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 |
|---|---|
| Pages (from-to) | 208-217 |
| Number of pages | 10 |
| Journal | European Journal of Heart Failure |
| Volume | 21 |
| Issue number | 2 |
| DOIs | |
| Publication status | Published - Feb 2019 |
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Keywords
- Disease Progression
- Exercise Test
- Female
- Follow-Up Studies
- Forecasting
- Heart Failure/diagnosis
- Humans
- Male
- Middle Aged
- Oxygen Consumption/physiology
- Prognosis
- Pulmonary Ventilation/physiology
- ROC Curve
- Respiratory Function Tests
- Retrospective Studies
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. / MECKI Score Research Group (see Appendix).
In: European Journal of Heart Failure, Vol. 21, No. 2, 02.2019, p. 208-217.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 - 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 - Lombardi, Carlo
AU - Filardi, Pasquale Perrone
AU - Agostoni, Piergiuseppe
N1 - © 2019 The Authors. European Journal of Heart Failure © 2019 European Society of Cardiology.
PY - 2019/2
Y1 - 2019/2
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 - Disease Progression
KW - Exercise Test
KW - Female
KW - Follow-Up Studies
KW - Forecasting
KW - Heart Failure/diagnosis
KW - Humans
KW - Male
KW - Middle Aged
KW - Oxygen Consumption/physiology
KW - Prognosis
KW - Pulmonary Ventilation/physiology
KW - ROC Curve
KW - Respiratory Function Tests
KW - Retrospective Studies
U2 - 10.1002/ejhf.1364
DO - 10.1002/ejhf.1364
M3 - Article
C2 - 30632680
VL - 21
SP - 208
EP - 217
JO - European Journal of Heart Failure
JF - European Journal of Heart Failure
SN - 1388-9842
IS - 2
ER -