Multiparametric prognostic scores in chronic heart failure with reduced ejection fraction: a long‐term comparison

Agostoni, Piergiuseppe; Paolillo, Stefania; Mapelli, Massimo; Gentile, Piero; Salvioni, Elisabetta; Veglia, Fabrizio; Bonomi, Alice; Corrà, Ugo; Lagioia, Rocco; Limongelli, Giuseppe; Sinagra, Gianfranco; Cattadori, Gaia; Scardovi, Angela Beatrice; Metra, Marco; Carubelli, Valentina; Scrutinio, Domenico; Raimondo, Rosa; Emdin, Michele; Piepoli, Massimo F; Magrì, Damiano; Parati, Gianfranco; Caravita, Sergio; Re, Federica; Cicoira, Mariantonietta; Minà, Chiara; Correale, Michele; Frigerio, Maria; Bussotti, Maurizio; Oliva, Fabrizio; Battaia, Elisa; Belardinelli, Romualdo; Mezzani, Alessandro; Pastormerlo, Luigi Emilio; Guazzi, Marco; Badagliacca, Roberto; Lenarda, Andrea Di; Passino, Claudio; Sciomer, Susanna; Zambon, Elena; Pacileo, Giuseppe; Ricci, Roberto; Apostolo, Anna; Palermo, Pietro; Contini, Mauro; Clemenza, Francesco; Marchese, Giovanni; Gargiulo, Paola; Binno, Simone; Lombardi, Carlo; Passantino, Andrea; Filardi, Pasquale Perrone

doi:10.1002/ejhf.989

Cited by 89 publications

(76 citation statements)

References 28 publications

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“…The 10‐year survival analysis was then repeated taking into account the potential confounding role of peak VO 2 expressed as mL/min/kg and of VE/VCO 2 slope ( Figure B and C ), indicating a steady improvement over time independently of peak VO 2 and VE/VCO 2 slope. When data were normalized for clinical variables, such as peak VO 2 , VE/VCO 2 slope, Na + , kidney function by means of MDRD formula, and haemoglobin — all known to be independent survival predictors — results were unchanged. However, when also treatment variables — which resulted significantly different between groups (such as ICD, CRT, ACE inhibitors, beta‐blockers, aldosterone antagonists) — were added, Kaplan–Meier survival curves showed an unchanged trend, but statistical difference was observed only between group 1 and the other groups.…”

Section: Resultsmentioning

confidence: 95%

“…Normally and non-normally distributed numeric and categorical variables are presented as mean ± standard deviation, as median [interquartile range (IQR)], or as frequency (%), and they were compared With follow-up arbitrarily truncated at 10 years, event-free survival in the different time ranges was estimated by Kaplan-Meier curves and by Cox regression models unadjusted and adjusted for peak VO 2 expressed as mL/min/kg, for VE/VCO 2 slope, for the combination of clinical variables known to be independently associated with prognosis -peak VO 2 , VE/VCO 2 slope, Na + , LVEF, kidney function by means of Modification of Diet in Renal Disease (MDRD) formula, and haemoglobin 11,12 -and for the same variables plus treatment strategies [e.g. implantable cardioverter defibrillator (ICD), cardiac resynchronization therapy (CRT), angiotensin-converting enzyme (ACE) inhibitors, beta-blockers, aldosterone antagonists], which resulted different between groups.…”

Section: Discussionmentioning

confidence: 99%

“…It is presently unknown whether and how the prognostic value of recognized predictors has changed over time. Among them, data derived from exercise evaluation, and specifically from cardiopulmonary exercise test (CPET), have gained a recognized pivotal role in HF prognosis both alone and in combination with non‐CPET parameters . Among CPET parameters, oxygen uptake at peak exercise (peak VO 2 ) and the slope of the relationship between minute ventilation and carbon dioxide production (VE/VCO 2 slope) have been recognized and validated as tools to assess disease severity, to discriminate short‐ and long‐term HF prognosis, and to select patients for heart transplantation (HTx) .…”

Section: Introductionmentioning

confidence: 99%

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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

Paolillo

Veglia

Salvioni

et al. 2019

European J of Heart Fail

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Aims Exercise‐derived parameters, specifically peak exercise oxygen uptake (peak VO2) and minute ventilation/carbon dioxide relationship slope (VE/VCO2 slope), have a pivotal prognostic value in heart failure (HF). It is unknown how the prognostic threshold of peak VO2 and VE/VCO2 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 VO2 and VE/VCO2 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 VO2 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/VCO2 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 VO2 and VE/VCO2 slope cut‐offs identifying a definite risk progressively decreased and increased over time, respectively. The prognostic threshold of peak VO2 and VE/VCO2 slope must be updated whenever HF prognosis improves.

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Section: Resultsmentioning

confidence: 95%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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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

Paolillo

Veglia

Salvioni

et al. 2019

European J of Heart Fail

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“…Numerous scores have been derived and validated for both acute heart failure and outpatients. Selected prognostic scores for advanced but non‐hospitalized heart failure include the Heart Failure Survival Score (HFSS), the Seattle Heart Failure Model (SHFM), the Metabolic Exercise test data combined with Cardiac and Kidney Indexes (MECKI) score, and the Meta‐Analysis Global Group in Chronic Heart Failure (MAGGIC) ( Table ). The SHFM has been shown to underestimate the risk of decompensation and indication for left ventricular assist device (LVAD) in patients with advanced heart failure .…”

Section: Prognostic Stratificationmentioning

confidence: 99%

Advanced heart failure: a position statement of the Heart Failure Association of the European Society of Cardiology

Crespo-Leiro

Metra

Lund

et al. 2018

European J of Heart Fail

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605

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This article updates the Heart Failure Association of the European Society of Cardiology (ESC) 2007 classification of advanced heart failure and describes new diagnostic and treatment options for these patients. Recognizing the patient with advanced heart failure is critical to facilitate timely referral to advanced heart failure centres. Unplanned visits for heart failure decompensation, malignant arrhythmias, co-morbidities, and the 2016 ESC guidelines criteria for the diagnosis of heart failure with preserved ejection fraction are included in this updated definition. Standard treatment is, by definition, insufficient in these patients. Inotropic therapy may be used as a bridge strategy, but it is only a palliative measure when used on its own, because of the lack of outcomes data. Major progress has occurred with short-term mechanical circulatory support devices for immediate management of cardiogenic shock and long-term mechanical circulatory support for either a bridge to transplantation or as destination therapy. Heart transplantation remains the treatment of choice for patients without contraindications. Some patients will not be candidates for advanced heart failure therapies. For these patients, who are often elderly with multiple co-morbidities, management of advanced heart failure to reduce symptoms and improve quality of life should be emphasized. Robust evidence from prospective studies is lacking for most therapies for advanced heart failure. There is an urgent need to develop evidence-based treatment algorithms to prolong life when possible and in accordance with patient preferences, increase life quality, and reduce the burden of hospitalization in this vulnerable patient population.

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“…In a long-term registry of chronic heart failure, patients with reduced ejection fraction were compared to multiparametric prognostic scores, and the MECKI (Metabolic Excercise test data combined with Cardiac and Kidney Indexes) score was superior to other tested scores [26]. Also, regarding our registry, NGAL should be included in the multi-biomarker approach to set prognosis more precisely.…”

Section: Figmentioning

confidence: 99%

Renal Functions and Prognosis Stratification in Chronic Heart Failure Patients and the Importance of Neutrophil Gelatinase-Associated Lipocalin

Lábr

Špinar

Pařenica

et al. 2018

Kidney Blood Press Res

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Background/Aims: The rate of incidence and prevalence of acute kidney injury is increasing due to an increased number of patients with heart failure. Therefore it is very pertinent to early detect the level of renal injuries and to make necessary heart failure predictions. Thus the aim of this study is to determine renal functions and prognosis stratification in chronic heart failure patients and importance of Neutrophil Gelatinase-Associated Lipocalin (NGAL), an early diagnostic marker of acute kidney injury, as well as stratification of cardiovascular risk in heart failure patients. Methods: Data including age, gender, comorbidities and medical history of outpatients and hospitalized patients from Farmacology and NeuroHumoraL activation (FAR NHL) multicenter prospective registry comprising three Cardiological Centers in the Czech Republic were collected between 1st October 2014 and 30th November 2015. One-year follow-up data were collected in November 2016 in such a way that all patients had at least one-year data from the time of recruitment, but up to two years to the time of follow-up. One-year data were used for the whole set of patients while data up to 24 months were used with Kaplan-Meier‘s survival curves to analyse the patients‘ survival data. Blood samples were collected from the patients and basic parameters were evaluated in order to analyse Neutrophil gelatinase-associated lipocalin (NGAL) and plasma levels of N-terminal pro-brain natriuretic peptide (NT-ProBNP) using Lipocalin-2/NGAL Human ELISA kit (Bio Vendor, Czechia) and the Cobas E411 NT-proBNP Immunoassay kit (Roche Diagnostics, Indianapolis, IN, USA) respectively. Statistical analysis was further carried out to explain the level of significance of the evaluated parameters using Spearman Correlation, Mann Whitney or Kruskal-Wallis test and log-rank test. Results: Out of 547 patients from Farmacology and NeuroHumoraL activation (FAR NHL) multicenter prospective registry with available data on hospitalizations, mortality, biomarkers and one-year follow-up that were recorded, there were 439 males (80.3%) with a median age of 66 years. At least one-month stable patients with left ventricle ejection fraction (LV EF) under 50% were recorded. The etiology of heart failure was ischemic heart disease in 54%, dilated cardiomyopathy in 40% and others in 6%. 69% patients were in New York Heart Association functional class II. There were 76 events (13.9%; all-cause mortality, acute heart failure hospitalization, left ventricle assist device implantation and orthotopic heart transplant) in the first 365 days of follow-up. The area under the receiver operating characteristic curve was higher for NT-proBNP (0.77) than the creatinine (0.57), NGAL (0.55) or creatinine clearance (0.54). In multivariable analyses, NT-proBNP (P= 0.001) and NGAL (P = 0.004) were significant predictors of events. Subjects with NT-proBNP and NGAL above the cut off value (NT-proBNP 1,121 pg/ml, NGAL 80 ng/ml) survived without any event in 55.7%, subjects with NT-proBNP and NGAL unde...

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Multiparametric prognostic scores in chronic heart failure with reduced ejection fraction: a long‐term comparison

Abstract: In this cohort, the prognostic accuracy of the MECKI score was superior to that of HFSS and SHFM at 2- and 4-year follow-up in HF patients in stable clinical condition. The MECKI score may be useful to improve resource allocation and patient outcome, but prospective evaluation is needed.

Cited by 89 publications

References 28 publications

Heart failure prognosis over time: how the prognostic role of oxygen consumption and ventilatory efficiency during exercise has changed in the last 20 years

Heart failure prognosis over time: how the prognostic role of oxygen consumption and ventilatory efficiency during exercise has changed in the last 20 years

Advanced heart failure: a position statement of the Heart Failure Association of the European Society of Cardiology

Renal Functions and Prognosis Stratification in Chronic Heart Failure Patients and the Importance of Neutrophil Gelatinase-Associated Lipocalin

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