Heart Failure Progression in Hypertrophic Cardiomyopathy　– Possible Insights From Cardiopulmonary Exercise Testing –

Magrì, Damiano; Re, Federica; Limongelli, Giuseppe; Agostoni, Piergiuseppe; Zachara, Elisabetta; Correale, Michele; Mastromarino, Vittoria; Santolamazza, Caterina; Casenghi, Matteo; Pacileo, Giuseppe; Valente, Fabio; Morosin, Marco; Musumeci, Beatrice; Pagannone, Erika; Maruotti, Antonello; Uguccioni, Massimo; Volpe, Massimo; Autore, Camillo

doi:10.1253/circj.cj-16-0432

Cited by 48 publications

(43 citation statements)

References 42 publications

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“…28 It is of note that VE/VCO 2 slope is included in a few scores as a continuum, avoiding any cut-off value. 10,29 To group patients for HF severity, we used a peak VO 2 cut-off value of 14 mL/min/kg. The choice of this value is totally arbitrary and based on historical reasons, 30 and an absolute peak VO 2 value (12/14 mL/min/kg) is still used by HF transplant guidelines.…”

Section: Discussionmentioning

confidence: 99%

Gender and age normalization and ventilation efficiency during exercise in heart failure with reduced ejection fraction

Salvioni¹,

Corrà²,

Piepoli³

et al. 2020

ESC Heart Failure

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Aims Ventilation vs. carbon dioxide production (VE/VCO2) is among the strongest cardiopulmonary exercise testing prognostic parameters in heart failure (HF). It is usually reported as an absolute value. The current definition of normal VE/VCO2 slope values is inadequate, since it was built from small groups of subjects with a particularly limited number of women and elderly. We aimed to define VE/VCO2 slope prediction formulas in a sizable population and to test whether the prognostic power of VE/VCO2 slope in HF was different if expressed as a percentage of the predicted value or as an absolute value. Methods and results We calculated the linear regressions between age and VE/VCO2 slope in 1136 healthy subjects (68% male, age 44.9 ± 14.5, range 13–83 years). We then applied age‐adjusted and sex‐adjusted formulas to predict VE/VCO2 slope to HF patients included in the metabolic exercise test data combined with cardiac and kidney indexes score database, which counts 6112 patients (82% male, age 61.4 ± 12.8, left ventricular ejection fraction 33.2 ± 10.5%, peakVO2 14.8 ± 4.9, mL/min/kg, VE/VCO2 slope 32.7 ± 7.7) from 24 HF centres. Finally, we evaluated whether the use of absolute values vs. percentages of predicted VE/VCO2 affected HF prognosis prediction (composite of cardiovascular mortality + urgent transplant or left ventricular assist device). We did so in the entire cardiac and kidney indexes score population and separately in HF patients with severe (peakVO2 < 14 mL/min/kg, n = 2919, 61.1 events/1000 pts/year) or moderate (peakVO2 ≥ 14 mL/min/kg, n = 3183, 19.9 events/1000 pts/year) HF. In the healthy population, we obtained the following equations: female, VE/VCO2 = 0.052 × Age + 23.808 (r = 0.192); male, VE/VCO2 = 0.095 × Age + 20.227 (r = 0.371) (P = 0.007). We applied these formulas to calculate the percentages of predicted VE/VCO2 values. The 2‐year survival prognostic power of VE/VCO2 slope was strong, and it was similar if expressed as absolute value or as a percentage of predicted value (AUCs 0.686 and 0.690, respectively). In contrast, in severe HF patients, AUCs significantly differed between absolute values (0.637) and percentages of predicted values (0.650, P = 0.0026). Moreover, VE/VCO2 slope expressed as a percentage of predicted value allowed to reclassify 6.6% of peakVO2 < 14 mL/min/kg patients (net reclassification improvement = 0.066, P = 0.0015). Conclusions The percentage of predicted VE/VCO2 slope value strengthens the prognostic power of VE/VCO2 in severe HF patients, and it should be preferred over the absolute value for HF prognostication. Furthermore, the widespread use of VE/VCO2 slope expressed as percentage of predicted value can improve our ability to identify HF patients at high risk, which is a goal of utmost clinical relevance.

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Section: Discussionmentioning

confidence: 99%

Gender and age normalization and ventilation efficiency during exercise in heart failure with reduced ejection fraction

Salvioni¹,

Corrà²,

Piepoli³

et al. 2020

ESC Heart Failure

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“…In order to quantify physical exhaustion, capillary blood was taken from the earlobe, and blood lactate concentration was measured (Super GL Ambulance; Hitado Diagnostic Systems, Möhnesee, Germany) directly after termination of both protocols. Participant effort was considered to be maximal according to the modified American Thoracic Society/American College of Chest Physicians statement of CPET if one of the following criteria was fulfilled: respiratory exchange ratio ≥ 1.15, predicted maximal work rate reached, subjective exhaustion (Borg scale rating ≥ 18‐20), heart rate reserve < 10 (220 – age – maximal heart rate during exercise), and capillary blood lactate concentration ≥ 6 mmol/L.…”

Section: Methodsmentioning

confidence: 99%

“…Spiroergometry testing of CRF has become a valuable tool in the clinical assessment of patients in past decades. It contributes to prognostic estimation and treatment decisions as well as the management of preventive and rehabilitative fitness training programs . Today, a considerable amount of people and patients undergoing spiroergometry testing suffer from obesity, which has become a major public health issue with the ongoing changes in lifestyle, such as increasing physical inactivity and overnutrition .…”

Section: Introductionmentioning

confidence: 99%

The Obesity Factor: How Cardiorespiratory Fitness is Estimated More Accurately in People with Obesity

Königstein

Klenk

Rossmeissl

et al. 2017

Obesity

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“…In order to measure oxygen capacity and thus evaluate the functional capacity, the cardiopulmonary (metabolic) exercise testing is very useful. The peak myocardial oxygen consumption with maximal exercise (Vo 2 ) is used to identify high-risk patients, potential heart transplant candidates [71][72][73][74][75]. Thus, exercise testing has an important role in clarifying the long-term prognosis and choosing the optimal treatment for patients with HCM [68].…”

Section: Exercise Testingmentioning

confidence: 99%

The Advantages of New Multimodality Imaging in Choosing the Optimal Management Strategy for Patients with Hypertrophic Cardiomyopathy

et al. 2020

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In recent years, significant advances have been made in the diagnosis and therapeutic management of hypertrophic cardiomyopathy (HCM) patients, which has led to an important improvement in their longevity and quality of life. The use of multimodality imaging has an essential role in the diagnosis, assessing the regional distribution and severity of the disease, with important prognostic implications. At the same time, imaging contributes to the identification of optimal treatment for patients with hypertrophic cardiomyopathy, whether it is pharmaceutical, interventional or surgical treatment. Novel pharmacotherapies (like myosin inhibitors), minimally invasive procedures (such as transcatheter mitral valve repair, high-intensity focused ultrasound or radiofrequency ablation) and gene-directed approaches, may soon become alternatives for HCM patients. However, there are only few data on the early diagnosis of patients with HCM, in order to initiate treatment as soon as possible, to reduce the risk of sudden cardiac death (SCD). The aim of our review is to highlight the advantages of contemporary imaging in choosing the optimal management strategies for HCM patients, considering the novel therapies which are currently applied or studied for these patients.

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Heart Failure Progression in Hypertrophic Cardiomyopathy　– Possible Insights From Cardiopulmonary Exercise Testing –

Cited by 48 publications

References 42 publications

Gender and age normalization and ventilation efficiency during exercise in heart failure with reduced ejection fraction

Gender and age normalization and ventilation efficiency during exercise in heart failure with reduced ejection fraction

The Obesity Factor: How Cardiorespiratory Fitness is Estimated More Accurately in People with Obesity

The Advantages of New Multimodality Imaging in Choosing the Optimal Management Strategy for Patients with Hypertrophic Cardiomyopathy

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Heart Failure Progression in Hypertrophic Cardiomyopathy – Possible Insights From Cardiopulmonary Exercise Testing –

Cited by 48 publications

References 42 publications

Gender and age normalization and ventilation efficiency during exercise in heart failure with reduced ejection fraction

Gender and age normalization and ventilation efficiency during exercise in heart failure with reduced ejection fraction

The Obesity Factor: How Cardiorespiratory Fitness is Estimated More Accurately in People with Obesity

The Advantages of New Multimodality Imaging in Choosing the Optimal Management Strategy for Patients with Hypertrophic Cardiomyopathy

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Heart Failure Progression in Hypertrophic Cardiomyopathy　– Possible Insights From Cardiopulmonary Exercise Testing –