Damiano MagrÌ1, Massimo Piepoli2, Ugo CorrÀ3, Giovanna Gallo1, Antonello Maruotti4, Carlo Vignati5, Elisabetta Salvioni5, Massimo Mapelli5, Stefania Paolillo6, Pasquale Perrone Filardi6, Davide Girola7, Marco Metra8, Angela B Scardovi9, Rocco Lagioia10, Giuseppe Limongelli11, Michele Senni12, Domenico Scrutinio10, Michele Emdin13, Claudio Passino13, Carlo Lombardi8, Gaia Cattadori14, Gianfranco Parati15, Mariantonietta Cicoira16, Michele Correale17, Maria Frigerio18, Francesco Clemenza19, Maurizio Bussotti20, Marco Guazzi21, Roberto Badagliacca22, Susanna Sciomer22, Andrea DI Lenarda23, Aldo Maggioni24, Gianfranco Sinagra25, Massimo Volpe26, Piergiuseppe Agostoni27. 1. Department of Clinical and Molecular Medicine, Azienda Ospedaliera Sant'Andrea, "Sapienza" Università degli Studi di Roma, Roma, Italy. 2. UOC Cardiologia, G da Saliceto Hospital, Piacenza, Italy. 3. Cardiology Department, Istituti Clinici Scientifici Maugeri, IRCCS, Veruno Institute, Veruno, Italy. 4. Dipartimento di Giurisprudenza, Economia, Politica e Lingue Moderne - Libera Università Maria Ss Assunta, Roma, Italy; Department of Mathematics, University of Bergen, Bergen, Norway; School of Computing, University of Portsmouth, Portsmouth, UK. 5. Centro Cardiologico Monzino, IRCCS, Milano, Italy. 6. Department of Advanced Biomedical Sciences, Federico II University of Naples, Naples, Italy. 7. Clinica Hildebrand Centro di riabilitazione Brissago, Brissago, Switzerland. 8. Cardiology, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy. 9. Cardiology Division, Santo Spirito Hospital, Roma, Italy. 10. Division of Cardiology, "S. Maugeri" Foundation, IRCCS, Institute of Cassano Murge, Bari, Italy. 11. Cardiologia SUN, Ospedale Monaldi (Azienda dei Colli), Seconda Università di Napoli, Napoli, Italy. 12. Department of Cardiology, Heart Failure and Heart Transplant Unit, Azienda Ospedaliera Papa Giovanni XXIII, Bergamo, Italy. 13. Fondazione Gabriele Monasterio, CNR-Regione Toscana, Pisa, Italy; Life Science Institute, Scuola Superiore Sant'Anna, Pisa, Italy. 14. Unità Operativa Cardiologia Riabilitativa, Multimedica IRCCS, Milano, Italy. 15. Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy; Department of Cardiovascular, Neural and Metabolic Sciences, San Luca Hospital, Istituto Auxologico Italiano, Milan, Italy. 16. Section of Cardiology, Department of Medicine, University of Verona, Verona, Italy. 17. Department of Cardiology, University of Foggia, Foggia, Italy. 18. Dipartimento Cardiologico "A. De Gasperis", Ospedale Cà Granda- A.O. Niguarda, Milano, Italy. 19. Department for the Treatment and Study of Cardiothoracic Diseases and Cardiothoracic Transplantation IRCCS - ISMETT, Palermo, Italy. 20. Cardiac Rehabilitation Unit, Fondazione Salvatore Maugeri, IRCCS, Scientific Institute of Milan, Milan, Italy. 21. Cardiology University Department, Heart Failure Unit and Cardiopulmonary Laboratory, IRCCS Policlinico San Donato, San Donato Milano, Italy. 22. Dipartimento di Scienze Cardiovascolari, Respiratorie, Nefrologiche, Anestesiologiche e Geriatriche, "Sapienza", Rome University, Rome, Italy. 23. Cardiovascular Center, Health Authority n°1 and University of, Trieste, Trieste, Italy. 24. ANMCO Research Center, Firenze, Italy. 25. Cardiovascular Department, Ospedali Riuniti and University of Trieste, Trieste, Italy. 26. Department of Clinical and Molecular Medicine, Azienda Ospedaliera Sant'Andrea, "Sapienza" Università degli Studi di Roma, Roma, Italy; IRCCS Neuromed, Pozzilli (Isernia), Italy. 27. Centro Cardiologico Monzino, IRCCS, Milano, Italy; Department of Clinical sciences and Community Health, Cardiovascular Section, University of Milano, Milano, Italy. Electronic address: piergiuseppe.agostoni@unimi.it.
Abstract
BACKGROUND: Heart failure with midrange ejection fraction (HFmrEF) represents a heterogeneous category where phenotype, as well as prognostic assessment, remains debated. The present study explores a specific HFmrEF subset, namely those who recovered from a reduced EF (rec-HFmrEF) and, particularly, it focuses on the possible additive prognostic role of cardiopulmonary exercise testing. METHODS AND RESULTS: We analyzed data from 4535 patients with HFrEF and 1176 patients with rec-HFmrEF from the Metabolic Exercise combined with Cardiac and Kidney Indexes database. The end point was cardiovascular death at 5 years. The median follow-up was 1343 days (25th-75th range 627-2403 days). Cardiovascular death occurred in 552 HFrEF and 61 rec-HFmrEF patients. The multivariate analysis confirmed an independent role of the MECKI score's variables in HFrEF (C-index = 0.744) whereas, in the rec-HFmrEF group, only age and peak oxygen uptake (pVO2) remained associated to the end point (C-index = 0.745). A peak oxygen uptake of ≤55% of predicted and a ventilatory efficiency of ≥31 resulted as the most accurate cut-off values in the outcome prediction. CONCLUSIONS: Present data support the cardiopulmonary exercise test and, particularly, the peak oxygen uptake, as a useful tool in the rec-HFmrEF prognostic assessment. A peak VO2 of ≤55% predicted and ventilatory efficiency of ≥31 might help to identify a high-risk rec-HFmrEF subgroup.
BACKGROUND:Heart failure with midrange ejection fraction (HFmrEF) represents a heterogeneous category where phenotype, as well as prognostic assessment, remains debated. The present study explores a specific HFmrEF subset, namely those who recovered from a reduced EF (rec-HFmrEF) and, particularly, it focuses on the possible additive prognostic role of cardiopulmonary exercise testing. METHODS AND RESULTS: We analyzed data from 4535 patients with HFrEF and 1176 patients with rec-HFmrEF from the Metabolic Exercise combined with Cardiac and Kidney Indexes database. The end point was cardiovascular death at 5 years. The median follow-up was 1343 days (25th-75th range 627-2403 days). Cardiovascular death occurred in 552 HFrEF and 61 rec-HFmrEF patients. The multivariate analysis confirmed an independent role of the MECKI score's variables in HFrEF (C-index = 0.744) whereas, in the rec-HFmrEF group, only age and peak oxygen uptake (pVO2) remained associated to the end point (C-index = 0.745). A peak oxygen uptake of ≤55% of predicted and a ventilatory efficiency of ≥31 resulted as the most accurate cut-off values in the outcome prediction. CONCLUSIONS: Present data support the cardiopulmonary exercise test and, particularly, the peak oxygen uptake, as a useful tool in the rec-HFmrEF prognostic assessment. A peak VO2 of ≤55% predicted and ventilatory efficiency of ≥31 might help to identify a high-risk rec-HFmrEF subgroup.