Sara Rovai1,2, Ugo Corrà3, Massimo Piepoli4, Carlo Vignati1,5, Elisabetta Salvioni1, Alice Bonomi1, Irene Mattavelli1, Luca Arcari6, Angela B Scardovi6, Pasquale Perrone Filardi7, Rocco Lagioia8, Stefania Paolillo7, Damiano Magrì9, Giuseppe Limongelli10, Marco Metra11, Michele Senni12, Domenico Scrutinio4, Rosa Raimondo13, Michele Emdin14,15, Carlo Lombardi11, Gaia Cattadori16, Gianfranco Parati17,18, Federica Re19, Mariantonietta Cicoira20, Giovanni Q Villani4, Chiara Minà21, Michele Correale22, Maria Frigerio23, Enrico Perna23, Massimo Mapelli1, Alessandra Magini1, Francesco Clemenza21, Maurizio Bussotti24, Elisa Battaia25, Marco Guazzi26, Francesco Bandera26, Roberto Badagliacca27, Andrea Di Lenarda28, Giuseppe Pacileo10, Aldo Maggioni29, Claudio Passino14,15, Susanna Sciomer27, Gianfranco Sinagra30, Piergiuseppe Agostoni1,5. 1. U.O Scompenso, Centro Cardiologico Monzino, IRCCS, Milan, Italy. 2. Sport and Exercise Medicine Division, Department of Medicine, Università degli Studi di Padova, Padova, Italy. 3. Cardiology Department, Istituti Clinici Scientifici Maugeri, IRCCS, Veruno Institute, Veruno, Italy. 4. UOC Cardiologia, G da Saliceto Hospital, Piacenza, Italy. 5. Department of Clinical Sciences and Community Health, Cardiovascular Section, University of Milano, Milan, Italy. 6. Cardiology Division, Santo Spirito Hospital, Rome, Italy. 7. Department of Advanced Biomedical Sciences, Federico II University of Naples, Naples, Italy. 8. Division of Cardiology, "S. Maugeri" Foundation, IRCCS, Institute of Cassano Murge, Bari, Italy. 9. Department of Clinical and Molecular Medicine, Azienda Ospedaliera Sant'Andrea, "Sapienza" Università degli Studi di Roma, Rome, Italy. 10. Cardiologia SUN, Ospedale Monaldi (Azienda dei Colli), Seconda Università di Napoli, Naples, Italy. 11. Cardiology, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy. 12. Department of Cardiology, Heart Failure and Heart Transplant Unit, Azienda Ospedaliera Papa Giovanni XXIII, Bergamo, Italy. 13. Divisione di Cardiologia Riabilitativa, Fondazione Salvatore Maugeri, IRCCS, Istituto Scientifico di Tradate, Italy. 14. UOC Cardiologia e Medicina cardiovascolare, Fondazione Gabriele Monasterio, CNR-Regione Toscana, Pisa, Italy. 15. Life Science Institute, Life Science Institute, Scuola Superiore Sant'Anna, Pisa, Italy. 16. Unità Operativa Cardiologia Riabilitativa, Multimedica IRCCS, Milan, Italy. 17. Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy. 18. Department of Cardiovascular, Neural and Metabolic Sciences, San Luca Hospital, Istituto Auxologico Italiano, Milan, Italy. 19. Cardiology Division, Cardiac Arrhythmia Center and Cardiomyopathies Unit, San Camillo-Forlanini Hospital, Rome, Italy. 20. Section of Cardiology, Department of Medicine, University of Verona, Verona, Italy. 21. Department for the Treatment and Study of Cardiothoracic Diseases and Cardiothoracic Transplantation, IRCCS - ISMETT, Palermo, Italy. 22. Department of Cardiology, University of Foggia, Foggia, Italy. 23. Dipartimento Cardiologico 'A. De Gasperis', Ospedale Cà Granda-A.O. Niguarda, Milan, Italy. 24. Cardiac Rehabilitation Unit, Fondazione Salvatore Maugeri, IRCCS, Scientific Institute of Milan, Milan, Italy. 25. Department of Cardiology, S. Chiara Hospital, Trento, Italy. 26. Cardiology University Department, Heart Failure Unit and Cardiopulmonary Laboratory, IRCCS Policlinico San Donato, San Donato Milano, Italy. 27. Dipartimento di Scienze Cardiovascolari, Respiratorie, Nefrologiche, Anestesiologiche e Geriatriche, 'Sapienza', Rome University, Rome, Italy. 28. Department of Cardiology, Cardiovascular Center, Health Authority no. 1 and University of, Trieste, Italy. 29. ANMCO Research Center, Florence, Italy. 30. Cardiovascular Department, Ospedali Riuniti and University of Trieste, Trieste, Italy.
Abstract
AIMS: Exercise oscillatory ventilation (EOV) is a pivotal cardiopulmonary exercise test parameter for the prognostic evaluation of patients with chronic heart failure (HF). It has been described in patients with HF with reduced ejection fraction (<40%, HFrEF) and with HF with preserved ejection fraction (>50%, HFpEF), but no data are available for patients with HF with mid-range ejection fraction (40-49%, HFmrEF). The aim of the study was to evaluate the prognostic role of EOV in HFmrEF patients. METHODS AND RESULTS: We analysed 1239 patients with HFmrEF and 4482 patients with HFrEF, enrolled in the MECKI score database, with a 2-year follow-up. The study endpoint was the composite of cardiovascular death, urgent heart transplant, and ventricular assist device implantation. We identified EOV in 968 cases (16% and 17% of cases in HFmrEF and HFrEF, respectively). HFrEF EOV+ patients were significantly older, and their parameters suggested a more severe HF than HFrEF EOV- patients. A similar behaviour was found in HFmrEF EOV+ vs. EOV- patients. Kaplan-Meier analysis, irrespective of ejection fraction, showed that EOV is associated with a worse survival, and that patients with HFrEF and HFmrEF EOV+ had a significantly worse outcome than the EOV- of the same ejection fraction groups. EOV-associated survival differences in HFmrEF patients started after 18 months of follow-up. CONCLUSION: Exercise oscillatory ventilation has a similar prevalence and ominous prognostic value in both HFmrEF and HFrEF patients, indicating a group of patients in need of a more intensive follow-up and a more aggressive therapy. In HFmrEF, the survival curves between EOV+ and EOV- patients diverged only after 18 months.
AIMS: Exercise oscillatory ventilation (EOV) is a pivotal cardiopulmonary exercise test parameter for the prognostic evaluation of patients with chronic heart failure (HF). It has been described in patients with HF with reduced ejection fraction (<40%, HFrEF) and with HF with preserved ejection fraction (>50%, HFpEF), but no data are available for patients with HF with mid-range ejection fraction (40-49%, HFmrEF). The aim of the study was to evaluate the prognostic role of EOV in HFmrEF patients. METHODS AND RESULTS: We analysed 1239 patients with HFmrEF and 4482 patients with HFrEF, enrolled in the MECKI score database, with a 2-year follow-up. The study endpoint was the composite of cardiovascular death, urgent heart transplant, and ventricular assist device implantation. We identified EOV in 968 cases (16% and 17% of cases in HFmrEF and HFrEF, respectively). HFrEF EOV+ patients were significantly older, and their parameters suggested a more severe HF than HFrEF EOV- patients. A similar behaviour was found in HFmrEF EOV+ vs. EOV- patients. Kaplan-Meier analysis, irrespective of ejection fraction, showed that EOV is associated with a worse survival, and that patients with HFrEF and HFmrEF EOV+ had a significantly worse outcome than the EOV- of the same ejection fraction groups. EOV-associated survival differences in HFmrEF patients started after 18 months of follow-up. CONCLUSION: Exercise oscillatory ventilation has a similar prevalence and ominous prognostic value in both HFmrEF and HFrEF patients, indicating a group of patients in need of a more intensive follow-up and a more aggressive therapy. In HFmrEF, the survival curves between EOV+ and EOV- patients diverged only after 18 months.
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