Gender and age normalization and ventilation efficiency during exercise in heart failure with reduced ejection fraction.

Autor:	Salvioni E; Centro Cardiologico Monzino, IRCCS, Via Parea 4, Milan, 20138, Italy., Corrà U; Cardiology Department, Istituti Clinici Scientifici Maugeri, IRCCS, Veruno Institute, Veruno, Italy., Piepoli M; UOC Cardiologia, G da Saliceto Hospital, Piacenza, Italy., Rovai S; Centro Cardiologico Monzino, IRCCS, Via Parea 4, Milan, 20138, Italy.; Università degli Studi di Padova, Padova, Italy., Correale M; Department of Cardiology, University of Foggia, Foggia, Italy., Paolillo S; Department of Advanced Biomedical Sciences, Federico II University of Naples, Naples, Italy., Pasquali M; Dipartimento di medicina e scienze dell'invecchiamento, Università G. D'Annunzio, Chieti, Italy., Magrì D; Department of Clinical and Molecular Medicine, Azienda Ospedaliera Sant'Andrea, 'Sapienza' Università degli Studi di Roma, Roma, Italy., Vitale G; Cardiovascular Rehabilitation Unit, Buccheri La Ferla Fatebenefratelli Hospital, Palermo, Italy., Fusini L; Centro Cardiologico Monzino, IRCCS, Via Parea 4, Milan, 20138, Italy., Mapelli M; Centro Cardiologico Monzino, IRCCS, Via Parea 4, Milan, 20138, Italy., Vignati C; Centro Cardiologico Monzino, IRCCS, Via Parea 4, Milan, 20138, Italy.; Department of Clinical Sciences and Community Health, Cardiovascular Section, University of Milano, Milano, Italy., Lagioia R; Division of Cardiology, 'S. Maugeri' Foundation, IRCCS, Institute of Cassano Murge, Bari, Italy., Raimondo R; Fondazione Salvatore Maugeri, IRCCS, Istituto Scientifico di Tradate, Tradate, Italy., Sinagra G; Cardiovascular Department, Ospedali Riuniti and University of Trieste, Trieste, Italy., Boggio F; Centro Cardiologico Monzino, IRCCS, Via Parea 4, Milan, 20138, Italy., Cangiano L; Centro Cardiologico Monzino, IRCCS, Via Parea 4, Milan, 20138, Italy., Gallo G; Department of Clinical and Molecular Medicine, Azienda Ospedaliera Sant'Andrea, 'Sapienza' Università degli Studi di Roma, Roma, Italy., Magini A; Centro Cardiologico Monzino, IRCCS, Via Parea 4, Milan, 20138, Italy., Contini M; Centro Cardiologico Monzino, IRCCS, Via Parea 4, Milan, 20138, Italy., Palermo P; Centro Cardiologico Monzino, IRCCS, Via Parea 4, Milan, 20138, Italy., Apostolo A; Centro Cardiologico Monzino, IRCCS, Via Parea 4, Milan, 20138, Italy., Pezzuto B; Centro Cardiologico Monzino, IRCCS, Via Parea 4, Milan, 20138, Italy., Bonomi A; Centro Cardiologico Monzino, IRCCS, Via Parea 4, Milan, 20138, Italy., Scardovi AB; Cardiology Division, Santo Spirito Hospital, Roma, Italy., Filardi PP; Department of Advanced Biomedical Sciences, Federico II University of Naples, Naples, Italy., Limongelli G; Cardiologia SUN, Ospedale Monaldi (Azienda dei Colli), Seconda Università di Napoli, Napoli, Italy., Metra M; Cardiology, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy., Scrutinio D; Division of Cardiology, 'S. Maugeri' Foundation, IRCCS, Institute of Cassano Murge, Bari, Italy., Emdin M; Fondazione Gabriele Monasterio, CNR-Regione Toscana, Pisa, Italy.; Life Science Institute, Scuola Superiore Sant'Anna, Pisa, Italy., Piccioli L; Department of Advanced Biomedical Sciences, Federico II University of Naples, Naples, Italy., Lombardi C; Cardiology, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy., Cattadori G; Unità Operativa Cardiologia Riabilitativa, Multimedica IRCCS, Milano, Italy., Parati G; 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., Caravita S; Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy., Re F; Cardiology Division, Cardiac Arrhythmia Center and Cardiomyopathies Unit, San Camillo-Forlanini Hospital, Roma, Italy., Cicoira M; Section of Cardiology, Department of Medicine, University of Verona, Verona, Italy., Frigerio M; Dipartimento Cardiologico 'A. De Gasperis', Ospedale Cà Granda-A.O. Niguarda, Milano, Italy., Clemenza F; Department for the Treatment and Study of Cardiothoracic Diseases and Cardiothoracic Transplantation, IRCCS-ISMETT, Palermo, Italy., Bussotti M; Cardiac Rehabilitation Unit, Fondazione Salvatore Maugeri, IRCCS, Scientific Institute of Milan, Milan, Italy., Battaia E; Department of Cardiology, S. Chiara Hospital, Trento, Italy., Guazzi M; Cardiology University Department, Heart Failure Unit and Cardiopulmonary Laboratory, IRCCS Policlinico San Donato, San Donato Milanese, Italy., Bandera F; Cardiology University Department, Heart Failure Unit and Cardiopulmonary Laboratory, IRCCS Policlinico San Donato, San Donato Milanese, Italy., Badagliacca R; Dipartimento di Scienze Cardiovascolari, Respiratorie, Nefrologiche, Anestesiologiche e Geriatriche, 'Sapienza', Rome University, Rome, Italy., Di Lenarda A; Cardiovascular Center, Health Authority no. 1, University of Trieste, Trieste, Italy., Pacileo G; Cardiologia SUN, Ospedale Monaldi (Azienda dei Colli), Seconda Università di Napoli, Napoli, Italy., Passino C; Fondazione Gabriele Monasterio, CNR-Regione Toscana, Pisa, Italy.; Life Science Institute, Scuola Superiore Sant'Anna, Pisa, Italy., Sciomer S; Dipartimento di Scienze Cardiovascolari, Respiratorie, Nefrologiche, Anestesiologiche e Geriatriche, 'Sapienza', Rome University, Rome, Italy., Ambrosio G; Division of Cardiology, University of Perugia School of Medicine, Perugia, Italy., Agostoni P; Centro Cardiologico Monzino, IRCCS, Via Parea 4, Milan, 20138, Italy.; Department of Clinical Sciences and Community Health, Cardiovascular Section, University of Milano, Milano, Italy.
Jazyk:	angličtina
Zdroj:	ESC heart failure [ESC Heart Fail] 2020 Feb; Vol. 7 (1), pp. 371-380. Date of Electronic Publication: 2020 Jan 01.
DOI:	10.1002/ehf2.12582
Abstrakt:	Aims: Ventilation vs. carbon dioxide production (VE/VCO 2 ) is among the strongest cardiopulmonary exercise testing prognostic parameters in heart failure (HF). It is usually reported as an absolute value. The current definition of normal VE/VCO 2 slope values is inadequate, since it was built from small groups of subjects with a particularly limited number of women and elderly. We aimed to define VE/VCO 2 slope prediction formulas in a sizable population and to test whether the prognostic power of VE/VCO 2 slope in HF was different if expressed as a percentage of the predicted value or as an absolute value. Methods and Results: We calculated the linear regressions between age and VE/VCO 2 slope in 1136 healthy subjects (68% male, age 44.9 ± 14.5, range 13-83 years). We then applied age-adjusted and sex-adjusted formulas to predict VE/VCO 2 slope to HF patients included in the metabolic exercise test data combined with cardiac and kidney indexes score database, which counts 6112 patients (82% male, age 61.4 ± 12.8, left ventricular ejection fraction 33.2 ± 10.5%, peakVO 2 14.8 ± 4.9, mL/min/kg, VE/VCO 2 slope 32.7 ± 7.7) from 24 HF centres. Finally, we evaluated whether the use of absolute values vs. percentages of predicted VE/VCO 2 affected HF prognosis prediction (composite of cardiovascular mortality + urgent transplant or left ventricular assist device). We did so in the entire cardiac and kidney indexes score population and separately in HF patients with severe (peakVO 2 < 14 mL/min/kg, n = 2919, 61.1 events/1000 pts/year) or moderate (peakVO 2 ≥ 14 mL/min/kg, n = 3183, 19.9 events/1000 pts/year) HF. In the healthy population, we obtained the following equations: female, VE/VCO 2 = 0.052 × Age + 23.808 (r = 0.192); male, VE/VCO 2 = 0.095 × Age + 20.227 (r = 0.371) (P = 0.007). We applied these formulas to calculate the percentages of predicted VE/VCO 2 values. The 2-year survival prognostic power of VE/VCO 2 slope was strong, and it was similar if expressed as absolute value or as a percentage of predicted value (AUCs 0.686 and 0.690, respectively). In contrast, in severe HF patients, AUCs significantly differed between absolute values (0.637) and percentages of predicted values (0.650, P = 0.0026). Moreover, VE/VCO 2 slope expressed as a percentage of predicted value allowed to reclassify 6.6% of peakVO 2 < 14 mL/min/kg patients (net reclassification improvement = 0.066, P = 0.0015). Conclusions: The percentage of predicted VE/VCO 2 slope value strengthens the prognostic power of VE/VCO 2 in severe HF patients, and it should be preferred over the absolute value for HF prognostication. Furthermore, the widespread use of VE/VCO 2 slope expressed as percentage of predicted value can improve our ability to identify HF patients at high risk, which is a goal of utmost clinical relevance. (© 2020 The Authors. ESC Heart Failure published by John Wiley & Sons Ltd on behalf of the European Society of Cardiology.)
Databáze:	MEDLINE
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