Cardiovascular Death Risk in Recovered Mid-Range Ejection Fraction Heart Failure: Insights From Cardiopulmonary Exercise Test

Abstract

This is a PDF file of an article that has undergone enhancements after acceptance, such as the addition of a cover page and metadata, and formatting for readability, but it is not yet the definitive version of record. This version will undergo additional copyediting, typesetting and review before it is published in its final form, but we are providing this version to give early visibility of the article. Please note that, during the production process, errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.

Risk stratification in heart failure with mild reduced ejection fraction

“…Furthermore, it investigated a possible adjunctive advantage of the CPET assessment in identifying those rec-HFmrEF patients at high risk of pure cardiovascular death. 29 Briefly, besides confirming that the rec-HFmrEF patients are usually older, with a lower prevalence of male gender as well of ischaemic aetiology compared to the HFrEF group, the study pointed out that this HF category is less likely to receive disease-modifying drugs such as ACEis or ARBs, β-blockers and MRAs. Furthermore, from a functional viewpoint, the rec-HFmrEF group showed a less severe functional impairment in terms of a number of CPET-derived parameters.…”

“…sample size, HFmrEF patients’ characteristics, pre-specified endpoints), what clearly emerges from each of them is that a CPET assessment might represent a useful tool in HFmrEF management. 8 , 25 – 29 In particular pVO 2 , either expressed in ml/kg/min or as percentage of maximum predicted, has been found always to be related to the HFmrEF outcome. The underlying reason for pVO 2 accuracy in identifying patients at highest risk might derive from its formula, namely the Fick law.…”

“…27 Eventually, a more recent study by Rovai and colleagues, on behalf of the metabolic exercise combined with cardiac and kidney indexes (MECKI) research group, confirmed a similar rate of exertional oscillatory ventilation (EOV) to those observed in HFrEF and its worse impact on prognosis in a large cohort of rec-HFmrEF patients. 28 Insights from the MECKI score research group in rec-HFmrEF A recent Italian multicentre study, conducted by the MECKI score research group, sought to characterise a large cohort of stable rec-HFmrEF (n ¼ 1176) and HFrEF (n ¼ 4535) patients on optimised drug regimen 29 1.176 rec-HFmrEF 4535 HFrEF…”

“…The incidence rate of cardiovascular mortality at 5 years in the overall HFrEF and rec-HFmrEF groups and in the rec-HFmrEF subgroups categorised according to cut-off values of peak VO 2 and VE/VCO 2 slope (central panel). Modified from Magrì et al 29 rec-HFmrEF: heart failure with recovered mid-range left ventricular ejection fraction; HFrEF, heart failure with reduced left ventricular ejection fraction; peak VO 2 : peak oxygen uptake; VE/VCO 2 slope: ventilatory efficiency.…”

“…Modified from Magrì et al. 29 rec-HFmrEF: heart failure with recovered mid-range left ventricular ejection fraction; HFrEF, heart failure with reduced left ventricular ejection fraction; peak VO 2 : peak oxygen uptake; VE/VCO 2 slope: ventilatory efficiency.…”