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 language | English |
|---|---|
| Journal | European Journal of Heart Failure |
| DOIs | |
| Publication status | Accepted/In press - Jan 1 2019 |
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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 journal › Article
}
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
UR - http://www.scopus.com/inward/record.url?scp=85059898081&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85059898081&partnerID=8YFLogxK
U2 - 10.1002/ejhf.1364
DO - 10.1002/ejhf.1364
M3 - Article
AN - SCOPUS:85059898081
JO - European Journal of Heart Failure
JF - European Journal of Heart Failure
SN - 1388-9842
ER -