TY - JOUR
T1 - Sex Profile and Risk Assessment With Cardiopulmonary Exercise Testing in Heart Failure: Propensity Score Matching for Sex Selection Bias
AU - Corrà, Ugo
AU - Agostoni, Piergiuseppe
AU - Giordano, Andrea
AU - Cattadori, Gaia
AU - Battaia, Elisa
AU - La Gioia, Rocco
AU - Scardovi, Angela Beatrice
AU - Emdin, Michele
AU - Metra, Marco
AU - Sinagra, Gianfranco
AU - Limongelli, Giuseppe
AU - Raimondo, Rosa
AU - Re, Federica
AU - Guazzi, Marco
AU - Belardinelli, Romualdo
AU - Parati, Gianfranco
AU - Magrì, Damiano
AU - Fiorentini, Cesare
AU - Cicoira, Mariantonietta
AU - Salvioni, Elisabetta
AU - Giovannardi, Marta
AU - Veglia, Fabrizio
AU - Mezzani, Alessandro
AU - Scrutinio, Domenico
AU - Lenarda, Andrea Di
AU - Ricci, Roberto
AU - Apostolo, Anna
AU - Iorio, Anna Maria
AU - Paolillo, Stefania
AU - Palermo, Pietro
AU - Contini, Mauro
AU - Vassanelli, Corrado
AU - Passino, Claudio
AU - Giannuzzi, Pantaleo
AU - Piepoli, Massimo F.
AU - Group, MECKI Score Research
N1 - Copyright © 2016 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.
PY - 2016/6/1
Y1 - 2016/6/1
N2 - BACKGROUND: In heart failure (HF), women show better survival despite a comparatively low peak oxygen consumption (V˙o2): this raises doubt about the accuracy of risk assessment by cardiopulmonary exercise testing (CPET) in women. Accordingly, we aimed to check (1) whether the predictive role of well-known CPET risk indexes, ie, peak V˙o2 and ventilatory response (V˙e/V˙co2 slope), is sex independent and (2) if sex-related characteristics that impact outcome in HF should be considered as associations that may confound the effect of sex on survival.METHODS: The study population consisted of 2985 patients with HF, 498 (17%) of whom were women, from the multicentre Metabolic Exercise Test Data Combined with Cardiac and Kidney Indexes (MECKI): the end point was cardiovascular death within a 3-year period.RESULTS: During the follow-up, 305 (12%) men and 39 (8%) women (P = 0.005) died, and female sex was linked to better survival on univariate analysis (P = 0.008) and independent of peak V˙o2 and V˙e/V˙co2 slope on multivariate analysis. According to propensity score matching for female sex to exclude a sex selection bias and sample discrepancy, 498 men were selected: the standardized percentage bias ranged from 20.8 (P <0.0001) to 3.3 (P = 0.667). After clinical profile harmonizing, female sex was predictive of HF at univariate analysis.CONCLUSIONS: The low peak V˙o2 and female association with better outcome in HF might be counterfeit: the female prognostic advantage is lost when sex-specific differences are correctly taken into account with propensity score matching, suggesting that for an effective and efficient HF model, adjustment must be made for sex-related characteristics.
AB - BACKGROUND: In heart failure (HF), women show better survival despite a comparatively low peak oxygen consumption (V˙o2): this raises doubt about the accuracy of risk assessment by cardiopulmonary exercise testing (CPET) in women. Accordingly, we aimed to check (1) whether the predictive role of well-known CPET risk indexes, ie, peak V˙o2 and ventilatory response (V˙e/V˙co2 slope), is sex independent and (2) if sex-related characteristics that impact outcome in HF should be considered as associations that may confound the effect of sex on survival.METHODS: The study population consisted of 2985 patients with HF, 498 (17%) of whom were women, from the multicentre Metabolic Exercise Test Data Combined with Cardiac and Kidney Indexes (MECKI): the end point was cardiovascular death within a 3-year period.RESULTS: During the follow-up, 305 (12%) men and 39 (8%) women (P = 0.005) died, and female sex was linked to better survival on univariate analysis (P = 0.008) and independent of peak V˙o2 and V˙e/V˙co2 slope on multivariate analysis. According to propensity score matching for female sex to exclude a sex selection bias and sample discrepancy, 498 men were selected: the standardized percentage bias ranged from 20.8 (P <0.0001) to 3.3 (P = 0.667). After clinical profile harmonizing, female sex was predictive of HF at univariate analysis.CONCLUSIONS: The low peak V˙o2 and female association with better outcome in HF might be counterfeit: the female prognostic advantage is lost when sex-specific differences are correctly taken into account with propensity score matching, suggesting that for an effective and efficient HF model, adjustment must be made for sex-related characteristics.
KW - Journal Article
U2 - 10.1016/j.cjca.2015.09.010
DO - 10.1016/j.cjca.2015.09.010
M3 - Articolo
VL - 32
SP - 754
EP - 759
JO - Canadian Journal of Cardiology
JF - Canadian Journal of Cardiology
SN - 0828-282X
IS - 6
ER -