Stefania Paolillo1, Fabrizio Veglia2, Elisabetta Salvioni2, Ugo Corrà3, Massimo Piepoli4, Rocco Lagioia5, Giuseppe Limongelli6, Gianfranco Sinagra7, Gaia Cattadori8, Angela B Scardovi9, Marco Metra10, Michele Senni11, Alice Bonomi2, Domenico Scrutinio5, Rosa Raimondo12, Michele Emdin13,14, Damiano Magrì15, Gianfranco Parati16,17, Federica Re18, Mariantonietta Cicoira19, Chiara Minà20, Michele Correale21, Maria Frigerio22, Maurizio Bussotti23, Elisa Battaia24, Marco Guazzi25, Roberto Badagliacca26, Andrea Di Lenarda27, Aldo Maggioni28, Claudio Passino13,14, Susanna Sciomer26, Giuseppe Pacileo6, Massimo Mapelli2, Carlo Vignati2, Francesco Clemenza20, Simone Binno4, Carlo Lombardi10, Pasquale Perrone Filardi1, Piergiuseppe Agostoni2,29. 1. Department of Advanced Biomedical Sciences, Federico II University of Naples, Naples, Italy. 2. Centro Cardiologico Monzino, IRCCS, Milan, Italy. 3. Division of Cardiac Rehabilitation, Salvatore Maugeri Foundation, IRCCS, Scientific Institute of Veruno, Veruno, Italy. 4. Division of Cardiology, G. da Saliceto Hospital, Piacenza, Italy. 5. Division of Cardiology, Salvatore Maugeri Foundation, IRCCS, Scientific Institute of Cassano Murge, Bari, Italy. 6. Cardiology SUN, Monaldi Hospital (Azienda dei Colli), Second University of Naples, Naples, Italy. 7. Cardiovascular Department, Ospedali Riuniti and University of Trieste, Trieste, Italy. 8. Division of Cardiac Rehabilitation, Multimedica IRCCS, Milan, Italy. 9. Cardiology Division, Santo Spirito Hospital, Rome, Italy. 10. Cardiology, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy. 11. Department of Cardiology, Heart Failure and Heart Transplant Unit, Papa Giovanni XXIII Hospital, Bergamo, Italy. 12. Salvatore Maugeri Foundation, IRCCS, Scientific Institute of Tradate, Tradate, Italy. 13. Gabriele Monasterio Foundation, CNR-Regione Toscana, Pisa, Italy. 14. Life Science Institute, Scuola Superiore Sant'Anna, Pisa, Italy. 15. Department of Clinical and Molecular Medicine, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy. 16. Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy. 17. Department of Cardiovascular, Neural and Metabolic Sciences, San Luca Hospital, Istituto Auxologico Italiano, Milan, Italy. 18. Cardiology Division, Cardiac Arrhythmia Center and Cardiomyopathies Unit, San Camillo-Forlanini Hospital, Rome, Italy. 19. Section of Cardiology, Department of Medicine, University of Verona, Verona, Italy. 20. Department for the Treatment and Study of Cardiothoracic Diseases and Cardiothoracic Transplantation, IRCCS - ISMETT, Palermo, Italy. 21. Department of Cardiology, University of Foggia, Foggia, Italy. 22. 'A. De Gasperis' Cardiology Department, Niguarda Hospital, Milan, Italy. 23. Cardiac Rehabilitation Unit, Salvatore Maugeri Foundation, IRCCS, Scientific Institute of Milan, Milan, Italy. 24. Department of Cardiology, S. Chiara Hospital, Trento, Italy. 25. Cardiology University Department, Heart Failure Unit and Cardiopulmonary Laboratory, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy. 26. Department of Cardiovascular Respiratory, Nephrological, Anesthesiological, and Geriatric Sciences, Sapienza University of Rome, Rome, Italy. 27. Cardiovascular Center, Health Authority 1 and University of Trieste, Trieste, Italy. 28. ANMCO Research Center, Florence, Italy. 29. Cardiovascular Section, Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy.
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.
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.
Authors: Marco Guazzi; Barry Borlaug; Marco Metra; Maurizio Losito; Francesco Bandera; Eleonora Alfonzetti; Sara Boveri; Tadafumi Sugimoto Journal: J Am Heart Assoc Date: 2021-02-20 Impact factor: 5.501
Authors: Scott C Silvestry; Claudius Mahr; Mark S Slaughter; Wayne C Levy; Richard K Cheng; Damian M May; Eleni Ismyrloglou; Stelios I Tsintzos; Edward Tuttle; Keziah Cook; Erica Birk; Aparna Gomes; Sophia Graham; William G Cotts Journal: ASAIO J Date: 2020-08 Impact factor: 2.872