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Mapelli M, Romani S, Magrì D, Merlo M, Cittar M, Masè M, Muratori M, Gallo G, Sclafani M, Carriere C, Zaffalon D, Salvioni E, Mattavelli I, Vignati C, De Martino F, Rovai S, Autore C, Sinagra G, Agostoni P. P295 EXERCISE OXYGEN KINETIC IN HYPERTROPHIC CARDIOMYOPATHY: RESULTS FROM A MULTICENTER CARDIOPULMONARY EXERCISE TESTING STUDY. Eur Heart J Suppl 2022. [DOI: 10.1093/eurheartj/suac012.283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Abstract
Aims
Reduced cardiac output (CO) has been considered crucial in symptoms’ genesis in hypertrophic cardiomyopathy (HCM). We evaluated the cardiopulmonary exercise testing (CPET) response in HCM focusing on parameters strongly associated with stroke volume (SV) and cardiac output (CO), such as oxygen uptake (VO2) and O2–pulse, considering both their absolute values and temporal behavior during physical exercise.
Methods and Results
We enrolled 312 non–end stage HCM patients, divided according to left ventricle outflow tract obstruction (LVOTO) at rest or during Valsalva maneuver (72% with LVOTO<30; 10% between 30 and 49 and 18% ≥ 50mmHg). Peak VO2 (percent of predicted), O2–pulse and ventilation to carbon dioxide production (VE/VCO2) slope did not change across LVOTO groups. Ninety–six (31%) HCM patients presented an abnormal O2–pulse temporal behavior, irrespective of LVOTO values. These patients showed lower peak systolic pressure, workload (106±45 vs. 130±49W), VO2 (74±17 vs. 80±20%) and O2–pulse (12 [9–14] vs. 14 [11–17]ml/beat), with higher VE/VCO2 slope (28 [25–31] vs. 27 [24–31]) (p < 0.005 for all). Only 2 patients had an abnormal VO2/work slope.
Conclusion
None of CPET parameters, either as absolute values or dynamic relationships, were associated with LVOTO. Differently, an abnormal O2–pulse exercise behavior, which is strongly related to inadequate SV during exercise, correlates with reduced functional capacity (peak and anaerobic threshold VO2 and workload) and increased VE/VCO2 slope, helping identifying more advanced disease irrespectively of LVOTO. Adding O2–pulse kinetics evaluation to standard CPET could lead to a potential incremental benefit in terms of HCM prognostic stratification and, then, therapeutic management.
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Affiliation(s)
- M Mapelli
- CENTRO CARDIOLOGICO MONZINO, IRCCS, MILANO; DIPARTIMENTO DI MEDICINA CLINICA E MOLECOLARE, SAPIENZA, UNIVERSITÀ DEGLI STUDI DI ROMA, ROMA; CARDIOTHORACOVASCULAR DEPARTMENT, CENTER FOR THE DIAGNOSIS AND TREATMENT OF CARDIOMYOPATHIES, AZIENDA SANITARIA UNIVERSITARIA GIULIANO ISONTINA, UNIVERSITY OF TRIESTE, TRIESTE
| | - S Romani
- CENTRO CARDIOLOGICO MONZINO, IRCCS, MILANO; DIPARTIMENTO DI MEDICINA CLINICA E MOLECOLARE, SAPIENZA, UNIVERSITÀ DEGLI STUDI DI ROMA, ROMA; CARDIOTHORACOVASCULAR DEPARTMENT, CENTER FOR THE DIAGNOSIS AND TREATMENT OF CARDIOMYOPATHIES, AZIENDA SANITARIA UNIVERSITARIA GIULIANO ISONTINA, UNIVERSITY OF TRIESTE, TRIESTE
| | - D Magrì
- CENTRO CARDIOLOGICO MONZINO, IRCCS, MILANO; DIPARTIMENTO DI MEDICINA CLINICA E MOLECOLARE, SAPIENZA, UNIVERSITÀ DEGLI STUDI DI ROMA, ROMA; CARDIOTHORACOVASCULAR DEPARTMENT, CENTER FOR THE DIAGNOSIS AND TREATMENT OF CARDIOMYOPATHIES, AZIENDA SANITARIA UNIVERSITARIA GIULIANO ISONTINA, UNIVERSITY OF TRIESTE, TRIESTE
| | - M Merlo
- CENTRO CARDIOLOGICO MONZINO, IRCCS, MILANO; DIPARTIMENTO DI MEDICINA CLINICA E MOLECOLARE, SAPIENZA, UNIVERSITÀ DEGLI STUDI DI ROMA, ROMA; CARDIOTHORACOVASCULAR DEPARTMENT, CENTER FOR THE DIAGNOSIS AND TREATMENT OF CARDIOMYOPATHIES, AZIENDA SANITARIA UNIVERSITARIA GIULIANO ISONTINA, UNIVERSITY OF TRIESTE, TRIESTE
| | - M Cittar
- CENTRO CARDIOLOGICO MONZINO, IRCCS, MILANO; DIPARTIMENTO DI MEDICINA CLINICA E MOLECOLARE, SAPIENZA, UNIVERSITÀ DEGLI STUDI DI ROMA, ROMA; CARDIOTHORACOVASCULAR DEPARTMENT, CENTER FOR THE DIAGNOSIS AND TREATMENT OF CARDIOMYOPATHIES, AZIENDA SANITARIA UNIVERSITARIA GIULIANO ISONTINA, UNIVERSITY OF TRIESTE, TRIESTE
| | - M Masè
- CENTRO CARDIOLOGICO MONZINO, IRCCS, MILANO; DIPARTIMENTO DI MEDICINA CLINICA E MOLECOLARE, SAPIENZA, UNIVERSITÀ DEGLI STUDI DI ROMA, ROMA; CARDIOTHORACOVASCULAR DEPARTMENT, CENTER FOR THE DIAGNOSIS AND TREATMENT OF CARDIOMYOPATHIES, AZIENDA SANITARIA UNIVERSITARIA GIULIANO ISONTINA, UNIVERSITY OF TRIESTE, TRIESTE
| | - M Muratori
- CENTRO CARDIOLOGICO MONZINO, IRCCS, MILANO; DIPARTIMENTO DI MEDICINA CLINICA E MOLECOLARE, SAPIENZA, UNIVERSITÀ DEGLI STUDI DI ROMA, ROMA; CARDIOTHORACOVASCULAR DEPARTMENT, CENTER FOR THE DIAGNOSIS AND TREATMENT OF CARDIOMYOPATHIES, AZIENDA SANITARIA UNIVERSITARIA GIULIANO ISONTINA, UNIVERSITY OF TRIESTE, TRIESTE
| | - G Gallo
- CENTRO CARDIOLOGICO MONZINO, IRCCS, MILANO; DIPARTIMENTO DI MEDICINA CLINICA E MOLECOLARE, SAPIENZA, UNIVERSITÀ DEGLI STUDI DI ROMA, ROMA; CARDIOTHORACOVASCULAR DEPARTMENT, CENTER FOR THE DIAGNOSIS AND TREATMENT OF CARDIOMYOPATHIES, AZIENDA SANITARIA UNIVERSITARIA GIULIANO ISONTINA, UNIVERSITY OF TRIESTE, TRIESTE
| | - M Sclafani
- CENTRO CARDIOLOGICO MONZINO, IRCCS, MILANO; DIPARTIMENTO DI MEDICINA CLINICA E MOLECOLARE, SAPIENZA, UNIVERSITÀ DEGLI STUDI DI ROMA, ROMA; CARDIOTHORACOVASCULAR DEPARTMENT, CENTER FOR THE DIAGNOSIS AND TREATMENT OF CARDIOMYOPATHIES, AZIENDA SANITARIA UNIVERSITARIA GIULIANO ISONTINA, UNIVERSITY OF TRIESTE, TRIESTE
| | - C Carriere
- CENTRO CARDIOLOGICO MONZINO, IRCCS, MILANO; DIPARTIMENTO DI MEDICINA CLINICA E MOLECOLARE, SAPIENZA, UNIVERSITÀ DEGLI STUDI DI ROMA, ROMA; CARDIOTHORACOVASCULAR DEPARTMENT, CENTER FOR THE DIAGNOSIS AND TREATMENT OF CARDIOMYOPATHIES, AZIENDA SANITARIA UNIVERSITARIA GIULIANO ISONTINA, UNIVERSITY OF TRIESTE, TRIESTE
| | - D Zaffalon
- CENTRO CARDIOLOGICO MONZINO, IRCCS, MILANO; DIPARTIMENTO DI MEDICINA CLINICA E MOLECOLARE, SAPIENZA, UNIVERSITÀ DEGLI STUDI DI ROMA, ROMA; CARDIOTHORACOVASCULAR DEPARTMENT, CENTER FOR THE DIAGNOSIS AND TREATMENT OF CARDIOMYOPATHIES, AZIENDA SANITARIA UNIVERSITARIA GIULIANO ISONTINA, UNIVERSITY OF TRIESTE, TRIESTE
| | - E Salvioni
- CENTRO CARDIOLOGICO MONZINO, IRCCS, MILANO; DIPARTIMENTO DI MEDICINA CLINICA E MOLECOLARE, SAPIENZA, UNIVERSITÀ DEGLI STUDI DI ROMA, ROMA; CARDIOTHORACOVASCULAR DEPARTMENT, CENTER FOR THE DIAGNOSIS AND TREATMENT OF CARDIOMYOPATHIES, AZIENDA SANITARIA UNIVERSITARIA GIULIANO ISONTINA, UNIVERSITY OF TRIESTE, TRIESTE
| | - I Mattavelli
- CENTRO CARDIOLOGICO MONZINO, IRCCS, MILANO; DIPARTIMENTO DI MEDICINA CLINICA E MOLECOLARE, SAPIENZA, UNIVERSITÀ DEGLI STUDI DI ROMA, ROMA; CARDIOTHORACOVASCULAR DEPARTMENT, CENTER FOR THE DIAGNOSIS AND TREATMENT OF CARDIOMYOPATHIES, AZIENDA SANITARIA UNIVERSITARIA GIULIANO ISONTINA, UNIVERSITY OF TRIESTE, TRIESTE
| | - C Vignati
- CENTRO CARDIOLOGICO MONZINO, IRCCS, MILANO; DIPARTIMENTO DI MEDICINA CLINICA E MOLECOLARE, SAPIENZA, UNIVERSITÀ DEGLI STUDI DI ROMA, ROMA; CARDIOTHORACOVASCULAR DEPARTMENT, CENTER FOR THE DIAGNOSIS AND TREATMENT OF CARDIOMYOPATHIES, AZIENDA SANITARIA UNIVERSITARIA GIULIANO ISONTINA, UNIVERSITY OF TRIESTE, TRIESTE
| | - F De Martino
- CENTRO CARDIOLOGICO MONZINO, IRCCS, MILANO; DIPARTIMENTO DI MEDICINA CLINICA E MOLECOLARE, SAPIENZA, UNIVERSITÀ DEGLI STUDI DI ROMA, ROMA; CARDIOTHORACOVASCULAR DEPARTMENT, CENTER FOR THE DIAGNOSIS AND TREATMENT OF CARDIOMYOPATHIES, AZIENDA SANITARIA UNIVERSITARIA GIULIANO ISONTINA, UNIVERSITY OF TRIESTE, TRIESTE
| | - S Rovai
- CENTRO CARDIOLOGICO MONZINO, IRCCS, MILANO; DIPARTIMENTO DI MEDICINA CLINICA E MOLECOLARE, SAPIENZA, UNIVERSITÀ DEGLI STUDI DI ROMA, ROMA; CARDIOTHORACOVASCULAR DEPARTMENT, CENTER FOR THE DIAGNOSIS AND TREATMENT OF CARDIOMYOPATHIES, AZIENDA SANITARIA UNIVERSITARIA GIULIANO ISONTINA, UNIVERSITY OF TRIESTE, TRIESTE
| | - C Autore
- CENTRO CARDIOLOGICO MONZINO, IRCCS, MILANO; DIPARTIMENTO DI MEDICINA CLINICA E MOLECOLARE, SAPIENZA, UNIVERSITÀ DEGLI STUDI DI ROMA, ROMA; CARDIOTHORACOVASCULAR DEPARTMENT, CENTER FOR THE DIAGNOSIS AND TREATMENT OF CARDIOMYOPATHIES, AZIENDA SANITARIA UNIVERSITARIA GIULIANO ISONTINA, UNIVERSITY OF TRIESTE, TRIESTE
| | - G Sinagra
- CENTRO CARDIOLOGICO MONZINO, IRCCS, MILANO; DIPARTIMENTO DI MEDICINA CLINICA E MOLECOLARE, SAPIENZA, UNIVERSITÀ DEGLI STUDI DI ROMA, ROMA; CARDIOTHORACOVASCULAR DEPARTMENT, CENTER FOR THE DIAGNOSIS AND TREATMENT OF CARDIOMYOPATHIES, AZIENDA SANITARIA UNIVERSITARIA GIULIANO ISONTINA, UNIVERSITY OF TRIESTE, TRIESTE
| | - P Agostoni
- CENTRO CARDIOLOGICO MONZINO, IRCCS, MILANO; DIPARTIMENTO DI MEDICINA CLINICA E MOLECOLARE, SAPIENZA, UNIVERSITÀ DEGLI STUDI DI ROMA, ROMA; CARDIOTHORACOVASCULAR DEPARTMENT, CENTER FOR THE DIAGNOSIS AND TREATMENT OF CARDIOMYOPATHIES, AZIENDA SANITARIA UNIVERSITARIA GIULIANO ISONTINA, UNIVERSITY OF TRIESTE, TRIESTE
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Mapelli M, Salvioni E, Paneroni M, Gugliandolo P, Bonomi A, Scalvini S, Raimondo R, Sciomer S, Mattavelli I, La Rovere M, Agostoni P. P244 BRISK WALKING CAN BE A MAXIMAL EFFORT IN HEART FAILURE PATIENTS. A COMPARISON OF CARDIOPULMONARY EXERCISE AND SIX–MINUTE WALKING TEST CARDIORESPIRATORY DATA. Eur Heart J Suppl 2022. [DOI: 10.1093/eurheartj/suac012.236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Abstract
Aims
Cardiopulmonary exercise test (CPET) and six–minute walking test (6MWT) are frequently used in heart failure (HF). CPET is a maximal exercise, whereas 6MWT is a self–selected constant load test usually considered a submaximal, and therefore safer, exercise but this has not been tested previously. The aim of this study was to compare the cardiorespiratory parameters collected during CPET and 6MWT in a large group of healthy subjects and patients with HF of different severity.
Methods and Results
Subjects performed a standard maximal CPET and a 6MWT wearing a portable device allowing breath–by–breath measurement of cardiorespiratory parameters. HF Patients were grouped according to their CPET peak oxygen uptake (peakV̇O2). One–hundred and fifty–five subjects were enrolled, of whom 40 were healthy (59±8 years; male 67%) and 115 were HF patients (69±10 years; male 80%; left ventricular ejection fraction 34.6±12.0%). CPET peakV̇O2 was 13.5±3.5 ml/kg/min in HF patients and 28.1±7.4 ml/kg/min in healthy (p < 0.001). 6MWT–V̇O2 was 98±20% of the CPET peakV̇O2 values in HF patients, while 72±20% in healthy subjects (p < 0.001). 6MWT–V̇O2 was >110% of CPET peakV̇O2 in 42% of more severe HF patients (peakV̇O2<12ml/kg/min). Similar results have been found for ventilation and heart rate. Of note, the slope of the relationship between V̇O2 at 6MWT, reported as percentage of CPET peakV̇O2 vs. 6MWT V̇O2 reported as absolute value, progressively increased as exercise limitation did.
Conclusions
6MWT must be perceived as a maximal or even supra–maximal exercise activity at least in patients with severe exercise limitation from HF. Our findings should influence the safety procedures needed for the 6MWT in HF.
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Affiliation(s)
- M Mapelli
- CENTRO CARDIOLOGICO MONZINO, IRCCS, MILANO; RESPIRATORY REHABILITATION, ISTITUTI CLINICI SCIENTIFICI MAUGERI, IRCCS, LUMEZZANE BRESCIA; RESPIRATORY REHABILITATION, ISTITUTI CLINICI SCIENTIFICI MAUGERI, IRCCS, TRADATE, VARESE, ITALY, TRADATE; DIPARTIMENTO DI SCIENZE CARDIOVASCOLARI, RESPIRATORIE, NEFROLOGICHE, ANESTESIOLOGICHE E GERIATRICHE, “SAPIENZA”, ROMA; DEPARTMENT OF CARDIAC REHABILITATION,
| | - E Salvioni
- CENTRO CARDIOLOGICO MONZINO, IRCCS, MILANO; RESPIRATORY REHABILITATION, ISTITUTI CLINICI SCIENTIFICI MAUGERI, IRCCS, LUMEZZANE BRESCIA; RESPIRATORY REHABILITATION, ISTITUTI CLINICI SCIENTIFICI MAUGERI, IRCCS, TRADATE, VARESE, ITALY, TRADATE; DIPARTIMENTO DI SCIENZE CARDIOVASCOLARI, RESPIRATORIE, NEFROLOGICHE, ANESTESIOLOGICHE E GERIATRICHE, “SAPIENZA”, ROMA; DEPARTMENT OF CARDIAC REHABILITATION,
| | - M Paneroni
- CENTRO CARDIOLOGICO MONZINO, IRCCS, MILANO; RESPIRATORY REHABILITATION, ISTITUTI CLINICI SCIENTIFICI MAUGERI, IRCCS, LUMEZZANE BRESCIA; RESPIRATORY REHABILITATION, ISTITUTI CLINICI SCIENTIFICI MAUGERI, IRCCS, TRADATE, VARESE, ITALY, TRADATE; DIPARTIMENTO DI SCIENZE CARDIOVASCOLARI, RESPIRATORIE, NEFROLOGICHE, ANESTESIOLOGICHE E GERIATRICHE, “SAPIENZA”, ROMA; DEPARTMENT OF CARDIAC REHABILITATION,
| | - P Gugliandolo
- CENTRO CARDIOLOGICO MONZINO, IRCCS, MILANO; RESPIRATORY REHABILITATION, ISTITUTI CLINICI SCIENTIFICI MAUGERI, IRCCS, LUMEZZANE BRESCIA; RESPIRATORY REHABILITATION, ISTITUTI CLINICI SCIENTIFICI MAUGERI, IRCCS, TRADATE, VARESE, ITALY, TRADATE; DIPARTIMENTO DI SCIENZE CARDIOVASCOLARI, RESPIRATORIE, NEFROLOGICHE, ANESTESIOLOGICHE E GERIATRICHE, “SAPIENZA”, ROMA; DEPARTMENT OF CARDIAC REHABILITATION,
| | - A Bonomi
- CENTRO CARDIOLOGICO MONZINO, IRCCS, MILANO; RESPIRATORY REHABILITATION, ISTITUTI CLINICI SCIENTIFICI MAUGERI, IRCCS, LUMEZZANE BRESCIA; RESPIRATORY REHABILITATION, ISTITUTI CLINICI SCIENTIFICI MAUGERI, IRCCS, TRADATE, VARESE, ITALY, TRADATE; DIPARTIMENTO DI SCIENZE CARDIOVASCOLARI, RESPIRATORIE, NEFROLOGICHE, ANESTESIOLOGICHE E GERIATRICHE, “SAPIENZA”, ROMA; DEPARTMENT OF CARDIAC REHABILITATION,
| | - S Scalvini
- CENTRO CARDIOLOGICO MONZINO, IRCCS, MILANO; RESPIRATORY REHABILITATION, ISTITUTI CLINICI SCIENTIFICI MAUGERI, IRCCS, LUMEZZANE BRESCIA; RESPIRATORY REHABILITATION, ISTITUTI CLINICI SCIENTIFICI MAUGERI, IRCCS, TRADATE, VARESE, ITALY, TRADATE; DIPARTIMENTO DI SCIENZE CARDIOVASCOLARI, RESPIRATORIE, NEFROLOGICHE, ANESTESIOLOGICHE E GERIATRICHE, “SAPIENZA”, ROMA; DEPARTMENT OF CARDIAC REHABILITATION,
| | - R Raimondo
- CENTRO CARDIOLOGICO MONZINO, IRCCS, MILANO; RESPIRATORY REHABILITATION, ISTITUTI CLINICI SCIENTIFICI MAUGERI, IRCCS, LUMEZZANE BRESCIA; RESPIRATORY REHABILITATION, ISTITUTI CLINICI SCIENTIFICI MAUGERI, IRCCS, TRADATE, VARESE, ITALY, TRADATE; DIPARTIMENTO DI SCIENZE CARDIOVASCOLARI, RESPIRATORIE, NEFROLOGICHE, ANESTESIOLOGICHE E GERIATRICHE, “SAPIENZA”, ROMA; DEPARTMENT OF CARDIAC REHABILITATION,
| | - S Sciomer
- CENTRO CARDIOLOGICO MONZINO, IRCCS, MILANO; RESPIRATORY REHABILITATION, ISTITUTI CLINICI SCIENTIFICI MAUGERI, IRCCS, LUMEZZANE BRESCIA; RESPIRATORY REHABILITATION, ISTITUTI CLINICI SCIENTIFICI MAUGERI, IRCCS, TRADATE, VARESE, ITALY, TRADATE; DIPARTIMENTO DI SCIENZE CARDIOVASCOLARI, RESPIRATORIE, NEFROLOGICHE, ANESTESIOLOGICHE E GERIATRICHE, “SAPIENZA”, ROMA; DEPARTMENT OF CARDIAC REHABILITATION,
| | - I Mattavelli
- CENTRO CARDIOLOGICO MONZINO, IRCCS, MILANO; RESPIRATORY REHABILITATION, ISTITUTI CLINICI SCIENTIFICI MAUGERI, IRCCS, LUMEZZANE BRESCIA; RESPIRATORY REHABILITATION, ISTITUTI CLINICI SCIENTIFICI MAUGERI, IRCCS, TRADATE, VARESE, ITALY, TRADATE; DIPARTIMENTO DI SCIENZE CARDIOVASCOLARI, RESPIRATORIE, NEFROLOGICHE, ANESTESIOLOGICHE E GERIATRICHE, “SAPIENZA”, ROMA; DEPARTMENT OF CARDIAC REHABILITATION,
| | - M La Rovere
- CENTRO CARDIOLOGICO MONZINO, IRCCS, MILANO; RESPIRATORY REHABILITATION, ISTITUTI CLINICI SCIENTIFICI MAUGERI, IRCCS, LUMEZZANE BRESCIA; RESPIRATORY REHABILITATION, ISTITUTI CLINICI SCIENTIFICI MAUGERI, IRCCS, TRADATE, VARESE, ITALY, TRADATE; DIPARTIMENTO DI SCIENZE CARDIOVASCOLARI, RESPIRATORIE, NEFROLOGICHE, ANESTESIOLOGICHE E GERIATRICHE, “SAPIENZA”, ROMA; DEPARTMENT OF CARDIAC REHABILITATION,
| | - P Agostoni
- CENTRO CARDIOLOGICO MONZINO, IRCCS, MILANO; RESPIRATORY REHABILITATION, ISTITUTI CLINICI SCIENTIFICI MAUGERI, IRCCS, LUMEZZANE BRESCIA; RESPIRATORY REHABILITATION, ISTITUTI CLINICI SCIENTIFICI MAUGERI, IRCCS, TRADATE, VARESE, ITALY, TRADATE; DIPARTIMENTO DI SCIENZE CARDIOVASCOLARI, RESPIRATORIE, NEFROLOGICHE, ANESTESIOLOGICHE E GERIATRICHE, “SAPIENZA”, ROMA; DEPARTMENT OF CARDIAC REHABILITATION,
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Elisabetta S, Mapelli M, Bonomi A, Mattavelli I, De Martino F, Vignati C, Gugliandolo P, Agostoni P. C73 PICK YOUR THRESHOLD! HOW TO CALCULATE THE ANAEROBIC THRESHOLD TO STRATIFY HEART FAILURE PROGNOSIS: A COMPARISON BETWEEN ABSOLUTE VALUE, PERCENTAGE OF PEAK VO2 OR PERCENTAGE OF PREDICTED MAXIMUM VO2 IN A LARGE MULTICENTER COHORT OF HFREF PATIENTS WHO UNDER. Eur Heart J Suppl 2022. [DOI: 10.1093/eurheartj/suac011.071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Abstract
Background
The anaerobic threshold (AT), identifies the moment during a maximal exercise when hyperventilation occurs in response to the introduction of an anaerobic metabolism. Its value is indicative of the subject‘s training and/or health, it can be used to guide training, rehabilitation or to define appropriateness to undergo major thoracic or abdominal surgery, and it is related to heart failure (HF) prognosis. AT can be expressed as absolute value or as the percentage of predicted maximum VO2 (VO2AT%pred). However, it is not uncommon to find papers that refer AT to the peak VO2 value achieved (VO2AT%peak), rather than its predicted value, but a direct comparison of the prognostic power of these different variables is missing. In this work, we aim to compare the risk–identifying ability of the AT value when expressed in these three different ways in a large population of HF patients. This will help identify which is more correct to use in assessing patient prognosis, especially when peakVO2 is not reached appropriately.
Methods
The population analyzed counts 7746 patients with HF with history of reduced EF (<40%), recruited between 1998 and 2020 within the MECKI score project. All patients underwent a maximal cardiopulmonary exercise test (CPET), executed in using a ramp protocol on an electronically braked cycle ergometer.
Results
The present study considered 6157 HF patients with identified AT during the CPET, with a median follow up of 1528 days (689–1826). The main characteristics are reported in Figure 1. Figure 2 shows stratification of patients according to these 3 variables divided in tertiles, considering cardiovascular death (combination of cardiovascular death, urgent transplant or LVAD implantation) as an end point. Comparing the AUC of the three variables considered, we found similar values between VO2AT and VO2AT%pred, while the peak VO2AT% value was significantly lower (p < 0.001), as shown in Figure 3A. Moreover VO2AT%pred is the only variable to maintain a comparable ROC to the peakVO2 one, with the others being significantly lower (Figure 3B).
Conclusions
VO2 at AT should always be expressed as % of predicted maximal VO2 to be reliable in predicting prognosis in HF patients. Moreover, evaluating a sub–maximal exercise, VO2AT%pred is the only variable to maintain a comparable prognostic power to the peakVO2 one.
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Affiliation(s)
- S Elisabetta
- CENTRO CARDIOLOGICO MONZINO, IRCCS, MILANO, MILANO
| | - M Mapelli
- CENTRO CARDIOLOGICO MONZINO, IRCCS, MILANO, MILANO
| | - A Bonomi
- CENTRO CARDIOLOGICO MONZINO, IRCCS, MILANO, MILANO
| | - I Mattavelli
- CENTRO CARDIOLOGICO MONZINO, IRCCS, MILANO, MILANO
| | - F De Martino
- CENTRO CARDIOLOGICO MONZINO, IRCCS, MILANO, MILANO
| | - C Vignati
- CENTRO CARDIOLOGICO MONZINO, IRCCS, MILANO, MILANO
| | | | - P Agostoni
- CENTRO CARDIOLOGICO MONZINO, IRCCS, MILANO, MILANO
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Mantegazza V, Volpato V, Mapelli M, Sassi V, Salvioni E, Mattavelli I, Tamborini G, Agostoni P, Pepi M. Cardiac reverse remodelling by 2D and 3D echocardiography in heart failure patients treated with sacubitril/valsartan: a prospective study. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.0776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Left ventricular (LV) reverse remodelling induced by sacubitril/valsartan (S/V) has been shown in heart failure patients with reduced ejection fraction (HFrEF) by two-dimensional (2D) transthoracic echocardiography (TTE). Data about S/V effect on the right ventricle (RV) are scarce.
Aims
We aimed to evaluate S/V-induced changes in NT-proBNP levels, and cardiac remodelling indices by 2D and three-dimensional (3D) TTE in HFrEF patients, classifying patients according to aetiology.
Methods
We prospectively enrolled 51 HFrEF patients (24 ischaemic, 27 non-ischaemic). At baseline and at 6-months follow-up (6MFU) after S/V treatment optimization, we i) assessed NT-proBNP; ii) performed 2D TTE according to guidelines for the assessment of biventricular size and function, mitral regurgitation grade and LV diastolic function; and iii) performed 3D TTE, using the Dynamic HeartModel software for the evaluation of LV volumes and function, the 4D LV-Analysis software for the assessment of LV longitudinal strain, and the 4D RV-Analysis software for the assessment of RV volumes and function (Figure 1).
Results
In non-ischaemic patients, both 2D and 3D TTE showed an improvement in LV volumes and biventricular function, whereas only 3D detected a reduction in RV size at 6MFU vs baseline (Table 1). In ischaemic patients, only 3D TTE showed an improvement in biventricular size and LV function (Table 1). Finally, S/V induced a significant improvement in NT-proBNP (Table 1) and diastolic function both in ischaemic and non-ischaemic groups: patients with elevated left atrial pressure (as assessed by 2D parameters of diastolic function) decreased from 45% to 20% in ischaemic and from 40% to 10% in non-ischaemic patients (p<0.05).
Conclusions
S/V induced a significant improvement in NTproBNP and diastolic function in both aetiologic groups. A clinically significant improvement in biventricular function was shown only in non-ischaemic patients. 3D TTE may be advantageous to ascertain subtle changes in LV size and function, undetected by 2D imaging, and to evaluate RV dimensions and function, which have a major impact on HFrEF prognosis.
Funding Acknowledgement
Type of funding sources: None. Figure 1Table 1
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Affiliation(s)
- V Mantegazza
- Centro Cardiologico Monzino, IRCCS, Milan, Italy
| | - V Volpato
- Centro Cardiologico Monzino, IRCCS, Milan, Italy
| | - M Mapelli
- Centro Cardiologico Monzino, IRCCS, Milan, Italy
| | - V Sassi
- Centro Cardiologico Monzino, IRCCS, Milan, Italy
| | - E Salvioni
- Centro Cardiologico Monzino, IRCCS, Milan, Italy
| | - I Mattavelli
- Centro Cardiologico Monzino, IRCCS, Milan, Italy
| | - G Tamborini
- Centro Cardiologico Monzino, IRCCS, Milan, Italy
| | - P Agostoni
- Centro Cardiologico Monzino, IRCCS, Milan, Italy
| | - M Pepi
- Centro Cardiologico Monzino, IRCCS, Milan, Italy
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Mapelli M, Mantegazza V, Volpato V, Sassi V, De Martino F, Salvioni E, Mattavelli I, Fusini L, Vignati C, Paolillo S, Corrieri N, Alimento M, Magini A, Pepi M, Agostoni P. P638 Short term reverse remodeling and exercise capacity improvement in a patient with valvular heart failure treated with Sacubitril Valsartan. Eur Heart J Cardiovasc Imaging 2020. [DOI: 10.1093/ehjci/jez319.1184] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Sacubitril/valsartan is a first-in-class angiotensin receptor-neprilysin inhibitor (ARNI) recommended in the guidelines to reduce morbidity and mortality in patients with symptomatic heart failure (HF) with reduced ejection fraction (HFrEF). Although the recent widespread use of the drug, data on left ventricle (LV) reverse remodeling and improvement in functional capacity (FC) under treatment are still lacking.
Case presentation
A 73 years old man with a known HFrEF was admitted to the hospital for clinical review due to progressive worsening dyspnea in the last 6 months (NYHA class III) with high NTproBNP values. Echocardiography showed dilated LV (EDVi/ESVi 137/98 ml/m2) with severe reduction in ejection fraction (EF), moderate/severe aortic incompetence, moderate functional mitral regurgitation. A maximal, ramp-protocol, cardiopulmonary exercise test (CPET) showed a moderate reduction in FC with signs of cardiogenic limitation. He was started on Sacubitril/Valsartan 24/26mg b.i.d. with progressive up-titration of the dose until a maximum dose of 97/103mg b.i.d. and without any other change in the therapy. ARNI was well tolerated without hypotension, worsening renal function or hyperkaliemia. After 3 months the echocardiography showed a reduction in LV volumes (EDVi/ESVi 112/72 ml/m2) with mild improvement in EF (from 28% to 34%) and increased FC, leading to a 56% reduction in estimated HF mortality at 2 years assessed through MECKI Score (See tab. 1 and Fig. 1). NTproBNP value was also reduced compared to baseline.
Conclusion
We present a case of a short term improvement in LV and atrium volumes and FC after 3 months of treatment with Sacubitril/valsartan in a patient with HFrEF. More studies are needed to assess LV volumes and CPET values response to ARNI.
Tab.1 Basaline 3 months Δ NYHA Class II III - MECKI Score (%) 5.12 2.23 -56-4% Peak VO2 /% of predicted) 60 72 +20% Maximal Work (W) 68 83 +22.1% Mitral regurgitation ++ + - eGFR (ml/min/1,73m2) 64 65 +1.6% Potassium (mmol/L) 4.26 4.20 -1.4% Aortic regurgitation +++ ++ - Clinical changes after the 3 months follow-up
Abstract P638 Figure. Fig. 1
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Affiliation(s)
- M Mapelli
- Cardiology Center Monzino IRCCS, Milan, Italy
| | | | - V Volpato
- Cardiology Center Monzino IRCCS, Milan, Italy
| | - V Sassi
- Cardiology Center Monzino IRCCS, Milan, Italy
| | | | - E Salvioni
- Cardiology Center Monzino IRCCS, Milan, Italy
| | | | - L Fusini
- Cardiology Center Monzino IRCCS, Milan, Italy
| | - C Vignati
- Cardiology Center Monzino IRCCS, Milan, Italy
| | - S Paolillo
- Federico II University Hospital, Naples, Italy
| | - N Corrieri
- Cardiology Center Monzino IRCCS, Milan, Italy
| | - M Alimento
- Cardiology Center Monzino IRCCS, Milan, Italy
| | - A Magini
- Cardiology Center Monzino IRCCS, Milan, Italy
| | - M Pepi
- Cardiology Center Monzino IRCCS, Milan, Italy
| | - P Agostoni
- Cardiology Center Monzino IRCCS, Milan, Italy
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Sassi VA, Mapelli M, Salvioni E, Mattavelli I, Mantegazza V, Volpato V, Vignati C, De Martino F, Paolillo S, Fusini L, Muratori M, Pepi M, Agostoni PG. 410 Early cardiac reverse remodeling in a large cohort of patients with HFrEF treated with Sacubitril/Valsartan. Eur Heart J Cardiovasc Imaging 2020. [DOI: 10.1093/ehjci/jez319.1182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Despite the widespread use of Sacubitril/valsartan (Sac/Val) in patients with reduced ejection fraction (HFrEF), definite data on cardiac remodeling under treatment are still lacking.
Methods
We conducted a retrospective analysis on a large cohort of 201 consecutive HFrEF ambulatory patients who started Sac/Val in our HF unit between Sept. 2016 and Dec. 2018 on top of optimal medical treatment. Patients with both basal and follow up (at least 3 months) echocardiographic assessment (TTE) were included.
Results
A follow up TTE was performed in 100 patients (male 76%; mean age 67.4 ± 11.1 years; medium follow-up 309 ± 182 days). Baseline characteristics are shown in Tab.1. 34% of the patients reached the maximal dose (97/103 b.i.d.) while 18 interrupted the treatment. We observed an overall significant improvement in ejection fraction (EF), end-diastolic and end-systolic ventricular volumes (EDV/ESV), while just a trend in pulmonary pressures (PAPs) and mitral regurgitation (MR) reduction was noted (p = 0.06 and 0.09 respectively). Non ischemic etiology and high dose of Sac/Val were predictors of better remodeling (Fig.1).
Conclusion
In our study Sac/Val led to an early favorable ventricular remodeling assessed by echocardiography. The observed benefit was greater in patients on higher dose of the drug and non ischemic etiology.
Table 1 n = 100 Clinical characteristics Systolic blood pressure (mmHg) 116 ± 11 Diastolic blood pressure (mmHg) 70 ± 9 Hemoglobin (g/dL) 13 ± 2.0 MDRD (ml/min/1.73 m2) 63 ± 21.4 Potassium (mmol/L) 4.26 ± 0.50 NYHA class II (n;%) 59 (59%) NYHA class III (n;%) 41 (41%) Ischemic etiology (n;%) 58 (58%) ICD (n;%) 41 (41%) CRT (n;%) 32 (32%) Beta-blockers (n;%) 94 (94%) ACEi or ARBs (n;%) 92 (92%) MRA (n;%) 77 (77%) Baseline clinical characteristics
Abstract 410 Figure. Fig. 1
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Affiliation(s)
- V A Sassi
- Cardiology Center Monzino IRCCS, Milan, Italy
| | - M Mapelli
- Cardiology Center Monzino IRCCS, Milan, Italy
| | - E Salvioni
- Cardiology Center Monzino IRCCS, Milan, Italy
| | | | | | - V Volpato
- Cardiology Center Monzino IRCCS, Milan, Italy
| | - C Vignati
- Cardiology Center Monzino IRCCS, Milan, Italy
| | | | - S Paolillo
- Federico II University Hospital, Naples, Italy
| | - L Fusini
- Cardiology Center Monzino IRCCS, Milan, Italy
| | - M Muratori
- Cardiology Center Monzino IRCCS, Milan, Italy
| | - M Pepi
- Cardiology Center Monzino IRCCS, Milan, Italy
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Mattavelli I, Patuzzo R, Torri V, Gallino G, Maurichi A, Lamera M, Valeri B, Bolzonaro E, Barbieri C, Tolomio E, Moglia D, Nespoli AM, Galeone C, Saw R, Santinami M. Prognostic factors in Merkel cell carcinoma patients undergoing sentinel node biopsy. Eur J Surg Oncol 2017; 43:1536-1541. [PMID: 28583789 DOI: 10.1016/j.ejso.2017.05.013] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2017] [Revised: 04/26/2017] [Accepted: 05/11/2017] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Debate remains about prognostic factors in primary Merkel cell carcinoma (MCC). We investigated clinicopathological factors as determinants of survival in patients with MCC submitted to sentinel node biopsy. METHODS Sixty-four consecutive patients treated for a primary MCC were identified from a prospectively maintained database at Fondazione IRCCS Istituto Nazionale dei Tumori, Milan. Time to events outcome were described by product limit estimators and proportional hazards model was used to investigate the association between outcome and potential predictors. RESULTS The most common site of primary tumor was lower limbs (56.3%). The size of primary lesion was ≤2 cm in 67.2% of cases. Presence of residual disease after the diagnostic surgical excision was observed in 28% of cases. All patients received sentinel node biopsy (SNB) and a SN positivity was detected in 26.6%. The median follow up was 78 months. Disease recurrence occurred in 17 patients (26.6%). In the SN negative group 10 recurrences occurred (21.3%), whereas 7 (41.2%) were found in SN positive one. Nine patients SN negative (19.1%) died of disease and 3 (17.6%) among SN positive. SN status was not associated with survival (p = 0.78). Neither age, gender, size and site of primary tumor resulted predictors of patients' outcome. The presence of residual tumor in the specimen of the wide local excision, after the diagnostic surgical excision, was the only variable associated with survival (p = 0.03). CONCLUSIONS Presence of residual tumor in the specimen of the wide local excision is the main prognostic factor in MCC patients.
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Affiliation(s)
- I Mattavelli
- Melanoma and Sarcoma Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy.
| | - R Patuzzo
- Melanoma and Sarcoma Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy.
| | - V Torri
- Department of Oncology, IRCCS-Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy.
| | - G Gallino
- Melanoma and Sarcoma Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy.
| | - A Maurichi
- Melanoma and Sarcoma Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy.
| | - M Lamera
- Melanoma and Sarcoma Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy.
| | - B Valeri
- Department of Pathology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy.
| | - E Bolzonaro
- Department of Surgery and Translational Medicine, Milano-Bicocca University, San Gerardo Hospital, Monza, Italy.
| | - C Barbieri
- Department of Surgery and Translational Medicine, Milano-Bicocca University, San Gerardo Hospital, Monza, Italy.
| | - E Tolomio
- Melanoma and Sarcoma Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy.
| | - D Moglia
- Melanoma and Sarcoma Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy.
| | - A M Nespoli
- Department of Surgery and Translational Medicine, Milano-Bicocca University, San Gerardo Hospital, Monza, Italy.
| | - C Galeone
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy.
| | - R Saw
- Division of Surgery Royal Prince Alfred Hospital and Melanoma Institute Australia, Sydney, Australia.
| | - M Santinami
- Melanoma and Sarcoma Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy.
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Gallino G, Patuzzo R, Maurichi A, Ruggeri R, Barbieri C, Mattavelli I, Niccolò G, Santinami M. 387. Detection of clinical occult lymph node metastases by lymphoscintigraphy and sentinel node biopsy in anorectal melanoma patients. Eur J Surg Oncol 2014. [DOI: 10.1016/j.ejso.2014.08.377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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