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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

2019; Elsevier BV; Volume: 21; Issue: 2 Linguagem: Inglês

10.1002/ejhf.1364

1879-0844

Stefania Paolillo, Fabrizio Veglia, Elisabetta Salvioni, Ugo Corrà, Massimo Piepoli, Rocco Lagioia, Giuseppe Limongelli, Gianfranco Sinagra, Gaia Cattadori, Angela Beatrice Scardovi, Marco Metra, Michele Senni, Alice Bonomi, Domenico Scrutinio, Rosa Raimondo, Michele Emdin, Damiano Magrì, Gianfranco Parati, Federica Re, Mariantonietta Cicoira, Chiara Minà, Michele Correale, Maria Frigerio, Maurizio Bussotti, Elisa Battaia, Marco Guazzi, Roberto Badagliacca, Andrea Di Lenarda, Aldo P. Maggioni, Claudio Passino, Susanna Sciomer, Giuseppe Pacileo, Massimo Mapelli, Carlo Vignati, Francesco Clemenza, Simone Binno, Carlo Lombardi, Pasquale Perrone Filardi, Piergiuseppe Agostoni,

Mechanical Circulatory Support Devices

Abstract 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.