Renal Function and Peak Exercise Oxygen Consumption in Chronic Heart Failure With Reduced Left Ventricular Ejection Fraction

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194

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Traditionally, the main indication for cardiopulmonary exercise testing (CPET) in heart failure (HF) was for the selection of candidates to heart transplantation: CPET was mainly performed in middle-aged male patients with HF and reduced left ventricular ejection fraction. Today, CPET is used in broader patients' populations, including women, elderly, patients with co-morbidities, those with preserved ejection fraction, or left ventricular assistance device recipients, i.e. individuals with different responses to incremental exercise and markedly different prognosis. Moreover, the diagnostic and prognostic utility of symptom-limited CPET parameters derived from submaximal tests is more and more considered, since many patients are unable to achieve maximal aerobic power. Repeated tests are also being used for risk stratification and evaluation of intervention, so that these data are now available. Finally, patients, physicians and healthcare decision makers are increasingly considering how treatments might impact morbidity and quality of life rather than focusing more exclusively on hard endpoints (such as mortality) as was often the case in the past. Innovative prognostic flowcharts, with CPET at their core, that help optimize risk stratification and the selection of management options in HF patients, have been developed.

Section: The Patientmentioning

confidence: 99%

Role of cardiopulmonary exercise testing in clinical stratification in heart failure. A position paper from the Committee on Exercise Physiology and Training of the Heart Failure Association of the European Society of Cardiology

Corrà

Agostoni

Anker

et al. 2017

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194

148

“…Thus, the HFrEF‐CKD classifier possesses sufficient discriminatory power for HFrEF diagnosis in CKD patients due to adequate urinary proteomic differences and indicates the discriminatory power of UPA. This is of clinical relevance since renal dysfunction has been associated with adverse outcomes such as increased risk of hospitalization and death in HFrEF . In repeated analyses, the rather broad urinary peptide biomarker pattern thereby has the potential to reveal pathophysiological aspects of the progression of HFrEF in patients with CKD as a co‐morbidity that are not depicted by current blood markers.…”

Section: Discussionmentioning

confidence: 99%

“…Since cardiovascular as well as non‐cardiac co‐morbidities such as renal impairment complicate disease management and may adversely affect outcome in heart failure, the aim of the present case–control study was to assess the ability of UPA to identify a HFrEF‐specific peptide biomarker pattern in urine of HFrEF patients with chronic kidney disease (CKD) and, based on this pattern, to establish a diagnostic HFrEF classifier in the presence of CKD.…”

Section: Introductionmentioning

confidence: 99%

Urine proteome analysis in heart failure with reduced ejection fraction complicated by chronic kidney disease: feasibility, and clinical and pathogenetic correlates

Farmakis

Koeck

Mullen

et al. 2016

Aims Urine proteome analysis (UPA) has already provided accurate discriminatory patterns of urinary peptides for renal disease, coronary artery disease, and asymptomatic LV diastolic dysfunction. UPA has now been used to characterize a discriminatory peptide biomarker pattern and establish a diagnostic classifier for heart failure patients with reduced ejection fraction (HFrEF) in the presence of chronic kidney disease (CKD). Methods and results We analysed the urine proteome profiles obtained by capillary electrophoresis online coupled to micro‐TOF (time of flight) mass spectrometry of 126 individuals, 59 HFrEF patients and 67 controls matched for age, sex, and renal function. In total, 107 significant discriminatory peptides were identified and used to establish a support vector machine‐based classifier that was successfully applied to a test set of 25 HFrEF patients and 33 controls, achieving 84% sensitivity and 91% specificity. The majority of sequenced peptides were fragments of collagen type I and III. Conclusion UPA was able to identify a set of HFrEF‐specific urinary peptide biomarkers on a background of CKD that were successfully utilized to establish a syndrome's classifier.

“…The MECKI score was later successfully validated in another population of HF patients on optimal pharmacological and non‐pharmacological treatment and with a comparatively lower event rate . Moreover, the MECKI score database is constantly updated, and additional HF units have contributed to the database by sharing their results …”

Section: Introductionmentioning

confidence: 99%

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

Agostoni

Paolillo

Mapelli

et al. 2017

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