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Exercise oscillatory ventilation and prognosis in heart failure patients with reduced and mid‐range ejection fraction

2019; Elsevier BV; Volume: 21; Issue: 12 Linguagem: Inglês

10.1002/ejhf.1595

1879-0844

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

Cardiovascular and exercise physiology

Abstract Aims Exercise oscillatory ventilation (EOV) is a pivotal cardiopulmonary exercise test parameter for the prognostic evaluation of patients with chronic heart failure (HF). It has been described in patients with HF with reduced ejection fraction (<40%, HFrEF) and with HF with preserved ejection fraction (>50%, HFpEF), but no data are available for patients with HF with mid‐range ejection fraction (40–49%, HFmrEF). The aim of the study was to evaluate the prognostic role of EOV in HFmrEF patients. Methods and results We analysed 1239 patients with HFmrEF and 4482 patients with HFrEF, enrolled in the MECKI score database, with a 2‐year follow‐up. The study endpoint was the composite of cardiovascular death, urgent heart transplant, and ventricular assist device implantation. We identified EOV in 968 cases (16% and 17% of cases in HFmrEF and HFrEF, respectively). HFrEF EOV+ patients were significantly older, and their parameters suggested a more severe HF than HFrEF EOV− patients. A similar behaviour was found in HFmrEF EOV+ vs. EOV− patients. Kaplan–Meier analysis, irrespective of ejection fraction, showed that EOV is associated with a worse survival, and that patients with HFrEF and HFmrEF EOV+ had a significantly worse outcome than the EOV− of the same ejection fraction groups. EOV‐associated survival differences in HFmrEF patients started after 18 months of follow‐up. Conclusion Exercise oscillatory ventilation has a similar prevalence and ominous prognostic value in both HFmrEF and HFrEF patients, indicating a group of patients in need of a more intensive follow‐up and a more aggressive therapy. In HFmrEF, the survival curves between EOV+ and EOV− patients diverged only after 18 months.