Gianfranco Sinagra1, Annamaria Iorio2, Marco Merlo2, Antonio Cannatà2, Davide Stolfo2, Elena Zambon2, Concetta Di Nora2, Stefania Paolillo3, Giulia Barbati2, Emanuela Berton4, Cosimo Carriere2, Damiano Magrì5, Gaia Cattadori6, Marco Confalonieri7, Andrea Di Lenarda8, Piergiuseppe Agostoni9. 1. Cardiovascular Department, Azienda Sanitaria Universitaria Integrata di Trieste "Ospedali Riuniti" and University of Trieste, Italy. Electronic address: gianfranco.sinagra@asuits.sanita.fvg.it. 2. Cardiovascular Department, Azienda Sanitaria Universitaria Integrata di Trieste "Ospedali Riuniti" and University of Trieste, Italy. 3. Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy. 4. Cardiac Surgery and Paediatric and Congenital Cardiology Unit, Azienda Ospedaliero Universitaria, Ancona, Italy. 5. Department of Clinical and Molecular Medicine, University of Rome "La Sapienza", Rome, Italy. 6. Unità Operativa Cardiologia Riabilitativa, Ospedale S.Giuseppe, Multimedica Spa, IRCCS, Milano, Italy. 7. Pneumology Department, "Ospedali Riuniti" and University of Trieste, Italy. 8. Cardiovascular Center, Azienda Sanitaria Universitaria Integrata di Trieste, Italy. 9. Centro Cardiologico Monzino, IRCCS, Milano, Italy; Dipartimento di Scienze Cliniche e di Comunità, Sezione Cardiovascolare, Università di Milano, Milano, Italy.
Abstract
BACKGROUND: Although cardiopulmonary exercise testing (CPET) is considered as an important tool in risk stratification of patients with heart failure (HF), prognostic data in the specific setting of Idiopathic Dilated Cardiomyopathy (iDCM) are still undetermined. The aim of the study was to test the prognostic value of CPET in a large cohort of iDCM patients. METHODS AND RESULTS: We analyzed 381 iDCM patients who consecutively performed CPET. The study end-point was a composite of cardiovascular death/urgent heart transplantation (CVD/HTx). In the overall population the average values of peak oxygen consumption (peak VO2/kg) and percent-predicted peak VO2 (peak VO2%) were 17.1±5.1ml/kg/min and 59±15%, respectively. Mean VE/VCO2 slope was 29.8±6.1. During a median follow-up of 47months (interquartile range 23-84), 83 patients experienced CVD/HTx. Peak VO2% (Area Under the Curve [AUC] 0.74; 95% CI 0.71-0.85, p<0.001) and VE/VCO2 slope (AUC 0.78; 95% CI 0.74-0.84, p<0.001) were more accurate in predicting CVD/HTx compared to peak VO2/kg (AUC 0.60; 95% CI 0.54-0.68, p=0.003) (p<0.001 for both comparisons). The most accurate threshold values for outcome prediction in our iDCM cohort were <60% for peak VO2% and >29 for VE/VCO2 slope. At multivariable analysis peak VO2% and VE/VCO2 slope were the strongest predictors of CVD/HTx, either as continuous and categorical variables, whereas peak VO2/kg was not independently related with prognosis. CONCLUSION: In a large population of iDCM patients peak VO2% and VE/VCO2 slope emerged as the strongest prognostic CPET variables. Prospective studies will be necessary to confirm these data.
BACKGROUND: Although cardiopulmonary exercise testing (CPET) is considered as an important tool in risk stratification of patients with heart failure (HF), prognostic data in the specific setting of Idiopathic Dilated Cardiomyopathy (iDCM) are still undetermined. The aim of the study was to test the prognostic value of CPET in a large cohort of iDCM patients. METHODS AND RESULTS: We analyzed 381 iDCM patients who consecutively performed CPET. The study end-point was a composite of cardiovascular death/urgent heart transplantation (CVD/HTx). In the overall population the average values of peak oxygen consumption (peak VO2/kg) and percent-predicted peak VO2 (peak VO2%) were 17.1±5.1ml/kg/min and 59±15%, respectively. Mean VE/VCO2 slope was 29.8±6.1. During a median follow-up of 47months (interquartile range 23-84), 83 patients experienced CVD/HTx. Peak VO2% (Area Under the Curve [AUC] 0.74; 95% CI 0.71-0.85, p<0.001) and VE/VCO2 slope (AUC 0.78; 95% CI 0.74-0.84, p<0.001) were more accurate in predicting CVD/HTx compared to peak VO2/kg (AUC 0.60; 95% CI 0.54-0.68, p=0.003) (p<0.001 for both comparisons). The most accurate threshold values for outcome prediction in our iDCM cohort were <60% for peak VO2% and >29 for VE/VCO2 slope. At multivariable analysis peak VO2% and VE/VCO2 slope were the strongest predictors of CVD/HTx, either as continuous and categorical variables, whereas peak VO2/kg was not independently related with prognosis. CONCLUSION: In a large population of iDCM patients peak VO2% and VE/VCO2 slope emerged as the strongest prognostic CPET variables. Prospective studies will be necessary to confirm these data.
Authors: Virginia Mihalick; George Wohlford; Azita H Talasaz; Ai-Chen Jane Ho; Francine Kim; Justin M Canada; Salvatore Carbone; Dinesh Kadariya; Hayley Billingsley; Cory Trankle; Marco Giuseppe Del Buono; Francesco Moroni; Ross Arena; Antonio Abbate; Benjamin Van Tassell Journal: Am J Cardiol Date: 2022-04-25 Impact factor: 3.133
Authors: Elisabetta Salvioni; Ugo Corrà; Massimo Piepoli; Sara Rovai; Michele Correale; Stefania Paolillo; Mario Pasquali; Damiano Magrì; Giuseppe Vitale; Laura Fusini; Massimo Mapelli; Carlo Vignati; Rocco Lagioia; Rosa Raimondo; Gianfranco Sinagra; Federico Boggio; Lorenzo Cangiano; Giovanna Gallo; Alessandra Magini; Mauro Contini; Pietro Palermo; Anna Apostolo; Beatrice Pezzuto; Alice Bonomi; Angela B Scardovi; Pasquale Perrone Filardi; Giuseppe Limongelli; Marco Metra; Domenico Scrutinio; Michele Emdin; Lucrezia Piccioli; Carlo Lombardi; Gaia Cattadori; Gianfranco Parati; Sergio Caravita; Federica Re; Mariantonietta Cicoira; Maria Frigerio; Francesco Clemenza; Maurizio Bussotti; Elisa Battaia; Marco Guazzi; Francesco Bandera; Roberto Badagliacca; Andrea Di Lenarda; Giuseppe Pacileo; Claudio Passino; Susanna Sciomer; Giuseppe Ambrosio; Piergiuseppe Agostoni Journal: ESC Heart Fail Date: 2020-01-01
Authors: Chunting Tan; Harry B Rossiter; Janos Porszasz; T Scott Bowen; Klaus K Witte; William W Stringer; Richard Casaburi; James E Hansen Journal: J Am Heart Assoc Date: 2018-03-27 Impact factor: 5.501