Gender and age normalization and ventilation efficiency during exercise in heart failure with reduced ejection fraction
| Autor: | Salvioni, E, Corrà, U, Piepoli, M, Rovai, S, Correale, M, Paolillo, S, Pasquali, M, Magrì, Damiano, Vitale, G, Fusini, L, Mapelli, M, Vignati, C, Lagioia, R, Raimondo, R, Sinagra, G, Boggio, F, Cangiano, L, Gallo, G, Magini, A, Contini, M, Palermo, P, Apostolo, A, Pezzuto, B, Bonomi, A, Scardovi, Ab, Filardi, Pp, Limongelli, G, Metra, M, Scrutinio, D, Emdin, M, Piccioli, L, Lombardi, C, Cattadori, G, Parati, G, Caravita, S, Re, F, Cicoira, M, Frigerio, M, Clemenza, F, Bussotti, M, Battaia, E, Guazzi, M, Bandera, F, Badagliacca, R, Di Lenarda, A, Pacileo, G, Passino, C, Sciomer, S, Ambrosio, G, Agostoni, P, MECKI score research, Group. |
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| Přispěvatelé: | Salvioni, E., Corra, U., Piepoli, M., Rovai, S., Correale, M., Paolillo, S., Pasquali, M., Magri, D., Vitale, G., Fusini, L., Mapelli, M., Vignati, C., Lagioia, R., Raimondo, R., Sinagra, G., Boggio, F., Cangiano, L., Gallo, G., Magini, A., Contini, M., Palermo, P., Apostolo, A., Pezzuto, B., Bonomi, A., Scardovi, A. B., Filardi, P. P., Limongelli, G., Metra, M., Scrutinio, D., Emdin, M., Piccioli, L., Lombardi, C., Cattadori, G., Parati, G., Caravita, S., Re, F., Cicoira, M., Frigerio, M., Clemenza, F., Bussotti, M., Battaia, E., Guazzi, M., Bandera, F., Badagliacca, R., Di Lenarda, A., Pacileo, G., Passino, C., Sciomer, S., Ambrosio, G., Agostoni, P., Guarino, Raimondo |
| Jazyk: | angličtina |
| Rok vydání: | 2020 |
| Předmět: |
Male
lcsh:Diseases of the circulatory (Cardiovascular) system cardiopulmonary exercise test heart failure prognosis ventilation efficiency medicine.medical_treatment Settore MED/11 - Malattie dell'Apparato Cardiovascolare 030204 cardiovascular system & hematology Ventricular Function Left 0302 clinical medicine Original Research Articles Original Research Article 030212 general & internal medicine Lung Aged 80 and over education.field_of_study Ejection fraction Age Factors Middle Aged Net reclassification improvement Italy Cardiology Female Cardiology and Cardiovascular Medicine Cardiopulmonary exercise test Prognosis Ventilation efficiency Heart failure Adult medicine.medical_specialty Adolescent Prognosi Population Age and gender Young Adult 03 medical and health sciences Oxygen Consumption Sex Factors Internal medicine Linear regression medicine Humans education Exercise Aged Retrospective Studies Cardiovascular mortality business.industry Stroke Volume medicine.disease lcsh:RC666-701 Ventricular assist device Exercise Test Morbidity business human activities Follow-Up Studies Forecasting |
| Zdroj: | ESC Heart Failure ESC Heart Failure, Vol 7, Iss 1, Pp 368-377 (2020) |
| Popis: | Aims Ventilation vs. carbon dioxide production (VE/VCO2) 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/VCO2 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/VCO2 slope prediction formulas in a sizable population and to test whether the prognostic power of VE/VCO2 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/VCO2 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/VCO2 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%, peakVO2 14.8 ± 4.9, mL/min/kg, VE/VCO2 slope 32.7 ± 7.7) from 24 HF centres. Finally, we evaluated whether the use of absolute values vs. percentages of predicted VE/VCO2 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 (peakVO2 < 14 mL/min/kg, n = 2919, 61.1 events/1000 pts/year) or moderate (peakVO2 ≥ 14 mL/min/kg, n = 3183, 19.9 events/1000 pts/year) HF. In the healthy population, we obtained the following equations: female, VE/VCO2 = 0.052 × Age + 23.808 (r = 0.192); male, VE/VCO2 = 0.095 × Age + 20.227 (r = 0.371) (P = 0.007). We applied these formulas to calculate the percentages of predicted VE/VCO2 values. The 2‐year survival prognostic power of VE/VCO2 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/VCO2 slope expressed as a percentage of predicted value allowed to reclassify 6.6% of peakVO2 < 14 mL/min/kg patients (net reclassification improvement = 0.066, P = 0.0015). Conclusions The percentage of predicted VE/VCO2 slope value strengthens the prognostic power of VE/VCO2 in severe HF patients, and it should be preferred over the absolute value for HF prognostication. Furthermore, the widespread use of VE/VCO2 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. |
| Databáze: | OpenAIRE |
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