Cardiopulmonary exercise testing and prognosis in heart failure due to systolic left ventricular dysfunction: a validation study of the European Society of Cardiology Guidelines and Recommendations (2008) and further developments

Corrà, Ugo; Giordano, Andrea; Mezzani, Alessandro; Gnemmi, Marco; Pistono, Massimo; Caruso, Rosalba; Giannuzzi, Pantaleo

doi:10.1177/1741826710393994

Cited by 48 publications

(36 citation statements)

References 37 publications

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“…In HF, a RQ ratio >1.05 is considered as an indication of a significant effort by the patient. 30 Several prognostic studies in HF have considered CPET data as relevant, 13,14,18,23,31,32 including VO 2 at AT. [9][10][11][12][13][14][15][16][17]31 In the present study, we confirmed this finding.…”

Section: Discussionmentioning

confidence: 99%

“…From a clinical point of view, the value of oxygen uptake (VO 2 ) at AT is used for grading the severity of HF or the effects of therapy, or to assess cardiovascular risk in case of surgery, [9][10][11][12][13][14][15][16][17][18] and it has been proposed as an alternative to peak VO 2 , being it independent of patients' motivation, exercise protocol, and exercise duration. 19 However, even in the presence of anaerobic metabolism, AT is not identified in a large number of patients with HF.…”

Section: Clinical Perspective On P 987mentioning

confidence: 99%

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Prognostic Value of Indeterminable Anaerobic Threshold in Heart Failure

Agostoni

Corrà

Cattadori

et al. 2013

Circ: Heart Failure

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Background-In patients with heart failure (HF), during maximal cardiopulmonary exercise test, anaerobic threshold (AT)is not always identified. We evaluated whether this finding has a prognostic meaning. Methods and Results-We recruited and prospectively followed up, in 14 dedicated HF units, 3058 patients with systolic (left ventricular ejection fraction <40%) HF in stable clinical conditions, New York Heart Association class I to III, who underwent clinical, laboratory, echocardiographic, and cardiopulmonary exercise test investigations at study enrollment. We excluded 921 patients who did not perform a maximal exercise, based on lack of achievement of anaerobic metabolism (peak respiratory quotient ≤1.05). Primary study end point was a composite of cardiovascular death and urgent cardiac transplant, and secondary end point was all-cause death. Median follow-up was 3.01 (1.39-4.98) years. AT was identified in 1935 out of 2137 patients (90.54%). At multivariable logistic analysis, failure in detecting AT resulted significantly in reduced peak oxygen uptake and higher metabolic exercise and cardiac and kidney index score value, a powerful prognostic composite HF index (P<0.001). At multivariable analysis, the following variables were significantly associated with primary study end point: peak oxygen uptake (% pred; P<0.001 T he anaerobic threshold (AT) concept is based on the principle that energy production shifts from an aerobic metabolism to a metabolism that combines both anaerobic and aerobic patterns during a progressively increasing workload exercise.1,2 According to the concept of threshold, the shift of metabolic pathway during incremental exercise must be more or less simultaneous among active muscular fibers. Therefore, the distribution of blood flow during exercise to and into muscles, the resistance to O 2 flow between capillaries and mitochondria, the type of muscular fibers, and their metabolic capability must be relatively homogeneous.3 This is not always the case in patients with heart failure (HF) who have an uneven distribution of blood flow to muscles and an uneven use of O 2 , so that, for example, an important percentage of subjects with HF increase their capillary PO 2 toward the end of exercise.4-7 Inhomogeneity of blood flow distribution, of O 2 flow resistance, and of O 2 use should widen the time frame where anaerobiosis starts to develop among the muscular fibers, in few cases making the threshold indefinable. If this hypothesis is correct, then AT should be more frequently undetectable in patients with a more severe disease. Clinical Perspective on p 987From a clinical point of view, the value of oxygen uptake (VO 2 ) at AT is used for grading the severity of HF or the effects of therapy, or to assess cardiovascular risk in case of surgery, 9-18 and it has been proposed as an alternative to peak VO 2 , being it independent of patients' motivation, exercise protocol, and exercise duration. 19 However, even in the presence of anaerobic metabolism, AT is not identified in a large num...

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Section: Discussionmentioning

confidence: 99%

Section: Clinical Perspective On P 987mentioning

confidence: 99%

Prognostic Value of Indeterminable Anaerobic Threshold in Heart Failure

Agostoni

Corrà

Cattadori

et al. 2013

Circ: Heart Failure

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“…С другой стороны, если АГ сопутствует нарушение сердечной функции и недостаточное увеличение сердечного выброса при физической нагрузке, то прогностическое значение АД во время физической нагрузки может пропадать [129]. Нако-нец, более высокое АД при физической нагрузке может сопровождаться даже лучшим прогнозом, например, как это имеет место у лиц в возрасте 75 лет [132], у пациентов с подозрением на заболева-ния сердца [133] или с сердечной недостаточностью [134], у которых более высокое АД при нагрузке говорит об относительно сохранной систолической функции сердца [125]. В заключение следует отме-тить, что совокупность имеющихся данных ставит под вопрос клиническую целесообразность измере-ния АД в пробах с физической нагрузкой в диагно-стических и прогностических целях у больных АГ.…”

Section: центральное артериальное давлениеunclassified

2013 Esh/Esc Guidelines for the Management of Arterial Hypertension

Mancia

Fagard²,

Redón³

et al. 2014

Russ J Cardiol

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Авторы/члены рабочей группы: Giuseppe Mancia (сопредседатель; италия)*, Robert Fagard (сопредседатель; бельгия)*, Krzysztof Narkiewicz (координатор секции, Польша), Josep Redón (координатор секции; испания), Alberto Zanchetti (координатор секции, италия), Michael Böhm

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“…Należy wreszcie zauważyć, że wyższe BP podczas wysiłku może się nawet wiązać z lepszym rokowaniem, np. u osób w wieku 75 lat [132], u pacjentów z podejrzeniem choroby serca [133] lub u chorych z niewydolnością serca [134], u któ-rych wyższe BP podczas wysiłku wskazuje na relatywnie zachowaną czynność skurczową serca [125]. Reasumując, można uznać, że powyższe wyniki podważają kliniczną przydatność pomiarów BP podczas próby wysiłkowej dla celów diagnostycznych i prognostycznych u pacjentów z nadciśnieniem tętniczym.…”

Section: Ciśnienie Tętnicze Podczas Wysiłku Fizycznego I Innych Testóunclassified