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)

Research output: Contribution to journalArticle

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
Pages (from-to)208-217
Number of pages10
JournalEuropean Journal of Heart Failure
Volume21
Issue number2
DOIs
Publication statusPublished - Feb 2019

Fingerprint

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

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 journalArticle

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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 = "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",
author = "{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 Carlo Lombardi and Filardi, {Pasquale Perrone} and Piergiuseppe Agostoni",
note = "{\circledC} 2019 The Authors. European Journal of Heart Failure {\circledC} 2019 European Society of Cardiology.",
year = "2019",
month = "2",
doi = "10.1002/ejhf.1364",
language = "English",
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journal = "European Journal of Heart Failure",
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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 - 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 -