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

Abstract

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.

Impact of Bariatric Surgery on Women Aerobic Exercise Capacity

“…Moreover, the VE/VCO 2 slope was inversely correlated to the amount of weight loss. The VE/VCO 2 slope is known to be an independent predictor of mortality in heart failure and other chronic diseases, probably related to increased chemosensibility [32]. This observation confirms the weight loss-induced reduction of ventilatory cost at a given metabolic level.…”

Cost-Effectiveness of a Small Intrapericardial Centrifugal Left Ventricular Assist Device

“… 33 Given the validation and regionalization of SHFM internationally, 34 it may be the most appropriate for this analysis, notwithstanding cardiopulmonary exercise testing-based score advantages. 35 The latest U.S. randomized study comparing VAD to MM, REMATCH, enrolled during 1998–2001 when therapies were less advanced. 27 This makes REMATCH HRs largely inapplicable.…”

Risk Stratification in Hypertrophic Cardiomyopathy. Insights from Genetic Analysis and Cardiopulmonary Exercise Testing

“…Each of the three abovementioned CPET-derived variables has a specific pathophysiological meaning in the HCM patients' context [30,31] and a possible capability as an outcome predictor. Particularly, the pVO 2 is a multidimensional parameter dependent on cardiac output (heart rate * stroke volume) and artero-venous O 2 extraction [24,32] and it has been extensively shown to be a strong predictor of poor outcome in HCM [14][15][16][17][18] as well as in HF patients [33,34]. The CP%, according to its formula [23,24], magnifies the prognostic power of the pVO 2 through the ABPRE [17,18] which, in turn, depends on the intrinsic myocardial function/geometry as well on abnormal peripheral autonomic reflexes [35,36].…”