HF prognosis improves.

AB - Aims: Exercise-derived parameters, specifically peak exercise oxygen uptake (peak VO2) and minute ventilation/carbon dioxide relationship slope (VE/VCO2 slope), have a pivotal prognostic value in heart failure (HF). It is unknown how the prognostic threshold of peak VO2 and VE/VCO2 slope has changed over the last 20 years in parallel with HF prognosis improvement. Methods and results: Data from 6083 HF patients (81% male, age 61 ± 13 years), enrolled in the MECKI score database between 1993 and 2015, were retrospectively analysed. By enrolment year, four groups were generated: group 1 1993–2000 (n = 440), group 2 2001–2005 (n = 1288), group 3 2006–2010 (n = 2368), and group 4 2011–2015 (n = 1987). We compared the 10-year survival of groups and analysed how the overall risk (cardiovascular death, urgent heart transplantation, or left ventricular assist device implantation) changed over time according to peak VO2 and VE/VCO2 slope and to major clinical and therapeutic variables. At 10 years, a progressively higher survival from group 1 to group 3 was observed, with no further improvement afterwards. A 20% risk for peak VO2 15 mL/min/kg (95% confidence interval 16–13), 9 (11–8), 4 (4–2) and 5 (7–4) was observed in group 1, 2, 3, and 4, respectively, while the VE/VCO2 slope value for a 20% risk was 32 (37–29), 47 (51–43), 59 (64–55), and 57 (63–52), respectively. Conclusions: Heart failure prognosis improved over time up to 2010 in a HF population followed by experienced centres. The peak VO2 and VE/VCO2 slope cut-offs identifying a definite risk progressively decreased and increased over time, respectively. The prognostic threshold of peak VO2 and VE/VCO2 slope must be updated whenever HF prognosis improves.

KW - Cardiopulmonary exercise test

KW - Heart failure

KW - Peak oxygen uptake

KW - Prognosis

KW - VE/VCO slope

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U2 - 10.1002/ejhf.1364

DO - 10.1002/ejhf.1364

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JO - European Journal of Heart Failure

JF - European Journal of Heart Failure

SN - 1388-9842

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