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Heart failure prognosis over time: how the prognostic role of oxygen consumption and ventilatory efficiency during exercise has changed in the last 20 years
Author(s) -
Paolillo Stefania,
Veglia Fabrizio,
Salvioni Elisabetta,
Corrà Ugo,
Piepoli Massimo,
Lagioia Rocco,
Limongelli Giuseppe,
Sinagra Gianfranco,
Cattadori Gaia,
Scardovi Angela B.,
Metra Marco,
Senni Michele,
Bonomi Alice,
Scrutinio Domenico,
Raimondo Rosa,
Emdin Michele,
Magrì Damiano,
Parati Gianfranco,
Re Federica,
Cicoira Mariantonietta,
Minà Chiara,
Correale Michele,
Frigerio Maria,
Bussotti Maurizio,
Battaia Elisa,
Guazzi Marco,
Badagliacca Roberto,
Di Lenarda Andrea,
Maggioni Aldo,
Passino Claudio,
Sciomer Susanna,
Pacileo Giuseppe,
Mapelli Massimo,
Vignati Carlo,
Clemenza Francesco,
Binno Simone,
Lombardi Carlo,
Filardi Pasquale Perrone,
Agostoni Piergiuseppe
Publication year - 2019
Publication title -
european journal of heart failure
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 5.149
H-Index - 133
eISSN - 1879-0844
pISSN - 1388-9842
DOI - 10.1002/ejhf.1364
Subject(s) - medicine , heart failure , cardiology , confidence interval , respiratory minute volume , heart transplantation , vo2 max , respiratory exchange ratio , ventilation (architecture) , respiratory system , heart rate , blood pressure , mechanical engineering , engineering
Aims Exercise‐derived parameters, specifically peak exercise oxygen uptake (peak VO 2 ) and minute ventilation/carbon dioxide relationship slope (VE/VCO 2 slope), have a pivotal prognostic value in heart failure (HF). It is unknown how the prognostic threshold of peak VO 2 and VE/VCO 2 slope has changed over the last 20 years in parallel with HF prognosis improvement. Methods and results Data from 6083 HF patients (81% male, age 61 ± 13 years), enrolled in the MECKI score database between 1993 and 2015, were retrospectively analysed. By enrolment year, four groups were generated: group 1 1993–2000 ( n = 440), group 2 2001–2005 ( n = 1288), group 3 2006–2010 ( n = 2368), and group 4 2011–2015 ( n = 1987). We compared the 10‐year survival of groups and analysed how the overall risk (cardiovascular death, urgent heart transplantation, or left ventricular assist device implantation) changed over time according to peak VO 2 and VE/VCO 2 slope and to major clinical and therapeutic variables. At 10 years, a progressively higher survival from group 1 to group 3 was observed, with no further improvement afterwards. A 20% risk for peak VO 2 15 mL/min/kg (95% confidence interval 16–13), 9 (11–8), 4 (4–2) and 5 (7–4) was observed in group 1, 2, 3, and 4, respectively, while the VE/VCO 2 slope value for a 20% risk was 32 (37–29), 47 (51–43), 59 (64–55), and 57 (63–52), respectively. Conclusions Heart failure prognosis improved over time up to 2010 in a HF population followed by experienced centres. The peak VO 2 and VE/VCO 2 slope cut‐offs identifying a definite risk progressively decreased and increased over time, respectively. The prognostic threshold of peak VO 2 and VE/VCO 2 slope must be updated whenever HF prognosis improves.