Echo-derived peak cardiac power output-to-left ventricular mass with cardiopulmonary exercise testing predicts outcome in patients with heart failure and depressed systolic function
| Autor: | Nicola Riccardo Pugliese, Anca Simioniuc, Mario Miccoli, Gian Giacomo Galeotti, Giulia Elena Mandoli, Alberto Lombardo, Frank Lloyd Dini, Iacopo Fabiani, G. Bigalli, Roberto Pedrinelli, Giacinta Guarini |
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| Jazyk: | angličtina |
| Rok vydání: | 2019 |
| Předmět: |
Male
cardiac work medicine.medical_specialty Cardiac output exercise stress echocardiography medicine.medical_treatment heart failure Kaplan-Meier Estimate cardiopulmonary exercise test prognosis 030204 cardiovascular system & hematology Cohort Studies Ventricular Dysfunction Left 03 medical and health sciences 0302 clinical medicine Predictive Value of Tests Internal medicine medicine Humans Radiology Nuclear Medicine and imaging Prospective Studies Cardiac Output Systole Aged Heart transplantation Ejection fraction business.industry Stroke Volume General Medicine Middle Aged Brain natriuretic peptide medicine.disease Survival Analysis Mean blood pressure Italy ROC Curve Echocardiography Ventricular assist device Heart failure Chronic Disease Multivariate Analysis Cardiology Female Cardiology and Cardiovascular Medicine business Echocardiography Stress |
| Popis: | AIMS Peak cardiac power output-to-mass (CPOM) represents a measure of the rate at which cardiac work is delivered respect to the potential energy stored in left ventricular (LV) mass. We studied the value of CPOM and cardiopulmonary exercise test (CPET) in risk stratification of patients with heart failure (HF). MATERIALS AND RESULTS We studied 159 patients with chronic HF (mean rest LV ejection fraction 30%) undergoing CPET and exercise stress echocardiography. CPOM was calculated as the product of a constant (K = 2.22 × 10-1) with cardiac output (CO) and the mean blood pressure (MBP), divided by LV mass (M), and expressed in the unit of W/100 g: CPOM = [K × CO (L/min) × MBP (mmHg)]/LVM(g). Patients were followed-up for the primary endpoint, including all-cause death, ventricular assist device implantation, and heart transplantation, and the secondary endpoint that comprised hospitalization for HF. In multivariate Cox regression analyses, peak CPOM was selected as the most powerful independent predictor of both primary and secondary endpoint [hazard ratio (HR) 0.004, 95% confidence interval (CI) 0.004-0.3; P = 0.002 and HR 0.09, 95% CI 0.02-0.55; P = 0.009]. Sixty-month survival free from the combined endpoint was 85% in those exhibiting oxygen consumption (VO2) > 14 mL/min/kg and peak CPOM > 0.6 W/100 g. Peak VO2 ≤ 14 mL/min/kg provided incremental prognostic value over demographic and clinical variables, brain natriuretic peptide, and resting echocardiographic parameters (χ2 from 58 to 64; P = 0.04), that was further increased by peak CPOM ≤ 0.6 W/100 g (χ2 77; P |
| Databáze: | OpenAIRE |
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