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Mapelli M, Salvioni E, Bonomi A, Paneroni M, Raimondo R, Gugliandolo P, Mattavelli I, Bidoglio J, Mirza KK, La Rovere MT, Gustafsson F, Agostoni P. Taking a walk on the heart failure side: comparison of metabolic variables during walking and maximal exertion. ESC Heart Fail 2024; 11:1269-1274. [PMID: 38287881 DOI: 10.1002/ehf2.14618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 10/20/2023] [Accepted: 11/17/2023] [Indexed: 01/31/2024] Open
Abstract
AIMS Although cardiopulmonary exercise testing (CPET) is the gold standard to assess exercise capacity, simpler tests (i.e., 6-min walk test, 6MWT) are also commonly used. The aim of this study was to evaluate the relationship between cardiorespiratory parameters during CPET and 6MWT in a large, multicentre, heterogeneous population. METHODS We included athletes, healthy subjects, and heart failure (HF) patients of different severity, including left ventricular assist device (LVAD) carriers, who underwent both CPET and 6MWT with oxygen consumption measurement. RESULTS We enrolled 186 subjects (16 athletes, 40 healthy, 115 non-LVAD HF patients, and 15 LVAD carriers). CPET-peakV̇O2 was 41.0 [35.0-45.8], 26.2 [23.1-31.0], 12.8 [11.1-15.3], and 15.2 [13.6-15.6] ml/Kg/min in athletes, healthy, HF patients, and LVAD carriers, respectively (P < 0.001). During 6MWT they used 63.5 [56.3-76.8], 72.0 [57.8-81.0], 95.5 [80.3-109], and 95.0 [92.0-99.0] % of their peakV̇O2, respectively. None of the athletes, 1 healthy (2.5%), 30 HF patients (26.1%), and 1 LVAD carrier (6.7%), reached a 6MWT-V̇O2 higher than their CPET-peakV̇O2. Both 6MWT-V̇O2 and walked distance were significantly associated with CPET-peakV̇O2 in the whole population (R2 = 0.637 and R2 = 0.533, P ≤ 0.001) but not in the sub-groups. This was confirmed after adjustment for groups. CONCLUSIONS The 6MWT can be a maximal effort especially in most severe HF patients and suggest that, in absence of prognostic studies related to 6MWT metabolic values, CPET should remain the first method of choice in the functional assessment of patients with HF as well as in sport medicine.
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Affiliation(s)
- Massimo Mapelli
- Centro Cardiologico Monzino IRCCS, Milan, Italy
- Department of Clinical Sciences and Community Health, Cardiovascular Section, University of Milan, Milan, Italy
| | | | | | - Mara Paneroni
- Department of Respiratory Rehabilitation, Istituti Clinici Scientifici Maugeri, IRCCS, Lumezzane, Italy
| | - Rosa Raimondo
- Department of Respiratory Rehabilitation, Istituti Clinici Scientifici Maugeri, IRCCS, Tradate, Italy
| | | | | | | | - Kiran K Mirza
- Department of Cardiology, University of Copenhagen, Rigshospitalet, Denmark
| | - Maria Teresa La Rovere
- Department of Cardiac Rehabilitation, Istituti Clinici Scientifici Maugeri, IRCCS, Montescano, Italy
| | - Finn Gustafsson
- Department of Cardiology, University of Copenhagen, Rigshospitalet, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Piergiuseppe Agostoni
- Centro Cardiologico Monzino IRCCS, Milan, Italy
- Department of Clinical Sciences and Community Health, Cardiovascular Section, University of Milan, Milan, Italy
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Scrutinio D, Guida P, La Rovere MT, Vecchia LAD, Forni G, Raimondo R, Scalvini S, Passantino A. Incremental prognostic value of functional impairment assessed by 6-min walking test for the prediction of mortality in heart failure. Sci Rep 2024; 14:3089. [PMID: 38321196 PMCID: PMC10847418 DOI: 10.1038/s41598-024-53817-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 06/01/2023] [Accepted: 02/05/2024] [Indexed: 02/08/2024] Open
Abstract
Natriuretic peptides (NP) are recognized as the most powerful predictors of adverse outcomes in heart failure (HF). We hypothesized that a measure of functional limitation, as assessed by 6-min walking test (6MWT), would improve the accuracy of a prognostic model incorporating a NP. This was a multicenter observational retrospective study. We studied the prognostic value of severe functional impairment (SFI), defined as the inability to perform a 6MWT or a distance walked during a 6MWT < 300 m, in 1696 patients with HF admitted to cardiac rehabilitation. The primary outcome was 1-year all-cause mortality. After adjusting for the baseline multivariable risk model-including age, sex, systolic blood pressure, anemia, renal dysfunction, sodium level, and NT-proBNP-or for the MAGGIC score, SFI had an odds ratio of 2.58 (95% CI 1.72-3.88; p < 0.001) and 3.12 (95% CI 2.16-4.52; p < 0.001), respectively. Adding SFI to the baseline risk model or the MAGGIC score yielded a significant improvement in discrimination and risk classification. Our data suggest that a simple, 6MWT-derived measure of SFI is a strong predictor of death and provide incremental prognostic information over well-established risk markers in HF, including NP, and the MAGGIC score.
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Affiliation(s)
- Domenico Scrutinio
- Istituti Clinici Scientifici Maugeri IRCCS, Institute of Bari, Via Generale Nicola Bellomo 73/75, Bari, Italy.
| | - Pietro Guida
- Regional General Hospital "F. Miulli", Acquaviva Delle Fonti, Bari, Italy
| | | | | | - Giovanni Forni
- Istituti Clinici Scientifici Maugeri IRCCS, Institute of Pavia, Pavia, Italy
| | - Rosa Raimondo
- Istituti Clinici Scientifici Maugeri IRCCS, Institute of Tradate, Varese, Italy
| | - Simonetta Scalvini
- Istituti Clinici Scientifici Maugeri IRCCS, Institute of Lumezzane, Brescia, Italy
| | - Andrea Passantino
- Istituti Clinici Scientifici Maugeri IRCCS, Institute of Bari, Via Generale Nicola Bellomo 73/75, Bari, Italy
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Mapelli M, Mattavelli I, Salvioni E, Capra N, Bonomi A, Cattadori G, Pezzuto B, Campodonico J, Piotti A, Nava A, Piepoli M, Magrì D, Paolillo S, Corrà U, Raimondo R, Lagioia R, Vignati C, Badagliacca R, Perrone Filardi P, Senni M, Correale M, Cicoira M, Metra M, Guazzi M, Limongelli G, Parati G, De Martino F, Bandera F, Bussotti M, Re F, Lombardi CM, Scardovi AB, Sciomer S, Passantino A, Emdin M, Santolamazza C, Perna E, Passino C, Sinagra G, Agostoni P. Exploring the Prognostic Performance of MECKI Score in Heart Failure Patients with Non-Valvular Atrial Fibrillation Treated with Edoxaban. J Clin Med 2023; 13:94. [PMID: 38202101 PMCID: PMC10780296 DOI: 10.3390/jcm13010094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Revised: 11/27/2023] [Accepted: 12/06/2023] [Indexed: 01/12/2024] Open
Abstract
INTRODUCTION Risk stratification in heart failure (HF) is essential for clinical and therapeutic management. The Metabolic Exercise test data combined with Cardiac and Kidney Indexes (MECKI) score is a validated prognostic model for assessing cardiovascular risk in HF patients with reduced ejection fraction (HFrEF). From the validation of the score, the prevalence of HF patients treated with direct oral anticoagulants (DOACs), such as edoxaban, for non-valvular atrial fibrillation (NVAF) has been increasing in recent years. This study aims to evaluate the reliability of the MECKI score in HFrEF patients treated with edoxaban for NVAF. MATERIALS AND METHODS This study included consecutive outpatients with HF and NVAF treated with edoxaban (n = 83) who underwent a cardiopulmonary exercise test (CPET). They were matched by propensity score with a retrospective group of HFrEF patients with NVAF treated with vitamin K antagonists (VKAs) from the MECKI score registry (n = 844). The study endpoint was the risk of cardiovascular mortality, urgent heart transplantation, or Left Ventricle Assist Device (LVAD) implantation. RESULTS Edoxaban patients were treated with a more optimized HF therapy and had different clinical characteristics, with a similar MECKI score. After propensity score, 77 patients treated with edoxaban were successfully matched with the MECKI-VKA control cohort. In both groups, MECKI accurately predicted the composite endpoint with similar area under the curves (AUC = 0.757 vs. 0.829 in the MECKI-VKA vs. edoxaban-treated group, respectively, p = 0.452). The two populations' survival appeared non-significantly different at the 2-year follow-up. CONCLUSIONS this study confirms the prognostic accuracy of the MECKI score in HFrEF patients with NVAF treated with edoxaban, showing improved predictive power compared to VKA-treated patients.
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Affiliation(s)
- Massimo Mapelli
- Centro Cardiologico Monzino, IRCCS, 20138 Milan, Italy; (M.M.); (I.M.); (E.S.); (N.C.); (A.B.); (B.P.); (J.C.); (A.P.); (C.V.); (P.A.)
- Department of Clinical Sciences and Community Health, Cardiovascular Section, University of Milan, 20122 Milan, Italy
| | - Irene Mattavelli
- Centro Cardiologico Monzino, IRCCS, 20138 Milan, Italy; (M.M.); (I.M.); (E.S.); (N.C.); (A.B.); (B.P.); (J.C.); (A.P.); (C.V.); (P.A.)
| | - Elisabetta Salvioni
- Centro Cardiologico Monzino, IRCCS, 20138 Milan, Italy; (M.M.); (I.M.); (E.S.); (N.C.); (A.B.); (B.P.); (J.C.); (A.P.); (C.V.); (P.A.)
| | - Nicolò Capra
- Centro Cardiologico Monzino, IRCCS, 20138 Milan, Italy; (M.M.); (I.M.); (E.S.); (N.C.); (A.B.); (B.P.); (J.C.); (A.P.); (C.V.); (P.A.)
| | - Alice Bonomi
- Centro Cardiologico Monzino, IRCCS, 20138 Milan, Italy; (M.M.); (I.M.); (E.S.); (N.C.); (A.B.); (B.P.); (J.C.); (A.P.); (C.V.); (P.A.)
- Department of Clinical Sciences and Community Health, Cardiovascular Section, University of Milan, 20122 Milan, Italy
| | - Gaia Cattadori
- Department of Clinical Sciences and Community Health, Cardiovascular Section, University of Milan, 20122 Milan, Italy
- Unità Operativa Cardiologia Riabilitativa, IRCCS Multimedica, 20138 Milan, Italy
| | - Beatrice Pezzuto
- Centro Cardiologico Monzino, IRCCS, 20138 Milan, Italy; (M.M.); (I.M.); (E.S.); (N.C.); (A.B.); (B.P.); (J.C.); (A.P.); (C.V.); (P.A.)
| | - Jeness Campodonico
- Centro Cardiologico Monzino, IRCCS, 20138 Milan, Italy; (M.M.); (I.M.); (E.S.); (N.C.); (A.B.); (B.P.); (J.C.); (A.P.); (C.V.); (P.A.)
- Department of Clinical Sciences and Community Health, Cardiovascular Section, University of Milan, 20122 Milan, Italy
| | - Arianna Piotti
- Centro Cardiologico Monzino, IRCCS, 20138 Milan, Italy; (M.M.); (I.M.); (E.S.); (N.C.); (A.B.); (B.P.); (J.C.); (A.P.); (C.V.); (P.A.)
| | | | - Massimo Piepoli
- Clinical Cardiology, IRCCS, Policlinico San Donato, 20097 San Donato Milanese, Italy;
- Department Biomedical Sciences for Health, University of Milan, 20122 Milan, Italy;
| | - Damiano Magrì
- Department of Clinical and Molecular Medicine, Azienda Ospedaliera Sant’Andrea, “Sapienza” Università degli Studi di Roma, 00185 Rome, Italy;
| | - Stefania Paolillo
- IRCCS SDN, Istituto di Ricerca, 80143 Napoli, Italy;
- Department of Advanced Biomedical Sciences, “Federico II” University, 80138 Napoli, Italy;
| | - Ugo Corrà
- Cardiology Department, Istituti Clinici Scientifici Maugeri, IRCCS, Veruno Institute, 28010 Veruno, Italy;
| | - Rosa Raimondo
- Divisione di Cardiologia Riabilitativa, Istituti Clinici Scientifici Maugeri, IRCCS, 21049 Tradate, Italy;
| | - Rocco Lagioia
- UOC Cardiologia di Riabilitativa, Mater Dei Hospital, 70125 Bari, Italy;
| | - Carlo Vignati
- Centro Cardiologico Monzino, IRCCS, 20138 Milan, Italy; (M.M.); (I.M.); (E.S.); (N.C.); (A.B.); (B.P.); (J.C.); (A.P.); (C.V.); (P.A.)
| | - Roberto Badagliacca
- Dipartimento di Scienze Cliniche, Internistiche, Anestesiologiche e Cardiovascolari, “Sapienza”, Rome University, 00185 Rome, Italy; (R.B.); (S.S.)
| | | | - Michele Senni
- Cardiology Unit, Cardiovascular Department, ASST Papa Giovanni XXIII, 24127 Bergamo, Italy;
| | - Michele Correale
- Department of Cardiology, University of Foggia, 71122 Foggia, Italy;
| | | | - Marco Metra
- Institute of Cardiology, Department of Medical and Surgical Specialities, Radiological Sciences, and Public Health, University of Brescia, 25121 Brescia, Italy; (M.M.); (C.M.L.)
| | - Marco Guazzi
- Dipartimento di Scienze Biomediche per la Salute, Ospedale San Paolo, Università Degli Studi di Milano, 20122 Milan, Italy;
| | - Giuseppe Limongelli
- Cardiologia SUN, Ospedale Monaldi (Azienda dei Colli), Seconda Università di Napoli, 80138 Napoli, Italy;
| | - Gianfranco Parati
- Istituto Auxologico Italiano, IRCCS, 20138 Milan, Italy;
- Department of Medicine and Surgery, University of Milano-Bicocca, 20126 Milan, Italy
| | - Fabiana De Martino
- Unità Funzionale di Cardiologia, Casa di Cura Tortorella, 84124 Salerno, Italy;
| | - Francesco Bandera
- Department Biomedical Sciences for Health, University of Milan, 20122 Milan, Italy;
- Cardiology University Department, IRCCS Policlinico San Donato, 20097 Milan, Italy
| | - Maurizio Bussotti
- Cardiac Rehabilitation Unit, Istituti Clinici Scientifici Maugeri, IRCCS, Scientific Institute of Milan, 20138 Milan, Italy;
| | - Federica Re
- Cardiology Division, Cardiac Arrhythmia Center and Cardiomyopathies Unit, San Camillo-Forlanini Hospital, 00152 Rome, Italy;
| | - Carlo M. Lombardi
- Institute of Cardiology, Department of Medical and Surgical Specialities, Radiological Sciences, and Public Health, University of Brescia, 25121 Brescia, Italy; (M.M.); (C.M.L.)
| | | | - Susanna Sciomer
- Dipartimento di Scienze Cliniche, Internistiche, Anestesiologiche e Cardiovascolari, “Sapienza”, Rome University, 00185 Rome, Italy; (R.B.); (S.S.)
| | - Andrea Passantino
- Division of Cardiology, Istituti Clinici Scientifici Maugeri, IRCCS, Institute of Bari, 70124 Bari, Italy;
| | - Michele Emdin
- Health Science Interdisciplinary Center, Scuola Superiore Sant’Anna, 56127 Pisa, Italy; (M.E.); (C.P.)
- Fondazione Toscana Gabriele Monasterio, 56124 Pisa, Italy
| | - Caterina Santolamazza
- Dipartimento Cardio-Toraco-Vascolare, Ospedale Cà Granda-A.O. Niguarda, 20162 Milan, Italy; (C.S.); (E.P.)
| | - Enrico Perna
- Dipartimento Cardio-Toraco-Vascolare, Ospedale Cà Granda-A.O. Niguarda, 20162 Milan, Italy; (C.S.); (E.P.)
| | - Claudio Passino
- Health Science Interdisciplinary Center, Scuola Superiore Sant’Anna, 56127 Pisa, Italy; (M.E.); (C.P.)
| | - Gianfranco Sinagra
- Cardiovascular Department, “Azienda Sanitaria Universitaria Giuliano-Isontina”, 34100 Trieste, Italy;
| | - Piergiuseppe Agostoni
- Centro Cardiologico Monzino, IRCCS, 20138 Milan, Italy; (M.M.); (I.M.); (E.S.); (N.C.); (A.B.); (B.P.); (J.C.); (A.P.); (C.V.); (P.A.)
- Department of Clinical Sciences and Community Health, Cardiovascular Section, University of Milan, 20122 Milan, Italy
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Agostoni P, Pluchinotta FR, Salvioni E, Mapelli M, Galotta A, Bonomi A, Magrì D, Perna E, Paolillo S, Corrà U, Raimondo R, Lagioia R, Badagliacca R, Perrone Filardi P, Apostolo A, Senni M, Iorio A, Correale M, Campodonico J, Palermo P, Cicoira M, Metra M, Guazzi M, Limongelli G, Contini M, Pezzuto B, Sinagra G, Parati G, Cattadori G, Carriere C, Cittar M, Matassini MV, Salzano A, Cittadini A, Masè M, Bandera F, Bussotti M, Mattavelli I, Re F, Vignati C, Lombardi C, Scardovi AB, Sciomer S, Passantino A, Emdin M, Di Lenarda A, Passino C, Santolamazza C, Moscucci F, Zaffalon D, Piepoli M. Heart failure patients with improved ejection fraction: Insights from the MECKI score database. Eur J Heart Fail 2023; 25:1976-1984. [PMID: 37702313 DOI: 10.1002/ejhf.3031] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Revised: 07/26/2023] [Accepted: 09/06/2023] [Indexed: 09/14/2023] Open
Abstract
AIMS Improvement of left ventricular ejection fraction is a major goal of heart failure (HF) treatment. However, data on clinical characteristics, exercise performance and prognosis in HF patients who improved ejection fraction (HFimpEF) are scarce. The study aimed to determine whether HFimpEF patients have a distinct clinical phenotype, biology and prognosis than HF patients with persistently reduced ejection fraction (pHFrEF). METHODS AND RESULTS A total of 7948 patients enrolled in the Metabolic Exercise Cardiac Kidney Indexes (MECKI) score database were evaluated (median follow-up of 1490 days). We analysed clinical, laboratory, electrocardiographic, echocardiographic, exercise, and survival data from HFimpEF (n = 1504) and pHFrEF (n = 6017) patients. The primary endpoint of the study was the composite of cardiovascular death, left ventricular assist device implantation, and urgent heart transplantation. HFimpEF patients had lower HF severity: left ventricular ejection fraction 44.0 [41.0-47.0] versus 29.7 [24.1-34.5]%, B-type natriuretic peptide 122 [65-296] versus 373 [152-888] pg/ml, haemoglobin 13.5 [12.2-14.6] versus 13.7 [12.5-14.7] g/dl, renal function by the Modification of Diet in Renal Disease equation 72.0 [56.7-89.3] versus 70.4 [54.5-85.3] ml/min, peak oxygen uptake 62.2 [50.7-74.1] versus 52.6 [41.8-64.3]% predicted, minute ventilation-to-carbon dioxide output slope 30.0 [26.9-34.4] versus 32.1 [28.0-38.0] in HFimpEF and pHFrEF, respectively (p < 0.001 for all). Cardiovascular mortality rates were 26.6 and 46.9 per 1000 person-years for HFimpEF and pHFrEF, respectively (p < 0.001). Kaplan-Meier analysis showed that HFimpEF had better a long-term prognosis compared with pHFrEF patients. After adjustment for variables differentiating HFimpEF from pHFrEF, except echocardiographic parameters, the Kaplan-Meier curves showed the same prognosis. CONCLUSIONS Heart failure with improved ejection fraction represents a peculiar group of HF patients whose clinical, laboratory, electrocardiographic, echocardiographic, and exercise characteristics parallel the recovery of systolic function. Nonetheless, these patients remain at risk for adverse outcome.
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Affiliation(s)
- Piergiuseppe Agostoni
- Centro Cardiologico Monzino, IRCCS, Milan, Italy
- Cardiovascular Section, Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | | | | | - Massimo Mapelli
- Centro Cardiologico Monzino, IRCCS, Milan, Italy
- Cardiovascular Section, Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | | | - Alice Bonomi
- Centro Cardiologico Monzino, IRCCS, Milan, Italy
| | - Damiano Magrì
- Department of Clinical and Molecular Medicine, Azienda Ospedaliera Sant'Andrea, 'Sapienza' University of Rome, Rome, Italy
| | - Enrico Perna
- Cardiology Department 'A. De Gasperis', Niguarda Hospital, Milan, Italy
| | - Stefania Paolillo
- Department of Advanced Biomedical Sciences, Federico II University of Naples, Italy
| | - Ugo Corrà
- Cardiology Department, Istituti Clinici Scientifici Maugeri, IRCCS, Veruno Institute, Veruno, Italy
| | - Rosa Raimondo
- Division of Cardiac Rehabilitation, Istituti Clinici Scientifici Maugeri, Tradate, Varese, Italy
| | - Rocco Lagioia
- Unit of of Cardiac Rehabilitation, Mater Dei Hospital, Bari, Italy
| | - Roberto Badagliacca
- Department of Clinical, Internal Medicine, Anesthesiological and Cardiovascular Sciences, 'Sapienza' University of Rome, Rome, Italy
| | - Pasquale Perrone Filardi
- Department of Advanced Biomedical Sciences, Federico II University of Naples, Italy
- Mediterranea CardioCentro, Naples, Italy
| | | | - Michele Senni
- Heart Failure and Heart Transplant Unit, Department of Cardiology, ASST Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Annamaria Iorio
- Heart Failure and Heart Transplant Unit, Department of Cardiology, ASST Papa Giovanni XXIII Hospital, Bergamo, Italy
| | | | | | | | | | - Marco Metra
- Cardiology, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Marco Guazzi
- San Paolo Hospital, University of Milan, Milan, Italy
| | - Giuseppe Limongelli
- Cardiology SUN, Monaldi Hospital (Azienda dei Colli), Second University of Naples, Naples, Italy
| | | | | | - Gianfranco Sinagra
- Cardiovascular Department, Azienda Sanitaria Universitaria Giuliano-Isontina (ASUGI), Trieste, Italy
| | - Gianfranco Parati
- Department of Cardiovascular Neural and Metabolic Sciences, San Luca Hospital, Istituto Auxologico Italiano, IRCCS Milan, Milan, Italy
- Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | | | - Cosimo Carriere
- Cardiovascular Department, Azienda Sanitaria Universitaria Giuliano-Isontina (ASUGI), Trieste, Italy
| | - Marco Cittar
- Cardiovascular Department, Azienda Sanitaria Universitaria Giuliano-Isontina (ASUGI), Trieste, Italy
| | | | - Andrea Salzano
- Cardiac Unit, AORN 'A. Cardarelli', Naples, Italy
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
| | - Antonio Cittadini
- Department of Translational Medical Sciences, Federico II University, Naples, Italy
| | - Marco Masè
- Cardiovascular Department, Azienda Sanitaria Universitaria Giuliano-Isontina (ASUGI), Trieste, Italy
| | - Francesco Bandera
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
- Heart Failure and Rehabilitation Cardiology Unit, IRCCS MultiMedica, Sesto San Giovanni, Milan, Italy
| | - Maurizio Bussotti
- Cardiac Rehabilitation Unit, Istituti Clinici Scientifici Maugeri, Scientific Institute of Milan, Milan, Italy
| | | | - Federica Re
- Cardiology Division, Cardiac Arrhythmia Center and Cardiomyopathies Unit, San Camillo Forlanini Hospital, Rome, Italy
| | | | - Carlo Lombardi
- Cardiology, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | | | - Susanna Sciomer
- Department of Clinical, Internal Medicine, Anesthesiological and Cardiovascular Sciences, 'Sapienza' University of Rome, Rome, Italy
| | - Andrea Passantino
- Division of Cardiology, Istituti Clinici Scientifici Maugeri, Institute of Bari, Bari, Italy
| | - Michele Emdin
- Institute of Life Science, Scuola Superiore Sant'Anna, Pisa, Italy
- Fondazione Gabriele Monasterio, CNR-Regione Toscana, Pisa, Italy
| | - Andrea Di Lenarda
- Cardiovascular Center, Health Authority n°1 and University of Trieste, Trieste, Italy
| | - Claudio Passino
- Fondazione Gabriele Monasterio, CNR-Regione Toscana, Pisa, Italy
| | | | - Federica Moscucci
- Department of Internal Medicine and Medical Specialties, Policlinico Umberto I, Rome, Italy
| | - Denise Zaffalon
- Cardiovascular Department, Azienda Sanitaria Universitaria Giuliano-Isontina (ASUGI), Trieste, Italy
| | - Massimo Piepoli
- Clinical Cardiology, IRCCS, Policlinico San Donato, San Donato Milanese, Milan, Italy
- Department Biomedical Sciences for Health, University of Milan, Milan, Italy
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Scrutinio D, Guida P, La Rovere MT, Bussotti M, Corrà U, Forni G, Raimondo R, Scalvini S, Passantino A. Functional outcome after cardiac rehabilitation and its association with survival in heart failure across the spectrum of ejection fraction. Eur J Intern Med 2023; 110:86-92. [PMID: 36759307 DOI: 10.1016/j.ejim.2023.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Revised: 01/31/2023] [Accepted: 02/02/2023] [Indexed: 02/10/2023]
Abstract
BACKGROUND There is limited evidence regarding the effects of cardiac rehabilitation (CR) in patients with heart failure and preserved ejection fraction (HFpEF). METHODS We studied 1784 patients admitted to inpatient CR. The patients were grouped into HFpEF (EF≥0.50), HF with mildly reduced EF (HFmrEF; EF 41-49), and HF with reduced EF (HFrEF; EF≤0.40). A standardized 6-min walking test was performed at admission and discharge. Measures of functional outcome were: (1) absolute increase in 6-min walking distance (6MWD) from admission to discharge >50 m and (2) increase in 6MWD to ≥300 among the patients who walked <300 m at admission. RESULTS After adjustment, the patients with HFpEF or HFmrEF were as likely as those with HFrEF to achieve an increase in 6MWD >50 m (odds ratio 0.95 [95%CI 0.71-1.24; p=0.648] and 1.04 [95%CI 0.77-1.41; p=0.769], respectively) or an increase in 6MWD to ≥300 m (odds ratio 0.79 [95%CI 0.51-1.23; p=0.299] and 0.65 [95%CI 0.38-1.12; p=0.118], respectively). The adjusted hazard ratio of 5-year mortality for patients who achieved an increase in 6MWD >50 m was 0.60 (95%CI 0.51-0.71; p<0.001) and that for patients who achieved an increase in 6MWD at discharge to ≥300 m 0.61 (95%CI 0.48-0.79; p<0.001). In each EF group, both outcomes remained independently associated with improved survival. CONCLUSIONS Our data suggest that patients with HFpEF or HFmrEF are as likely as those with HFrEF to benefit from CR in terms of functional improvement. Functional improvement was independently associated with improved long-term survival, regardless of EF.
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Affiliation(s)
- Domenico Scrutinio
- Istituti Clinici Scientifici Maugeri SpA SB, IRCCS, Institute of Bari, Via Generale Nicola Bellomo 73/75, Bari, Italy.
| | - Pietro Guida
- Istituti Clinici Scientifici Maugeri SpA SB, IRCCS, Institute of Bari, Via Generale Nicola Bellomo 73/75, Bari, Italy
| | - Maria Teresa La Rovere
- Istituti Clinici Scientifici Maugeri SpA SB, IRCCS, Institute of Montescano, Pavia, Italy
| | - Maurizio Bussotti
- Istituti Clinici Scientifici Maugeri SpA SB, IRCCS, Institute of Milano, Milano, Italy
| | - Ugo Corrà
- Istituti Clinici Scientifici Maugeri SpA SB, IRCCS, Institute of Veruno, Novara, Italy
| | - Giovanni Forni
- Istituti Clinici Scientifici Maugeri SpA SB, IRCCS, Institute of Pavia, Pavia, Italy
| | - Rosa Raimondo
- Istituti Clinici Scientifici Maugeri SpA SB, IRCCS, Institute of Tradate, Varese, Italy
| | - Simonetta Scalvini
- Istituti Clinici Scientifici Maugeri SpA SB, IRCCS, Institute of Lumezzane, Brescia, Italy
| | - Andrea Passantino
- Istituti Clinici Scientifici Maugeri SpA SB, IRCCS, Institute of Bari, Via Generale Nicola Bellomo 73/75, Bari, Italy
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6
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Toto F, Salvioni E, Magrì D, Sciomer S, Piepoli M, Badagliacca R, Galotta A, Baracchini N, Paolillo S, Corrà U, Raimondo R, Lagioia R, Filardi PP, Iorio A, Senni M, Correale M, Cicoira M, Perna E, Metra M, Guazzi M, Limongelli G, Sinagra G, Parati G, Cattadori G, Bandera F, Bussotti M, Mapelli M, Cipriani M, Bonomi A, Cunha G, Re F, Vignati C, Garascia A, Lombardi C, Scardovi AB, Passantino A, Emdin M, Passino C, Santolamazza C, Girola D, Zaffalon D, Vizza D, De Martino F, Agostoni P. Does moderate hyperkalemia influence survival in HF? Insights from the MECKI score data base. Int J Cardiol 2023; 371:273-277. [PMID: 36115445 DOI: 10.1016/j.ijcard.2022.09.030] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Accepted: 09/12/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND The prognostic role of moderate hyperkalemia in reduced ejection fraction (HFrEF) patients is still controversial. Despite this, it affects the use of renin-angiotensin-aldosterone system inhibitors (RAASi) with therapy down-titration or discontinuation. OBJECTIVES Aim of the study was to assess the prognostic impact of moderate hyperkalemia in chronic HFrEF optimally treated patients. METHODS AND RESULTS We retrospectively analyzed MECKI (Metabolic Exercise test data combined with Cardiac and Kidney Indexes) database, with median follow-up of 4.2 [IQR 1.9-7.5] years. Data on K+ levels were available in 7087 cases. Patients with K+ plasma level ≥ 5.6 mEq/L and < 4 mEq/L were excluded. Remaining patients were categorized into normal >4 and < 5 mEq/L (n = 4826, 68%) and moderately high ≥5.0 and ≤ 5.5 mEq/L (n = 496, 7%) K+. Then patients were matched by propensity score in 484 couplets of patients. MECKI score value was 7% [IQR 3.1-14.1%] and 7.3% [IQR 3.4-15%] (p = 0.678) in patients with normal and moderately high K+ values while cardiovascular mortality events at two years follow-up were 41 (4.2%) and 33 (3.4%) (p = 0.333) in each group respectively. CONCLUSIONS Moderate hyperkalemia does not influence patients' outcome in a large cohort of ambulatory HFrEF patients.
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Affiliation(s)
- Federica Toto
- Centro Cardiologico Monzino, IRCCS, Milan, Italy; Department of Cardiovascular and Respiratory Science, Sapienza University of Rome, Rome, Italy
| | | | - Damiano Magrì
- Department of Clinical and Molecular Medicine, Azienda Ospedaliera Sant'Andrea, "Sapienza" Università degli Studi di Roma, Roma, Italy
| | - Susanna Sciomer
- Dipartimento di Scienze Cliniche, Internistiche, Anestesiologiche e Cardiovascolari, "Sapienza", Rome University, Rome, Italy
| | | | - Roberto Badagliacca
- Department of Cardiovascular and Respiratory Science, Sapienza University of Rome, Rome, Italy
| | | | - Nikita Baracchini
- Cardiovascular Department, "Azienda Sanitaria Universitaria Giuliano-Isontina", Trieste, Italy
| | | | - Ugo Corrà
- Cardiology Department, Istituti Clinici Scientifici Maugeri, IRCCS, Veruno Institute, Veruno, Italy
| | - Rosa Raimondo
- Divisione di Cardiologia Riabilitativa, Istituti Clinici Scientifici Maugeri, Tradate, Italy
| | - Rocco Lagioia
- UOC Cardiologia di Riabilitativa, Mater Dei Hospital, Bari, Italy
| | - Pasquale Perrone Filardi
- Department of Advanced Biomedical Sciences, Federico II University of Naples and Mediterranea CardioCentro, Naples, Italy
| | - Annamaria Iorio
- Department of Cardiology, Heart Failure and Heart Transplant Unit, Azienda Ospedaliera Papa Giovanni XXIII, Bergamo, Italy
| | - Michele Senni
- Department of Cardiology, Heart Failure and Heart Transplant Unit, Azienda Ospedaliera Papa Giovanni XXIII, Bergamo, Italy
| | | | | | - Enrico Perna
- Dipartimento Cardiologico "A. De Gasperis", Ospedale Cà Granda- A.O. Niguarda, Milano, Italy
| | - Marco Metra
- Cardiology, Department of Medical and Surgical Specialities, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Marco Guazzi
- Ospedale San Paolo, Università degli studi di Milano, Italy
| | - Giuseppe Limongelli
- Cardiologia SUN, Ospedale Monaldi (Azienda dei Colli), Seconda Università di Napoli, Napoli
| | - Gianfranco Sinagra
- Cardiovascular Department, "Azienda Sanitaria Universitaria Giuliano-Isontina", Trieste, Italy
| | - Gianfranco Parati
- Istituto Auxologico Italiano, Milan, Italy; Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Gaia Cattadori
- Unità Operativa Cardiologia Riabilitativa, IRCCS Multimedica, Milano, Italy
| | - Francesco Bandera
- Department of Biomedical Sciences for Health, University of Milano, Milan, Italy; Cardiology University Department, IRCCS Policlinico San Donato, Milan, Italy
| | - Maurizio Bussotti
- Cardiac Rehabilitation Unit, Istituti Clinici Scientifici Maugeri, Scientific Institute of Milan, Milan, Italy
| | - Massimo Mapelli
- Centro Cardiologico Monzino, IRCCS, Milan, Italy; Department of clinical sciences and community health, Cardiovascular section, University of Milan, Milan, Italy
| | - Manlio Cipriani
- ISMETT (Istituto Mediterraneo per i Trapianti e Terapie ad alta specializzazione), Palermo, Italy
| | - Alice Bonomi
- Centro Cardiologico Monzino, IRCCS, Milan, Italy
| | - Gonçalo Cunha
- Centro Cardiologico Monzino, IRCCS, Milan, Italy; Cardiology department, Hospital de Santa Cruz, Carnaxide, Portugal
| | - Federica Re
- Cardiology Division, Cardiac Arrhythmia Center and Cardiomyopathies Unit, San Camillo-Forlanini Hospital, Roma, Italy
| | | | - Andrea Garascia
- Dipartimento Cardiologico "A. De Gasperis", Ospedale Cà Granda- A.O. Niguarda, Milano, Italy
| | - Carlo Lombardi
- Cardiology, Department of Medical and Surgical Specialities, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | | | - Andrea Passantino
- Division of Cardiology, Istituti Clinici Scientifici Maugeri, Institute of Bari, Bari, Italy
| | - Michele Emdin
- Institute of Life Science, Scuola Superiore Sant'Anna, Pisa, Italy; Fondazione Gabriele Monasterio, CNR-Regione Toscana, Pisa, Italy
| | - Claudio Passino
- Institute of Life Science, Scuola Superiore Sant'Anna, Pisa, Italy
| | - Caterina Santolamazza
- Dipartimento Cardiologico "A. De Gasperis", Ospedale Cà Granda- A.O. Niguarda, Milano, Italy
| | - Davide Girola
- Clinica Hildebrand Centro di riabilitazione Brissago, Switzerland
| | - Denise Zaffalon
- Cardiovascular Department, "Azienda Sanitaria Universitaria Giuliano-Isontina", Trieste, Italy
| | - Dario Vizza
- Department of Cardiovascular and Respiratory Science, Sapienza University of Rome, Rome, Italy
| | | | - Piergiuseppe Agostoni
- Centro Cardiologico Monzino, IRCCS, Milan, Italy; Department of clinical sciences and community health, Cardiovascular section, University of Milan, Milan, Italy,.
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7
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Corrà U, Piepoli MF, Giordano A, Doni F, Magini A, Bonomi A, Salvioni E, Lagioia R, Limongelli G, Paolillo S, Magrì D, Filardi PP, Sinagra G, Scardovi AB, Metra M, Senni M, Scrutinio D, Raimondo R, Emdin M, Cattadori G, Parati G, Re F, Cicoira M, Minà C, Correale M, Frigerio M, Perna E, Bussotti M, Battaia E, Guazzi M, Bandera F, Badagliacca R, Lenarda AD, Maggioni A, Passino C, Sciomer S, Pacileo G, Mapelli M, Vignati C, Clemenza F, Lombardi C, Agostoni P. Revisiting a Prognosticating Algorithm from Cardiopulmonary Exercise Testing in Chronic Heart Failure (from the MECKI Score Population). Am J Cardiol 2022; 180:65-71. [DOI: 10.1016/j.amjcard.2022.06.034] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Revised: 06/13/2022] [Accepted: 06/17/2022] [Indexed: 11/01/2022]
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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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Paneroni M, Scalvini S, Corrà U, Lovagnini M, Maestri R, Mazza A, Raimondo R, Agostoni P, La Rovere MT. The Impact of Cardiac Rehabilitation on Activities of Daily Life in Elderly Patients With Heart Failure. Front Physiol 2022; 12:785501. [PMID: 35069247 PMCID: PMC8766860 DOI: 10.3389/fphys.2021.785501] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Accepted: 11/30/2021] [Indexed: 12/21/2022] Open
Abstract
Background: In elderly chronic heart failure (HF) patients, activities of daily living (ADLs) require the use of a high proportion of patients’ peak aerobic capacity, heart rate, and ventilation. Objectives: To assess the effects of short-term comprehensive cardiac rehabilitation (CR) on the metabolic requirement of ADLs in elderly patients with chronic HF. Methods: The study population comprised 99 elderly chronic HF patients (mean age 72 ± 5 years, 80% male, 61% ejection fraction <40%, mean NT-proBNP 2,559 ± 4,511 pg/ml) participating in a short-term (mean days 19 ± 7) residential CR program. Before and after CR, participants, while wearing a portable ergospirometer, performed a standardized ADL battery: ADL1 (getting dressed), ADL2 (folding 8 towels), ADL3 (putting away 6 bottles), ADL4 (making a bed), ADL5 (sweeping the floor for 4 min), ADL6 (climbing 1 flight of stairs carrying a 1.5 Kg load), and ADL7 (a standard 6-min walking test). Results: After CR, task-related oxygen uptake did not change in any of the domestic ADLs. Notably, there was a significant decrease in the cumulative time required to perform ADLs (ADL 1–4 and ADL6; from 412 ± 147 to 388 ± 141 s, p = 0.001) and a reduction in maximal heart rate in ADL1 and 3 (p = 0.005 and p = 0.027, respectively). Changes occurred in the 6MWT with an increase in oxygen uptake (p = 0.005) and in the distance covered (p < 0.001) and a significant decrease in the Borg scale of dyspnea (p = 0.004). Conclusion: Elderly patients with chronic heart failure who are engaged in a short-term residential CR program improve the performance of routine ADLs.
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Affiliation(s)
- Mara Paneroni
- Respiratory Rehabilitation, Istituti Clinici Scientifici Maugeri IRCCS, Lumezzane (Brescia), Italy
| | - Simonetta Scalvini
- Department of Cardiac Rehabilitation, Istituti Clinici Scientifici Maugeri IRCCS, Lumezzane (Brescia), Italy
| | - Ugo Corrà
- Department of Cardiac Rehabilitation, Istituti Clinici Scientifici Maugeri IRCCS, Veruno (Novara), Italy
| | - Marta Lovagnini
- Department of Cardiac Rehabilitation, Istituti Clinici Scientifici Maugeri IRCCS, Montescano (Pavia), Italy
| | - Roberto Maestri
- Department of Bioengineering, Istituti Clinici Scientifici Maugeri IRCCS, Montescano (Pavia), Italy
| | - Antonio Mazza
- Department of Cardiac Rehabilitation, Istituti Clinici Scientifici Maugeri IRCCS, Montescano (Pavia), Italy
| | - Rosa Raimondo
- Department of Cardiac Rehabilitation, Istituti Clinici Scientifici Maugeri IRCCS, Tradate (Varese), Italy
| | - Piergiuseppe Agostoni
- Department of Clinical Sciences and Community Health, Centro Cardiologico Monzino, IRCCS, University of Milan, Milan, Italy
| | - Maria Teresa La Rovere
- Department of Cardiac Rehabilitation, Istituti Clinici Scientifici Maugeri IRCCS, Montescano (Pavia), Italy
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Mapelli M, Salvioni E, Paneroni M, Gugliandolo P, Bonomi A, Scalvini S, Raimondo R, Sciomer S, Mattavelli I, La Rovere MT, Agostoni P. Brisk walking can be a maximal effort in heart failure patients: a comparison of cardiopulmonary exercise and 6 min walking test cardiorespiratory data. ESC Heart Fail 2021; 9:812-821. [PMID: 34970846 PMCID: PMC8934957 DOI: 10.1002/ehf2.13781] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 10/25/2021] [Accepted: 12/13/2021] [Indexed: 12/02/2022] Open
Abstract
Aims Cardiopulmonary exercise test (CPET) and 6 min 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 subjects (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 < 12 mL/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 a percentage of CPET peakV̇O2 vs. 6MWT V̇O2 reported as the absolute value, progressively increased as exercise limitation did. Conclusions In conclusion, the last minute of 6MWT must be perceived as a maximal or even supramaximal exercise activity in patients with more severe HF. Our findings should influence the safety procedures needed for the 6MWT in HF.
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Affiliation(s)
- Massimo Mapelli
- Centro Cardiologico Monzino, IRCCS, Milan, Italy.,Department of Clinical Sciences and Community Health, Cardiovascular Section, University of Milan, Via Parea, 4-20138, Milan, Italy
| | | | - Mara Paneroni
- Respiratory Rehabilitation, Istituti Clinici Scientifici Maugeri, IRCCS, Lumezzane, Brescia, Italy
| | | | - Alice Bonomi
- Centro Cardiologico Monzino, IRCCS, Milan, Italy
| | - Simonetta Scalvini
- Respiratory Rehabilitation, Istituti Clinici Scientifici Maugeri, IRCCS, Lumezzane, Brescia, Italy
| | - Rosa Raimondo
- Respiratory Rehabilitation, Istituti Clinici Scientifici Maugeri, IRCCS, Tradate, Varese, Italy
| | - Susanna Sciomer
- Dipartimento di Scienze Cardiovascolari, Respiratorie, Nefrologiche, Anestesiologiche e Geriatriche, 'Sapienza' Rome University, Rome, Italy
| | | | - Maria Teresa La Rovere
- Department of Cardiac Rehabilitation, Istituti Clinici Scientifici Maugeri, IRCCS, Montescano, Pavia, Italy
| | - Piergiuseppe Agostoni
- Centro Cardiologico Monzino, IRCCS, Milan, Italy.,Department of Clinical Sciences and Community Health, Cardiovascular Section, University of Milan, Via Parea, 4-20138, Milan, Italy
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11
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Salvioni E, Mapelli M, Paneroni M, Gugliandolo P, Bonomi A, Scalvini S, Raimondo R, Sciomer S, Mattavelli I, Rovere MTL, Agostoni P. 55 Brisk walking can be a maximal effort in heart failure patients. A comparison of cardiopulmonary exercise and 6-min walking test cardiorespiratory data. Eur Heart J Suppl 2021. [DOI: 10.1093/eurheartj/suab139.023] [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: 11/14/2022]
Abstract
Abstract
Aims
Cardiopulmonary exercise test (CPET) and 6-min 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 (peakṼO2). 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 peakṼO2 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-ṼO2 was 98 ± 20% of the CPET peakṼO2 values in HF patients, while 72 ± 20% in healthy subjects (P < 0.001). 6MWT-ṼO2 was >110% of CPET peakṼO2 in 42% of more severe HF patients (peakṼO2 <12 ml/kg/min). Similar results have been found for ventilation and heart rate. Of note, the slope of the relationship between ṼO2 at 6MWT, reported as percentage of CPET peakṼO2 vs. 6MWT ṼO2 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)
| | - Massimo Mapelli
- IRCCS, Centro Cardiologico Monzino, Milan, Italy
- Cardiovascular Section, Department of Clinical Sciences and Community Health, University of Milan, Italy
| | - Mara Paneroni
- Istituti Clinici Scientifici Maugeri IRCCS, Respiratory Rehabilitation, Lumezzane, Brescia, Italy
| | | | - Alice Bonomi
- IRCCS, Centro Cardiologico Monzino, Milan, Italy
| | - Simonetta Scalvini
- Istituti Clinici Scientifici Maugeri IRCCS, Respiratory Rehabilitation, Lumezzane, Brescia, Italy
| | - Rosa Raimondo
- Istituti Clinici Scientifici Maugeri IRCCS, Respiratory Rehabilitation, Tradate, Varese, Italy
| | - Susanna Sciomer
- Dipartimento di Scienze Cardiovascolari, Respiratorie, Nefrologiche, Anestesiologiche e Geriatriche, ‘Sapienza’, Rome, Italy
| | | | - Maria Teresa La Rovere
- Department of Cardiac Rehabilitation, Istituti Clinici Scientifici Maugeri, Montescano, Pavia, Italy
| | - Piergiuseppe Agostoni
- IRCCS, Centro Cardiologico Monzino, Milan, Italy
- Cardiovascular Section, Department of Clinical Sciences and Community Health, University of Milan, Italy
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12
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Paolillo S, Salvioni E, Perrone Filardi P, Bonomi A, Sinagra G, Gentile P, Gargiulo P, Scoccia A, Cosentino N, Gugliandolo P, Badagliacca R, Lagioia R, Correale M, Frigerio M, Perna E, Piepoli M, Re F, Raimondo R, Minà C, Clemenza F, Bussotti M, Limongelli G, Gravino R, Passantino A, Magrì D, Parati G, Caravita S, Scardovi AB, Arcari L, Vignati C, Mapelli M, Cattadori G, Cavaliere C, Corrà U, Agostoni P. Corrigendum to "Long-term prognostic role of diabetes mellitus and glycemic control in heart failure patients with reduced ejection fraction: Insights from the MECKI Score database" [Int J Cardiol. 2020 Oct 15; 317: 103-110. PMID: 32360652]. Int J Cardiol 2021; 333:252. [PMID: 33640418 DOI: 10.1016/j.ijcard.2021.02.045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- S Paolillo
- Department of Advanced Biomedical Sciences, Federico II University of Naples, Italy; Mediterranea Cardiocentro, Naples, Italy
| | - E Salvioni
- Centro Cardiologico Monzino, IRCCS, Milano, Italy
| | - P Perrone Filardi
- Department of Advanced Biomedical Sciences, Federico II University of Naples, Italy
| | - A Bonomi
- Centro Cardiologico Monzino, IRCCS, Milano, Italy
| | - G Sinagra
- Cardiovascular Department, Ospedali Riuniti and University of Trieste, Trieste, Italy
| | - P Gentile
- Cardiovascular Department, Ospedali Riuniti and University of Trieste, Trieste, Italy
| | - P Gargiulo
- Department of Advanced Biomedical Sciences, Federico II University of Naples, Italy
| | - A Scoccia
- Centro Cardiologico Monzino, IRCCS, Milano, Italy
| | - N Cosentino
- Centro Cardiologico Monzino, IRCCS, Milano, Italy
| | | | - R Badagliacca
- Dipartimento di Scienze Cardiovascolari, Respiratorie, Nefrologiche, Anestesiologiche e Geriatriche, "Sapienza", Rome University, Rome, Italy
| | - R Lagioia
- Division of Cardiology, "S. Maugeri" Foundation, IRCCS, Institute of Cassano Murge, Bari, Italy
| | - M Correale
- Department of Cardiology, University of Foggia, Foggia, Italy
| | - M Frigerio
- Dipartimento Cardiologico "A. De Gasperis", Ospedale Cà Granda - A.O. Niguarda, Milano, Italy
| | - E Perna
- Dipartimento Cardiologico "A. De Gasperis", Ospedale Cà Granda - A.O. Niguarda, Milano, Italy
| | - M Piepoli
- UOC Cardiologia, G da Saliceto Hospital, Piacenza, Italy
| | - F Re
- Cardiology Division, Cardiac Arrhythmia Center and Cardiomyopathies Unit, San Camillo-Forlanini Hospital, Roma, Italy
| | - R Raimondo
- Fondazione Salvatore Maugeri, IRCCS, Istituto Scientifico di Tradate, Italy
| | - C Minà
- Department for the Treatment and Study of Cardiothoracic Diseases and Cardiothoracic Transplantation IRCCS - ISMETT, Palermo, Italy
| | - F Clemenza
- Department for the Treatment and Study of Cardiothoracic Diseases and Cardiothoracic Transplantation IRCCS - ISMETT, Palermo, Italy
| | - M Bussotti
- Department of Cardiology, Istituti Clinici Scientifici Maugeri IRCCS, Milano, Italy
| | - G Limongelli
- Cardiologia SUN, Ospedale Monaldi (Azienda dei Colli), Seconda Università di Napoli, Napoli, Italy
| | - R Gravino
- Cardiologia SUN, Ospedale Monaldi (Azienda dei Colli), Seconda Università di Napoli, Napoli, Italy
| | - A Passantino
- Division of Cardiology, "S. Maugeri" Foundation, IRCCS, Institute of Cassano Murge, Bari, Italy
| | - D Magrì
- Department of Clinical and Molecular Medicine, Azienda Ospedaliera Sant'Andrea, "Sapienza" Università degli Studi di Roma, Roma, Italy
| | - G Parati
- Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy; San Luca Hospital, Istituto Auxologico Italiano, Milan, Italy
| | - S Caravita
- San Luca Hospital, Istituto Auxologico Italiano, Milan, Italy; Department of Management, Information and Production Engineering, University of Bergamo, Dalmine, BG, Italy
| | - A B Scardovi
- Cardiology Division, Santo Spirito Hospital, Roma, Italy
| | - L Arcari
- Cardiology Division, Santo Spirito Hospital, Roma, Italy
| | - C Vignati
- Centro Cardiologico Monzino, IRCCS, Milano, Italy; Department of Clinical Sciences and Community Health, Cardiovascular Section, University of Milano, Milano, Italy
| | - M Mapelli
- Centro Cardiologico Monzino, IRCCS, Milano, Italy
| | - G Cattadori
- Unità Operativa Cardiologia Riabilitativa, Multimedica IRCCS, Milano, Italy
| | | | - U Corrà
- Fondazione Salvatore Maugeri, IRCCS, Istituto Scientifico di Veruno, Italy
| | - P Agostoni
- Centro Cardiologico Monzino, IRCCS, Milano, Italy; Department of Clinical Sciences and Community Health, Cardiovascular Section, University of Milano, Milano, Italy.
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Quattrocchi GLJE, Fazio N, Raimondo R, Camerano C. ICF Rehabilitation Set for monitoring the efficacy of botulinum toxin type A in post-stroke subjects with spasticity: New prospects and meta-analysis of the first results. Toxicon 2021. [DOI: 10.1016/j.toxicon.2020.11.472] [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: 10/22/2022]
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14
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Tedeschi A, Agostoni P, Pezzuto B, Corra’ U, Scrutinio D, La Gioia R, Raimondo R, Passantino A, Piepoli MF. Role of comorbidities in heart failure prognosis Part 2: Chronic kidney disease, elevated serum uric acid. Eur J Prev Cardiol 2020; 27:35-45. [PMID: 33238740 PMCID: PMC7691631 DOI: 10.1177/2047487320957793] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Accepted: 08/18/2020] [Indexed: 12/18/2022]
Abstract
Despite improvements in pharmacotherapy, morbidity and mortality rates in community-based populations with chronic heart failure still remain high. The increase in medical complexity among patients with heart failure may be reflected by an increase in concomitant non-cardiovascular comorbidities, which are recognized as independent prognostic factors in this population. Heart failure and chronic kidney disease share many risk factors, and often coexist. The presence of kidney failure is associated with incremented risk of cardiovascular and non-cardiovascular mortality in heart failure patients. Chronic kidney disease is also linked with underutilization of evidence-based heart failure therapy that may reduce morbidity and mortality. More targeted therapies would be important to improve the prognosis of patients with these diseases. In recent years, serum uric acid as a determinant of cardiovascular risk has gained interest. Epidemiological, experimental and clinical data show that patients with hyperuricaemia are at increased risk of cardiac, renal and vascular damage and cardiovascular events. Moreover, elevated serum uric acid predicts worse outcome in both acute and chronic heart failure. While studies have raised the possibility of preventing heart failure through the use of uric acid lowering agents, the literature is still inconclusive on whether the reduction in uric acid will result in a measurable clinical benefit. Available evidences suggest that chronic kidney disease and elevated uric acid could worsen heart failure patients' prognosis. The aim of this review is to analyse a possible utilization of these comorbidities in risk stratification and as a therapeutic target to get a prognostic improvement in heart failure patients.
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Affiliation(s)
- Andrea Tedeschi
- Cardiology Dept, Guglielmo da Saliceto Hospital, AUSL Piacenza
and University of Parma, Italy
| | - Piergiuseppe Agostoni
- Clinical Cardiology and Rehabilitation Unit, Università degli
Studi di Milano, Centro Cardiologico Monzino IRCCS, Italy
| | - Beatrice Pezzuto
- Clinical Cardiology and Rehabilitation Unit, Università degli
Studi di Milano, Centro Cardiologico Monzino IRCCS, Italy
| | - Ugo Corra’
- Centro Cardiologico di Veruno, Istituti Clinici Maugeri,
Italy
| | - Domenico Scrutinio
- Istituti Clinici Scientifici Maugeri-SPA SB. I.R.C.C.S.
Institute of Bari, Italy
| | - Rocco La Gioia
- Istituti Clinici Scientifici Maugeri-SPA SB. I.R.C.C.S.
Institute of Bari, Italy
| | - Rosa Raimondo
- Istituti Clinici Scientifici Maugeri-SPA SB. I.R.C.C.S.
Institute of Bari, Italy
| | - Andrea Passantino
- Istituti Clinici Scientifici Maugeri-SPA SB. I.R.C.C.S.
Institute of Bari, Italy
| | - Massimo F Piepoli
- Cardiology Dept, Guglielmo da Saliceto Hospital, AUSL Piacenza
and University of Parma, Italy
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15
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Piepoli MF, Salvioni E, Corrà U, Doni F, Bonomi A, La Gioia R, Limongelli G, Paolillo S, Sinagra G, Scardovi AB, Raimondo R, Emdin M, Re F, Cicoira M, Correale M, Badagliacca R, Clemenza F, Lombardi C, Agostoni P. Increased serum uric acid level predicts poor prognosis in mildly severe chronic heart failure with reduced ejection fraction. An analysis from the MECKI score research group. Eur J Intern Med 2020; 72:47-52. [PMID: 31787490 DOI: 10.1016/j.ejim.2019.11.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Revised: 10/21/2019] [Accepted: 11/07/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND Hyperuricemia prognostic impact on clinical outcomes in chronic heart failure (HF) patients has been investigated with inconclusive results. OBJECTIVES Aim of the study was to evaluate the prognostic impact of serum uric acid (SUA) on long-term clinical outcomes in HF. METHODS An analysis of MECKI (Metabolic Exercise Cardiac Kidney Index) database, with median follow-up of 3.4 years. RESULTS Relation between SUA and all-cause/ cardiovascular (CV) deaths have been analysed in 4,577 patients (3,688 males, age 62.7 ± 12.9 years), with reduced ejection fraction HF (35 ± 11%), peakVO2 1151 ± 440 ml/min; NYHA class I-II (72.6%), III-IV (27.4%). SUA was associated with increased total and CV mortality (HR 1.120 and HR 1.128, respectively p < 0.0001), also after adjustment for peakVO2, VE/VCO2 slope, diuretic use and MECKI score. SUA was significantly associated with CV mortality only in NYHA class I-II (HR 1.17, p < 0.0001) while there was no association in class III-IV (HR 1.03, p = NS). No prognostic added values of SUA with respect to the MECKI score was observed at the ROC analysis. CONCLUSIONS SUA is confirmed to be associated with increased mortality, but in less severe HF only. However SUA did not show additional prognostic power to the MECKI score.
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Affiliation(s)
- Massimo Francesco Piepoli
- UOC Cardiologia, G da Saliceto Hospital, Piacenza, Italy; Department of Cardiology, University of Foggia, Foggia, Italy
| | | | - Ugo Corrà
- Cardiology Department, Istituti Clinici Scientifici Maugeri, Veruno Institute, Veruno, Italy
| | - Francesco Doni
- Cardiology Department, Istituti Clinici Scientifici Maugeri, Veruno Institute, Veruno, Italy
| | - Alice Bonomi
- Centro Cardiologico Monzino, IRCCS, Milano, Italy
| | - Rocco La Gioia
- Division of Cardiology, "S. Maugeri" Foundation, IRCCS, Institute of Cassano Murge, Bari, Italy
| | - Giuseppe Limongelli
- Cardiologia SUN, Ospedale Monaldi (Azienda dei Colli), Seconda Università di Napoli, Napoli, Italy
| | - Stefania Paolillo
- Department of Advanced Biomedical Sciences, Federico II University of Naples, Italy
| | - Gianfranco Sinagra
- Cardiovascular Department, Ospedali Riuniti and University of Trieste, Trieste, Italy
| | | | - Rosa Raimondo
- Fondazione Salvatore Maugeri, IRCCS, Istituto Scientifico di Tradate, Italy
| | - Michele Emdin
- Fondazione Gabriele Monasterio, CNR-Regione Toscana, Pisa, Italy; Life Science Institute, Scuola Superiore Sant'Anna, Pisa, Italy
| | - Federica Re
- Cardiology Division, Cardiac Arrhythmia Center and Cardiomyopathies Unit, San Camillo-Forlanini Hospital, Roma, Italy
| | | | | | - Roberto Badagliacca
- Dipartimento di Scienze Cardiovascolari, Respiratorie, Nefrologiche, Anestesiologiche e Geriatriche, "Sapienza", Rome University, Rome, Italy
| | - Francesco Clemenza
- Department for the Treatment and Study of Cardiothoracic Diseases and Cardiothoracic Transplantation IRCCS - ISMETT, Palermo, Italy
| | - Carlo Lombardi
- Cardiology, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Piergiuseppe Agostoni
- Centro Cardiologico Monzino, IRCCS, Milano, Italy; Department of Clinical Sciences and Community Health, Cardiovascular Section, University of Milano, Milano, Italy.
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16
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Salvioni E, Corrà U, Piepoli M, Rovai S, Correale M, Paolillo S, Pasquali M, Magrì D, Vitale G, Fusini L, Mapelli M, Vignati C, Lagioia R, Raimondo R, Sinagra G, Boggio F, Cangiano L, Gallo G, Magini A, Contini M, Palermo P, Apostolo A, Pezzuto B, Bonomi A, Scardovi AB, Filardi PP, Limongelli G, Metra M, Scrutinio D, Emdin M, Piccioli L, Lombardi C, Cattadori G, Parati G, Caravita S, Re F, Cicoira M, Frigerio M, Clemenza F, Bussotti M, Battaia E, Guazzi M, Bandera F, Badagliacca R, Di Lenarda A, Pacileo G, Passino C, Sciomer S, Ambrosio G, Agostoni P. Gender and age normalization and ventilation efficiency during exercise in heart failure with reduced ejection fraction. ESC Heart Fail 2020; 7:371-380. [PMID: 31893579 PMCID: PMC7083437 DOI: 10.1002/ehf2.12582] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Revised: 10/21/2019] [Accepted: 11/11/2019] [Indexed: 01/20/2023] Open
Abstract
Aims Ventilation vs. carbon dioxide production (VE/VCO2) is among the strongest cardiopulmonary exercise testing prognostic parameters in heart failure (HF). It is usually reported as an absolute value. The current definition of normal VE/VCO2 slope values is inadequate, since it was built from small groups of subjects with a particularly limited number of women and elderly. We aimed to define VE/VCO2 slope prediction formulas in a sizable population and to test whether the prognostic power of VE/VCO2 slope in HF was different if expressed as a percentage of the predicted value or as an absolute value. Methods and results We calculated the linear regressions between age and VE/VCO2 slope in 1136 healthy subjects (68% male, age 44.9 ± 14.5, range 13–83 years). We then applied age‐adjusted and sex‐adjusted formulas to predict VE/VCO2 slope to HF patients included in the metabolic exercise test data combined with cardiac and kidney indexes score database, which counts 6112 patients (82% male, age 61.4 ± 12.8, left ventricular ejection fraction 33.2 ± 10.5%, peakVO2 14.8 ± 4.9, mL/min/kg, VE/VCO2 slope 32.7 ± 7.7) from 24 HF centres. Finally, we evaluated whether the use of absolute values vs. percentages of predicted VE/VCO2 affected HF prognosis prediction (composite of cardiovascular mortality + urgent transplant or left ventricular assist device). We did so in the entire cardiac and kidney indexes score population and separately in HF patients with severe (peakVO2 < 14 mL/min/kg, n = 2919, 61.1 events/1000 pts/year) or moderate (peakVO2 ≥ 14 mL/min/kg, n = 3183, 19.9 events/1000 pts/year) HF. In the healthy population, we obtained the following equations: female, VE/VCO2 = 0.052 × Age + 23.808 (r = 0.192); male, VE/VCO2 = 0.095 × Age + 20.227 (r = 0.371) (P = 0.007). We applied these formulas to calculate the percentages of predicted VE/VCO2 values. The 2‐year survival prognostic power of VE/VCO2 slope was strong, and it was similar if expressed as absolute value or as a percentage of predicted value (AUCs 0.686 and 0.690, respectively). In contrast, in severe HF patients, AUCs significantly differed between absolute values (0.637) and percentages of predicted values (0.650, P = 0.0026). Moreover, VE/VCO2 slope expressed as a percentage of predicted value allowed to reclassify 6.6% of peakVO2 < 14 mL/min/kg patients (net reclassification improvement = 0.066, P = 0.0015). Conclusions The percentage of predicted VE/VCO2 slope value strengthens the prognostic power of VE/VCO2 in severe HF patients, and it should be preferred over the absolute value for HF prognostication. Furthermore, the widespread use of VE/VCO2 slope expressed as percentage of predicted value can improve our ability to identify HF patients at high risk, which is a goal of utmost clinical relevance.
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Affiliation(s)
| | - Ugo Corrà
- Cardiology Department, Istituti Clinici Scientifici Maugeri, IRCCS, Veruno Institute, Veruno, Italy
| | | | - Sara Rovai
- Centro Cardiologico Monzino, IRCCS, Via Parea 4, Milan, 20138, Italy.,Università degli Studi di Padova, Padova, Italy
| | | | - Stefania Paolillo
- Department of Advanced Biomedical Sciences, Federico II University of Naples, Naples, Italy
| | - Mario Pasquali
- Dipartimento di medicina e scienze dell'invecchiamento, Università G. D'Annunzio, Chieti, Italy
| | - Damiano Magrì
- Department of Clinical and Molecular Medicine, Azienda Ospedaliera Sant'Andrea, "Sapienza" Università degli Studi di Roma, Roma, Italy
| | - Giuseppe Vitale
- Cardiovascular Rehabilitation Unit, Buccheri La Ferla Fatebenefratelli Hospital, Palermo, Italy
| | - Laura Fusini
- Centro Cardiologico Monzino, IRCCS, Via Parea 4, Milan, 20138, Italy
| | - Massimo Mapelli
- Centro Cardiologico Monzino, IRCCS, Via Parea 4, Milan, 20138, Italy
| | - Carlo Vignati
- Centro Cardiologico Monzino, IRCCS, Via Parea 4, Milan, 20138, Italy.,Department of Clinical Sciences and Community Health, Cardiovascular Section, University of Milano, Milano, Italy
| | - Rocco Lagioia
- Division of Cardiology, "S. Maugeri" Foundation, IRCCS, Institute of Cassano Murge, Bari, Italy
| | - Rosa Raimondo
- Fondazione Salvatore Maugeri, IRCCS, Istituto Scientifico di Tradate, Tradate, Italy
| | - Gianfranco Sinagra
- Cardiovascular Department, Ospedali Riuniti and University of Trieste, Trieste, Italy
| | - Federico Boggio
- Centro Cardiologico Monzino, IRCCS, Via Parea 4, Milan, 20138, Italy
| | - Lorenzo Cangiano
- Centro Cardiologico Monzino, IRCCS, Via Parea 4, Milan, 20138, Italy
| | - Giovanna Gallo
- Department of Clinical and Molecular Medicine, Azienda Ospedaliera Sant'Andrea, "Sapienza" Università degli Studi di Roma, Roma, Italy
| | - Alessandra Magini
- Centro Cardiologico Monzino, IRCCS, Via Parea 4, Milan, 20138, Italy
| | - Mauro Contini
- Centro Cardiologico Monzino, IRCCS, Via Parea 4, Milan, 20138, Italy
| | - Pietro Palermo
- Centro Cardiologico Monzino, IRCCS, Via Parea 4, Milan, 20138, Italy
| | - Anna Apostolo
- Centro Cardiologico Monzino, IRCCS, Via Parea 4, Milan, 20138, Italy
| | - Beatrice Pezzuto
- Centro Cardiologico Monzino, IRCCS, Via Parea 4, Milan, 20138, Italy
| | - Alice Bonomi
- Centro Cardiologico Monzino, IRCCS, Via Parea 4, Milan, 20138, Italy
| | | | | | - Giuseppe Limongelli
- Cardiologia SUN, Ospedale Monaldi (Azienda dei Colli), Seconda Università di Napoli, Napoli, Italy
| | - Marco Metra
- Cardiology, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Domenico Scrutinio
- Division of Cardiology, "S. Maugeri" Foundation, IRCCS, Institute of Cassano Murge, Bari, Italy
| | - Michele Emdin
- Fondazione Gabriele Monasterio, CNR-Regione Toscana, Pisa, Italy.,Life Science Institute, Scuola Superiore Sant'Anna, Pisa, Italy
| | - Lucrezia Piccioli
- Department of Advanced Biomedical Sciences, Federico II University of Naples, Naples, Italy
| | - Carlo Lombardi
- Cardiology, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Gaia Cattadori
- Unità Operativa Cardiologia Riabilitativa, Multimedica IRCCS, Milano, Italy
| | - Gianfranco Parati
- Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy.,Department of Cardiovascular, Neural and Metabolic Sciences, San Luca Hospital, Istituto Auxologico Italiano, Milan, Italy
| | - Sergio Caravita
- Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Federica Re
- Cardiology Division, Cardiac Arrhythmia Center and Cardiomyopathies Unit, San Camillo-Forlanini Hospital, Roma, Italy
| | | | - Maria Frigerio
- Dipartimento Cardiologico "A. De Gasperis", Ospedale Cà Granda-A.O. Niguarda, Milano, Italy
| | - Francesco Clemenza
- Department for the Treatment and Study of Cardiothoracic Diseases and Cardiothoracic Transplantation, IRCCS-ISMETT, Palermo, Italy
| | - Maurizio Bussotti
- Cardiac Rehabilitation Unit, Fondazione Salvatore Maugeri, IRCCS, Scientific Institute of Milan, Milan, Italy
| | - Elisa Battaia
- Department of Cardiology, S. Chiara Hospital, Trento, Italy
| | - Marco Guazzi
- Cardiology University Department, Heart Failure Unit and Cardiopulmonary Laboratory, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Francesco Bandera
- Cardiology University Department, Heart Failure Unit and Cardiopulmonary Laboratory, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Roberto Badagliacca
- Dipartimento di Scienze Cardiovascolari, Respiratorie, Nefrologiche, Anestesiologiche e Geriatriche, "Sapienza", Rome University, Rome, Italy
| | - Andrea Di Lenarda
- Cardiovascular Center, Health Authority no. 1, University of Trieste, Trieste, Italy
| | - Giuseppe Pacileo
- Cardiologia SUN, Ospedale Monaldi (Azienda dei Colli), Seconda Università di Napoli, Napoli, Italy
| | - Claudio Passino
- Fondazione Gabriele Monasterio, CNR-Regione Toscana, Pisa, Italy.,Life Science Institute, Scuola Superiore Sant'Anna, Pisa, Italy
| | - Susanna Sciomer
- Dipartimento di Scienze Cardiovascolari, Respiratorie, Nefrologiche, Anestesiologiche e Geriatriche, "Sapienza", Rome University, Rome, Italy
| | - Giuseppe Ambrosio
- Division of Cardiology, University of Perugia School of Medicine, Perugia, Italy
| | - Piergiuseppe Agostoni
- Centro Cardiologico Monzino, IRCCS, Via Parea 4, Milan, 20138, Italy.,Department of Clinical Sciences and Community Health, Cardiovascular Section, University of Milano, Milano, Italy
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Rovai S, Corrà U, Piepoli M, Vignati C, Salvioni E, Bonomi A, Mattavelli I, Arcari L, Scardovi AB, Perrone Filardi P, Lagioia R, Paolillo S, Magrì D, Limongelli G, Metra M, Senni M, Scrutinio D, Raimondo R, Emdin M, Lombardi C, Cattadori G, Parati G, Re F, Cicoira M, Villani GQ, Minà C, Correale M, Frigerio M, Perna E, Mapelli M, Magini A, Clemenza F, Bussotti M, Battaia E, Guazzi M, Bandera F, Badagliacca R, Di Lenarda A, Pacileo G, Maggioni A, Passino C, Sciomer S, Sinagra G, Agostoni P. Exercise oscillatory ventilation and prognosis in heart failure patients with reduced and mid-range ejection fraction. Eur J Heart Fail 2019; 21:1586-1595. [PMID: 31782225 DOI: 10.1002/ejhf.1595] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Revised: 07/31/2019] [Accepted: 07/31/2019] [Indexed: 12/12/2022] Open
Abstract
AIMS Exercise oscillatory ventilation (EOV) is a pivotal cardiopulmonary exercise test parameter for the prognostic evaluation of patients with chronic heart failure (HF). It has been described in patients with HF with reduced ejection fraction (<40%, HFrEF) and with HF with preserved ejection fraction (>50%, HFpEF), but no data are available for patients with HF with mid-range ejection fraction (40-49%, HFmrEF). The aim of the study was to evaluate the prognostic role of EOV in HFmrEF patients. METHODS AND RESULTS We analysed 1239 patients with HFmrEF and 4482 patients with HFrEF, enrolled in the MECKI score database, with a 2-year follow-up. The study endpoint was the composite of cardiovascular death, urgent heart transplant, and ventricular assist device implantation. We identified EOV in 968 cases (16% and 17% of cases in HFmrEF and HFrEF, respectively). HFrEF EOV+ patients were significantly older, and their parameters suggested a more severe HF than HFrEF EOV- patients. A similar behaviour was found in HFmrEF EOV+ vs. EOV- patients. Kaplan-Meier analysis, irrespective of ejection fraction, showed that EOV is associated with a worse survival, and that patients with HFrEF and HFmrEF EOV+ had a significantly worse outcome than the EOV- of the same ejection fraction groups. EOV-associated survival differences in HFmrEF patients started after 18 months of follow-up. CONCLUSION Exercise oscillatory ventilation has a similar prevalence and ominous prognostic value in both HFmrEF and HFrEF patients, indicating a group of patients in need of a more intensive follow-up and a more aggressive therapy. In HFmrEF, the survival curves between EOV+ and EOV- patients diverged only after 18 months.
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Affiliation(s)
- Sara Rovai
- U.O Scompenso, Centro Cardiologico Monzino, IRCCS, Milan, Italy.,Sport and Exercise Medicine Division, Department of Medicine, Università degli Studi di Padova, Padova, Italy
| | - Ugo Corrà
- Cardiology Department, Istituti Clinici Scientifici Maugeri, IRCCS, Veruno Institute, Veruno, Italy
| | | | - Carlo Vignati
- U.O Scompenso, Centro Cardiologico Monzino, IRCCS, Milan, Italy.,Department of Clinical Sciences and Community Health, Cardiovascular Section, University of Milano, Milan, Italy
| | | | - Alice Bonomi
- U.O Scompenso, Centro Cardiologico Monzino, IRCCS, Milan, Italy
| | | | - Luca Arcari
- Cardiology Division, Santo Spirito Hospital, Rome, Italy
| | | | | | - Rocco Lagioia
- Division of Cardiology, "S. Maugeri" Foundation, IRCCS, Institute of Cassano Murge, Bari, Italy
| | - Stefania Paolillo
- Department of Advanced Biomedical Sciences, Federico II University of Naples, Naples, Italy
| | - Damiano Magrì
- Department of Clinical and Molecular Medicine, Azienda Ospedaliera Sant'Andrea, "Sapienza" Università degli Studi di Roma, Rome, Italy
| | - Giuseppe Limongelli
- Cardiologia SUN, Ospedale Monaldi (Azienda dei Colli), Seconda Università di Napoli, Naples, Italy
| | - Marco Metra
- Cardiology, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Michele Senni
- Department of Cardiology, Heart Failure and Heart Transplant Unit, Azienda Ospedaliera Papa Giovanni XXIII, Bergamo, Italy
| | | | - Rosa Raimondo
- Divisione di Cardiologia Riabilitativa, Fondazione Salvatore Maugeri, IRCCS, Istituto Scientifico di Tradate, Italy
| | - Michele Emdin
- UOC Cardiologia e Medicina cardiovascolare, Fondazione Gabriele Monasterio, CNR-Regione Toscana, Pisa, Italy.,Life Science Institute, Life Science Institute, Scuola Superiore Sant'Anna, Pisa, Italy
| | - Carlo Lombardi
- Cardiology, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Gaia Cattadori
- Unità Operativa Cardiologia Riabilitativa, Multimedica IRCCS, Milan, Italy
| | - Gianfranco Parati
- Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy.,Department of Cardiovascular, Neural and Metabolic Sciences, San Luca Hospital, Istituto Auxologico Italiano, Milan, Italy
| | - Federica Re
- Cardiology Division, Cardiac Arrhythmia Center and Cardiomyopathies Unit, San Camillo-Forlanini Hospital, Rome, Italy
| | | | | | - Chiara Minà
- Department for the Treatment and Study of Cardiothoracic Diseases and Cardiothoracic Transplantation, IRCCS - ISMETT, Palermo, Italy
| | | | - Maria Frigerio
- Dipartimento Cardiologico 'A. De Gasperis', Ospedale Cà Granda-A.O. Niguarda, Milan, Italy
| | - Enrico Perna
- Dipartimento Cardiologico 'A. De Gasperis', Ospedale Cà Granda-A.O. Niguarda, Milan, Italy
| | - Massimo Mapelli
- U.O Scompenso, Centro Cardiologico Monzino, IRCCS, Milan, Italy
| | | | - Francesco Clemenza
- Department for the Treatment and Study of Cardiothoracic Diseases and Cardiothoracic Transplantation, IRCCS - ISMETT, Palermo, Italy
| | - Maurizio Bussotti
- Cardiac Rehabilitation Unit, Fondazione Salvatore Maugeri, IRCCS, Scientific Institute of Milan, Milan, Italy
| | - Elisa Battaia
- Department of Cardiology, S. Chiara Hospital, Trento, Italy
| | - Marco Guazzi
- Cardiology University Department, Heart Failure Unit and Cardiopulmonary Laboratory, IRCCS Policlinico San Donato, San Donato Milano, Italy
| | - Francesco Bandera
- Cardiology University Department, Heart Failure Unit and Cardiopulmonary Laboratory, IRCCS Policlinico San Donato, San Donato Milano, Italy
| | - Roberto Badagliacca
- Dipartimento di Scienze Cardiovascolari, Respiratorie, Nefrologiche, Anestesiologiche e Geriatriche, 'Sapienza', Rome University, Rome, Italy
| | - Andrea Di Lenarda
- Department of Cardiology, Cardiovascular Center, Health Authority no. 1 and University of, Trieste, Italy
| | - Giuseppe Pacileo
- Cardiologia SUN, Ospedale Monaldi (Azienda dei Colli), Seconda Università di Napoli, Naples, Italy
| | | | - Claudio Passino
- UOC Cardiologia e Medicina cardiovascolare, Fondazione Gabriele Monasterio, CNR-Regione Toscana, Pisa, Italy.,Life Science Institute, Life Science Institute, Scuola Superiore Sant'Anna, Pisa, Italy
| | - Susanna Sciomer
- Dipartimento di Scienze Cardiovascolari, Respiratorie, Nefrologiche, Anestesiologiche e Geriatriche, 'Sapienza', Rome University, Rome, Italy
| | - Gianfranco Sinagra
- Cardiovascular Department, Ospedali Riuniti and University of Trieste, Trieste, Italy
| | - Piergiuseppe Agostoni
- U.O Scompenso, Centro Cardiologico Monzino, IRCCS, Milan, Italy.,Department of Clinical Sciences and Community Health, Cardiovascular Section, University of Milano, Milan, Italy
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18
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Scrutinio D, Guida P, Passantino A, Ammirati E, Oliva F, Lagioia R, Raimondo R, Venezia M, Frigerio M. Acutely decompensated heart failure with chronic obstructive pulmonary disease: Clinical characteristics and long-term survival. Eur J Intern Med 2019; 60:31-38. [PMID: 30446355 DOI: 10.1016/j.ejim.2018.11.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2018] [Revised: 10/30/2018] [Accepted: 11/06/2018] [Indexed: 12/31/2022]
Abstract
BACKGROUND Chronic obstructive pulmonary disease (COPD) is among the most common comorbidities in patients hospitalized with heart failure and is generally associated with poor outcomes. However, the results of previous studies with regard to increased mortality and risk trajectories were not univocal. We sought to assess the prognostic impact of COPD in patients admitted for acutely decompensated heart failure (ADHF) and investigate the association between use of β-blockers at discharge and mortality in patients with COPD. METHODS We studied 1530 patients. The association of COPD with mortality was examined in adjusted Fine-Gray proportional hazard models where heart transplantation and ventricular assist device implantation were treated as competing risks. The primary outcome was 5-year all-cause mortality. RESULTS After adjusting for establisked risk markers, the subdistribution hazard ratios (SHR) of 5-year mortality for COPD patients compared with non-COPD patients was 1.25 (95% confidence intervals [CIs] 1.06-1.47; p = .007). The relative risk of death for COPD patients increased steeply from 30 to 180 days, and remained noticeably high throughout the entire follow-up. Among patients with comorbid COPD, the use of β-blockers at discharge was associated with a significantly reduced risk of 1-year post-discharge mortality (SHR 0.66, 95%CIs 0.53-0.83; p ≤.001). CONCLUSIONS Our data indicate that ADHF patients with comorbid COPD have a worse long-term survival than those without comorbid COPD. Most of the excess mortality occurred in the first few months following hospitalization. Our data also suggest that the use of β-blockers at discharge is independently associated with improved survival in ADHF patients with COPD.
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Affiliation(s)
| | - Pietro Guida
- Istituti Clinici Scientifici Maugeri, I.R.C.C.S., Italy
| | | | | | - Fabrizio Oliva
- De Gasperis Cardio Center, Niguarda Hospital, Milan, Italy
| | - Rocco Lagioia
- Istituti Clinici Scientifici Maugeri, I.R.C.C.S., Italy
| | - Rosa Raimondo
- Istituti Clinici Scientifici Maugeri, I.R.C.C.S., Italy
| | - Mario Venezia
- Istituti Clinici Scientifici Maugeri, I.R.C.C.S., Italy
| | - Maria Frigerio
- De Gasperis Cardio Center, Niguarda Hospital, Milan, Italy
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19
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Paolillo S, Veglia F, Salvioni E, Corrà U, Piepoli M, Lagioia R, Limongelli G, Sinagra G, Cattadori G, Scardovi AB, Metra M, Senni M, Bonomi A, Scrutinio D, Raimondo R, Emdin M, Magrì D, Parati G, Re F, Cicoira M, Minà C, Correale M, Frigerio M, Bussotti M, Battaia E, Guazzi M, Badagliacca R, Di Lenarda A, Maggioni A, Passino C, Sciomer S, Pacileo G, Mapelli M, Vignati C, Clemenza F, Binno S, Lombardi C, Filardi PP, Agostoni P. Heart failure prognosis over time: how the prognostic role of oxygen consumption and ventilatory efficiency during exercise has changed in the last 20 years. Eur J Heart Fail 2019; 21:208-217. [PMID: 30632680 DOI: 10.1002/ejhf.1364] [Citation(s) in RCA: 58] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2018] [Revised: 10/15/2018] [Accepted: 10/18/2018] [Indexed: 12/11/2022] Open
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.
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Affiliation(s)
- Stefania Paolillo
- Department of Advanced Biomedical Sciences, Federico II University of Naples, Naples, Italy
| | | | | | - Ugo Corrà
- Division of Cardiac Rehabilitation, Salvatore Maugeri Foundation, IRCCS, Scientific Institute of Veruno, Veruno, Italy
| | - Massimo Piepoli
- Division of Cardiology, G. da Saliceto Hospital, Piacenza, Italy
| | - Rocco Lagioia
- Division of Cardiology, Salvatore Maugeri Foundation, IRCCS, Scientific Institute of Cassano Murge, Bari, Italy
| | - Giuseppe Limongelli
- Cardiology SUN, Monaldi Hospital (Azienda dei Colli), Second University of Naples, Naples, Italy
| | - Gianfranco Sinagra
- Cardiovascular Department, Ospedali Riuniti and University of Trieste, Trieste, Italy
| | - Gaia Cattadori
- Division of Cardiac Rehabilitation, Multimedica IRCCS, Milan, Italy
| | | | - Marco Metra
- Cardiology, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Michele Senni
- Department of Cardiology, Heart Failure and Heart Transplant Unit, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Alice Bonomi
- Centro Cardiologico Monzino, IRCCS, Milan, Italy
| | - Domenico Scrutinio
- Division of Cardiology, Salvatore Maugeri Foundation, IRCCS, Scientific Institute of Cassano Murge, Bari, Italy
| | - Rosa Raimondo
- Salvatore Maugeri Foundation, IRCCS, Scientific Institute of Tradate, Tradate, Italy
| | - Michele Emdin
- Gabriele Monasterio Foundation, CNR-Regione Toscana, Pisa, Italy.,Life Science Institute, Scuola Superiore Sant'Anna, Pisa, Italy
| | - Damiano Magrì
- Department of Clinical and Molecular Medicine, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - Gianfranco Parati
- Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy.,Department of Cardiovascular, Neural and Metabolic Sciences, San Luca Hospital, Istituto Auxologico Italiano, Milan, Italy
| | - Federica Re
- Cardiology Division, Cardiac Arrhythmia Center and Cardiomyopathies Unit, San Camillo-Forlanini Hospital, Rome, Italy
| | | | - Chiara Minà
- Department for the Treatment and Study of Cardiothoracic Diseases and Cardiothoracic Transplantation, IRCCS - ISMETT, Palermo, Italy
| | | | - Maria Frigerio
- 'A. De Gasperis' Cardiology Department, Niguarda Hospital, Milan, Italy
| | - Maurizio Bussotti
- Cardiac Rehabilitation Unit, Salvatore Maugeri Foundation, IRCCS, Scientific Institute of Milan, Milan, Italy
| | - Elisa Battaia
- Department of Cardiology, S. Chiara Hospital, Trento, Italy
| | - Marco Guazzi
- Cardiology University Department, Heart Failure Unit and Cardiopulmonary Laboratory, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Roberto Badagliacca
- Department of Cardiovascular Respiratory, Nephrological, Anesthesiological, and Geriatric Sciences, Sapienza University of Rome, Rome, Italy
| | - Andrea Di Lenarda
- Cardiovascular Center, Health Authority 1 and University of Trieste, Trieste, Italy
| | | | - Claudio Passino
- Gabriele Monasterio Foundation, CNR-Regione Toscana, Pisa, Italy.,Life Science Institute, Scuola Superiore Sant'Anna, Pisa, Italy
| | - Susanna Sciomer
- Department of Cardiovascular Respiratory, Nephrological, Anesthesiological, and Geriatric Sciences, Sapienza University of Rome, Rome, Italy
| | - Giuseppe Pacileo
- Cardiology SUN, Monaldi Hospital (Azienda dei Colli), Second University of Naples, Naples, Italy
| | | | | | - Francesco Clemenza
- Department for the Treatment and Study of Cardiothoracic Diseases and Cardiothoracic Transplantation, IRCCS - ISMETT, Palermo, Italy
| | - Simone Binno
- Division of Cardiology, G. da Saliceto Hospital, Piacenza, Italy
| | - Carlo Lombardi
- Cardiology, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | | | - Piergiuseppe Agostoni
- Centro Cardiologico Monzino, IRCCS, Milan, Italy.,Cardiovascular Section, Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
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20
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Campodonico J, Piepoli M, Clemenza F, Bonomi A, Paolillo S, Salvioni E, Corrà U, Binno S, Veglia F, Lagioia R, Sinagra G, Cattadori G, Scardovi AB, Metra M, Senni M, Scrutinio D, Raimondo R, Emdin M, Magrì D, Parati G, Re F, Cicoira M, Minà C, Limongelli G, Correale M, Frigerio M, Bussotti M, Perna E, Battaia E, Guazzi M, Badagliacca R, Di Lenarda A, Maggioni A, Passino C, Sciomer S, Pacileo G, Mapelli M, Vignati C, Lombardi C, Filardi PP, Agostoni P. Dose-dependent efficacy of β-blocker in patients with chronic heart failure and atrial fibrillation. Int J Cardiol 2018; 273:141-146. [DOI: 10.1016/j.ijcard.2018.08.012] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2018] [Revised: 07/30/2018] [Accepted: 08/04/2018] [Indexed: 12/28/2022]
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21
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Scrutinio D, Guida P, Passantino A, Lagioia R, Raimondo R, Venezia M, Ammirati E, Oliva F, Stucchi M, Frigerio M. Female gender and mortality risk in decompensated heart failure. Eur J Intern Med 2018; 51:34-40. [PMID: 29317139 DOI: 10.1016/j.ejim.2018.01.011] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2017] [Revised: 01/02/2018] [Accepted: 01/04/2018] [Indexed: 12/25/2022]
Abstract
BACKGROUND Still there is conflicting evidence about gender-related differences in prognosis among patients with heart failure. This prognostic uncertainty may have implications for risk stratification and planning management strategy. The aim of the present study was to explore the association between gender and one-year mortality in patients admitted with acute decompensated heart failure (ADHF). METHODS We studied 1513 patients. The Cumulative Incidence Function (CIF) method was used to estimate the absolute rate of mortality, heart transplantation (HT)/ventricular assist device (VAD) implantation, and survival free of HT/VAD implantation at 1year. An interaction analysis was performed to assess the association between covariates, gender, and mortality risk. Propensity score matching and Cox regression were used to compare mortality rates in the gender subgroups. RESULTS The CIF estimates of 1-year mortality, HT/VAD implantation, and survival free of HT/VAD implantation at 1year were 33.1%, 7.0%, and 59.9% for women and 30.2%, 10.2%, and 59.6% for men, respectively. Except for diabetes, there was no significant interaction between gender, covariates, and mortality risk. In the matched cohort, the hazard ratio of death for women was 1.19 (95% confidence intervals [CIs]: 0.90-1.59; p=.202). After adjusting for age and baseline risk, the hazard ratio of death for women was 1.18 (95% CIs: 0.95-1.43; p=.127). The use of gender-specific predictive models did not allow improving the accuracy of risk prediction. CONCLUSIONS Our data strongly suggest that women and men have comparable outcome in the year following a hospitalization for ADHF.
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Affiliation(s)
- Domenico Scrutinio
- Istituti Clinici Scientifici Maugeri SPA SB, I.R.C.C.S. Division of Cardiology and Cardiac Rehabilitation, Institute of Cassano Murge, Bari, Italy.
| | - Pietro Guida
- Istituti Clinici Scientifici Maugeri SPA SB, I.R.C.C.S. Division of Cardiology and Cardiac Rehabilitation, Institute of Cassano Murge, Bari, Italy
| | - Andrea Passantino
- Istituti Clinici Scientifici Maugeri SPA SB, I.R.C.C.S. Division of Cardiology and Cardiac Rehabilitation, Institute of Cassano Murge, Bari, Italy
| | - Rocco Lagioia
- Istituti Clinici Scientifici Maugeri SPA SB, I.R.C.C.S. Division of Cardiology and Cardiac Rehabilitation, Institute of Cassano Murge, Bari, Italy
| | - Rosa Raimondo
- Istituti Clinici Scientifici Maugeri SPA SB, I.R.C.C.S. Division of Cardiology and Cardiac Rehabilitation, Institute of Tradate, Varese, Italy
| | - Mario Venezia
- Istituti Clinici Scientifici Maugeri SPA SB, Institute of Ginosa Marina, Taranto, Italy
| | - Enrico Ammirati
- "De Gasperis" Cardio Center, Niguarda Hospital, Milan, Italy
| | - Fabrizio Oliva
- "De Gasperis" Cardio Center, Niguarda Hospital, Milan, Italy
| | - Miriam Stucchi
- "De Gasperis" Cardio Center, Niguarda Hospital, Milan, Italy
| | - Maria Frigerio
- "De Gasperis" Cardio Center, Niguarda Hospital, Milan, Italy
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22
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Bruno N, Sinagra G, Paolillo S, Bonomi A, Corrà U, Piepoli M, Veglia F, Salvioni E, Lagioia R, Metra M, Limongelli G, Cattadori G, Scardovi AB, Carubelli V, Scrutino D, Badagliacca R, Guazzi M, Raimondo R, Gentile P, Magrì D, Correale M, Parati G, Re F, Cicoira M, Frigerio M, Bussotti M, Vignati C, Oliva F, Mezzani A, Vergaro G, Di Lenarda A, Passino C, Sciomer S, Pacileo G, Ricci R, Contini M, Apostolo A, Palermo P, Mapelli M, Carriere C, Clemenza F, Binno S, Belardinelli R, Lombardi C, Perrone Filardi P, Emdin M, Agostoni P. Mineralocorticoid receptor antagonists for heart failure: a real-life observational study. ESC Heart Fail 2018; 5:267-274. [PMID: 29397584 PMCID: PMC5933965 DOI: 10.1002/ehf2.12244] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2017] [Revised: 11/13/2017] [Accepted: 11/14/2017] [Indexed: 11/21/2022] Open
Abstract
Aims Mineralocorticoid receptor antagonists (MRAs) have been demonstrated to improve outcomes in reduced ejection fraction heart failure (HFrEF) patients. However, MRAs added to conventional treatment may lead to worsening of renal function and hyperkalaemia. We investigated, in a population‐based analysis, the long‐term effects of MRA treatment in HFrEF patients. Methods and results We analysed data of 6046 patients included in the Metabolic Exercise Cardiac Kidney Index score dataset. Analysis was performed in patients treated (n = 3163) and not treated (n = 2883) with MRA. The study endpoint was a composite of cardiovascular death, urgent heart transplantation, or left ventricular assist device implantation. Ten years' survival was analysed through Kaplan–Meier, compared by log‐rank test and propensity score matching. At 10 years' follow‐up, the MRA‐untreated group had a significantly lower number of events than the MRA‐treated group (P < 0.001). MRA‐treated patients had more severe heart failure (higher New York Heart Association class and lower left ventricular ejection fraction, kidney function, and peak VO2). At a propensity‐score‐matching analysis performed on 1587 patients, MRA‐treated and MRA‐untreated patients showed similar study endpoint values. Conclusions In conclusion, MRA treatment does not affect the composite of cardiovascular death, urgent heart transplantation or left ventricular assist device implantation in a real‐life setting. A meticulous patient follow‐up, as performed in trials, is likely needed to match the positive MRA‐related benefits observed in clinical trials.
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Affiliation(s)
- Noemi Bruno
- Centro Cardiologico Monzino, IRCCS, Milan, Italy
| | - Gianfranco Sinagra
- CardiovascularDepartment, Ospedali Riuniti and University of Trieste, Trieste, Italy
| | | | - Alice Bonomi
- Centro Cardiologico Monzino, IRCCS, Milan, Italy
| | - Ugo Corrà
- Divisione di Cardiologia Riabilitativa, Istituti Clinici Scientifici Maugeri, Veruno, Italy
| | - Massimo Piepoli
- UOC Cardiologia, Guglielmo da Saliceto Hospital, Piacenza, Italy
| | | | | | - Rocco Lagioia
- Division of Cardiology, Istituti Clinici Scientifici Maugeri, Cassano delle Murge, Bari, Italy
| | - Marco Metra
- Cardiology, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Giuseppe Limongelli
- Cardiologia SUN, Ospedale Monaldi (Azienda dei Colli), Seconda Università degli Studi di Napoli, Naples, Italy
| | - Gaia Cattadori
- Unità Operativa Cardiologia Riabilitativa, Multimedica IRCCS, Milan, Italy
| | | | - Valentina Carubelli
- Cardiology, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Domenico Scrutino
- Division of Cardiology, Istituti Clinici Scientifici Maugeri, Cassano delle Murge, Bari, Italy
| | - Roberto Badagliacca
- Dipartimento di Scienze Cardiovascolari, Respiratorie, Nefrologiche, Anestesiologiche eGeriatriche, 'Sapienza' University of Rome, Rome, Italy
| | - Marco Guazzi
- Cardiology University Department, Heart Failure Unit and Cardiopulmonary Laboratory, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Rosa Raimondo
- Divisione di Cardiologia Riabilitativa, Istituti Clinici Scientifici Maugeri, Tradate, Italy
| | - Piero Gentile
- CardiovascularDepartment, Ospedali Riuniti and University of Trieste, Trieste, Italy
| | - Damiano Magrì
- Department of Clinical and Molecular Medicine, Azienda Ospedaliera Sant'Andrea, 'Sapienza' Università degli Studi di Roma, Rome, Italy
| | | | - Gianfranco Parati
- Department of Cardiovascular, Neural, and Metabolic Sciences, San Luca Hospital, Istituto Auxologico Italiano, Milan, Italy.,Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Federica Re
- Cardiology Division, Cardiac Arrhythmia Center and Cardiomyopathies Unit, San Camillo-Forlanini Hospital, Rome, Italy
| | | | - Maria Frigerio
- Dipartimento Cardiologico 'A. De Gasperis', Ospedale Cà Granda-A.O. Niguarda, Milan, Italy
| | - Maurizio Bussotti
- Cardiac Rehabilitation Unit, Istituti Clinici Scientifici Maugeri, Milan, Italy
| | | | - Fabrizio Oliva
- Dipartimento Cardiologico 'A. De Gasperis', Ospedale Cà Granda-A.O. Niguarda, Milan, Italy
| | - Alessandro Mezzani
- Divisione di Cardiologia Riabilitativa, Istituti Clinici Scientifici Maugeri, Veruno, Italy
| | - Giuseppe Vergaro
- Fondazione Gabriele Monasterio, CNR-Regione Toscana, Pisa, Italy
| | - Andrea Di Lenarda
- Cardiovascular Center, Health Authority n.1 and University of Trieste, Trieste, Italy
| | - Claudio Passino
- Fondazione Gabriele Monasterio, CNR-Regione Toscana, Pisa, Italy.,Life Science Institute, Scuola Superiore Sant'Anna, Pisa, Italy
| | - Susanna Sciomer
- Dipartimento di Scienze Cardiovascolari, Respiratorie, Nefrologiche, Anestesiologiche eGeriatriche, 'Sapienza' University of Rome, Rome, Italy
| | - Giuseppe Pacileo
- Cardiologia SUN, Ospedale Monaldi (Azienda dei Colli), Seconda Università degli Studi di Napoli, Naples, Italy
| | - Roberto Ricci
- Cardiology Division, Santo Spirito Hospital, Rome, Italy
| | | | | | | | | | - Cosimo Carriere
- CardiovascularDepartment, Ospedali Riuniti and University of Trieste, Trieste, Italy
| | | | - Simone Binno
- UOC Cardiologia, Guglielmo da Saliceto Hospital, Piacenza, Italy
| | | | - Carlo Lombardi
- Cardiology, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | | | - Michele Emdin
- Fondazione Gabriele Monasterio, CNR-Regione Toscana, Pisa, Italy.,Life Science Institute, Scuola Superiore Sant'Anna, Pisa, Italy
| | - Piergiuseppe Agostoni
- Centro Cardiologico Monzino, IRCCS, Milan, Italy.,Deparment of Clinical Sciences and Community Health, Cardiovascular Section, University of Milano, Milan, Italy
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23
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Agostoni P, Paolillo S, Mapelli M, Gentile P, Salvioni E, Veglia F, Bonomi A, Corrà U, Lagioia R, Limongelli G, Sinagra G, Cattadori G, Scardovi AB, Metra M, Carubelli V, Scrutinio D, Raimondo R, Emdin M, Piepoli M, Magrì D, Parati G, Caravita S, Re F, Cicoira M, Minà C, Correale M, Frigerio M, Bussotti M, Oliva F, Battaia E, Belardinelli R, Mezzani A, Pastormerlo L, Guazzi M, Badagliacca R, Di Lenarda A, Passino C, Sciomer S, Zambon E, Pacileo G, Ricci R, Apostolo A, Palermo P, Contini M, Clemenza F, Marchese G, Gargiulo P, Binno S, Lombardi C, Passantino A, Filardi PP. Multiparametric prognostic scores in chronic heart failure with reduced ejection fraction: a long-term comparison. Eur J Heart Fail 2017; 20:700-710. [PMID: 28949086 DOI: 10.1002/ejhf.989] [Citation(s) in RCA: 73] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2017] [Revised: 07/31/2017] [Accepted: 08/07/2017] [Indexed: 12/28/2022] Open
Abstract
AIMS Risk stratification in heart failure (HF) is crucial for clinical and therapeutic management. A multiparametric approach is the best method to stratify prognosis. In 2012, the Metabolic Exercise test data combined with Cardiac and Kidney Indexes (MECKI) score was proposed to assess the risk of cardiovascular mortality and urgent heart transplantation. The aim of the present study was to compare the prognostic accuracy of MECKI score to that of HF Survival Score (HFSS) and Seattle HF Model (SHFM) in a large, multicentre cohort of HF patients with reduced ejection fraction. METHODS AND RESULTS We collected data on 6112 HF patients and compared the prognostic accuracy of MECKI score, HFSS, and SHFM at 2- and 4-year follow-up for the combined endpoint of cardiovascular death, urgent cardiac transplantation, or ventricular assist device implantation. Patients were followed up for a median of 3.67 years, and 931 cardiovascular deaths, 160 urgent heart transplantations, and 12 ventricular assist device implantations were recorded. At 2-year follow-up, the prognostic accuracy of MECKI score was significantly superior [area under the curve (AUC) 0.781] to that of SHFM (AUC 0.739) and HFSS (AUC 0.723), and this relationship was also confirmed at 4 years (AUC 0.764, 0.725, and 0.720, respectively). CONCLUSION 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.
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Affiliation(s)
- Piergiuseppe Agostoni
- Centro Cardiologico Monzino, IRCCS, Milan, Italy.,Cardiovascular Section, Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | | | | | - Piero Gentile
- Cardiovascular Department, Ospedali Riuniti and University of Trieste, Trieste, Italy
| | | | | | - Alice Bonomi
- Centro Cardiologico Monzino, IRCCS, Milan, Italy
| | - Ugo Corrà
- Division of Cardiac Rehabilitation, Salvatore Maugeri Foundation, IRCCS, Scientific Institute of Veruno, Veruno, Italy
| | - Rocco Lagioia
- Division of Cardiology, Salvatore Maugeri Foundation, IRCCS, Scientific Institute of Cassano Murge, Bari, Italy
| | - Giuseppe Limongelli
- Cardiology SUN, Monaldi Hospital (Azienda dei Colli), Second University of Naples, Naples, Italy
| | - Gianfranco Sinagra
- Cardiovascular Department, Ospedali Riuniti and University of Trieste, Trieste, Italy
| | - Gaia Cattadori
- Cardiac Rehabilitation Unit, Multimedica IRCCS, Milan, Italy
| | | | - Marco Metra
- Cardiology, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Valentina Carubelli
- Cardiology, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Domenico Scrutinio
- Division of Cardiology, Salvatore Maugeri Foundation, IRCCS, Scientific Institute of Cassano Murge, Bari, Italy
| | - Rosa Raimondo
- Salvatore Maugeri Foundation, IRCCS, Scientific Institute of Tradate, Tradate, Italy
| | - Michele Emdin
- Gabriele Monasterio Foundation, CNR-Regione Toscana, Pisa, Italy.,Life Science Institute, Scuola Superiore Sant'Anna, Pisa, Italy
| | - Massimo Piepoli
- Heart Failure Unit, Cardiac Department, Guglielmo da Saliceto Hospital, Piacenza, Italy
| | - Damiano Magrì
- Department of Clinical and Molecular Medicine, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - Gianfranco Parati
- Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy.,Department of Cardiovascular, Neural and Metabolic Sciences, San Luca Hospital, Istituto Auxologico Italiano, Milan, Italy
| | - Sergio Caravita
- Department of Cardiovascular, Neural and Metabolic Sciences, San Luca Hospital, Istituto Auxologico Italiano, Milan, Italy
| | - Federica Re
- Cardiology Division, Cardiac Arrhythmia Center and Cardiomyopathies Unit, San Camillo-Forlanini Hospital, Rome, Italy
| | | | - Chiara Minà
- Department for the Treatment and Study of Cardiothoracic Diseases and Cardiothoracic Transplantation, IRCCS - ISMETT, Palermo, Italy
| | | | - Maria Frigerio
- De Gasperis Cardiocenter, Niguarda Ca' Granda Hospital, Milan, Italy
| | - Maurizio Bussotti
- Cardiac Rehabilitation Unit, Salvatore Maugeri Foundation, IRCCS, Scientific Institute of Milan, Milan, Italy
| | - Fabrizio Oliva
- Department of Cardiology, S. Chiara Hospital, Trento, Italy
| | - Elisa Battaia
- Department of Cardiology, S. Chiara Hospital, Trento, Italy
| | | | - Alessandro Mezzani
- Division of Cardiac Rehabilitation, Salvatore Maugeri Foundation, IRCCS, Scientific Institute of Veruno, Veruno, Italy
| | | | - Marco Guazzi
- Cardiology University Department, Heart Failure Unit and Cardiopulmonary Laboratory, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Roberto Badagliacca
- Department of Cardiovascular, Respiratory, Nephrology, Anesthesiology and Geriatric Sciences, Sapienza University of Rome, Rome, Italy
| | - Andrea Di Lenarda
- Cardiovascular Center, Health Authority n. 1 and University of Trieste, Trieste, Italy
| | - Claudio Passino
- Gabriele Monasterio Foundation, CNR-Regione Toscana, Pisa, Italy.,Life Science Institute, Scuola Superiore Sant'Anna, Pisa, Italy
| | - Susanna Sciomer
- Department of Cardiovascular, Respiratory, Nephrology, Anesthesiology and Geriatric Sciences, Sapienza University of Rome, Rome, Italy
| | - Elena Zambon
- Cardiovascular Department, Ospedali Riuniti and University of Trieste, Trieste, Italy
| | - Giuseppe Pacileo
- Cardiology SUN, Monaldi Hospital (Azienda dei Colli), Second University of Naples, Naples, Italy
| | - Roberto Ricci
- Cardiology Division, Santo Spirito Hospital, Rome, Italy
| | | | | | | | - Francesco Clemenza
- Section of Cardiology, Department of Medicine, University of Verona, Verona, Italy
| | - Giovanni Marchese
- De Gasperis Cardiocenter, Niguarda Ca' Granda Hospital, Milan, Italy
| | | | - Simone Binno
- Heart Failure Unit, Cardiac Department, Guglielmo da Saliceto Hospital, Piacenza, Italy
| | - Carlo Lombardi
- Cardiology, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Andrea Passantino
- Division of Cardiology, Salvatore Maugeri Foundation, IRCCS, Scientific Institute of Cassano Murge, Bari, Italy
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24
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Paolillo S, Mapelli M, Bonomi A, Corrà U, Piepoli M, Veglia F, Salvioni E, Gentile P, Lagioia R, Metra M, Limongelli G, Sinagra G, Cattadori G, Scardovi AB, Carubelli V, Scrutino D, Badagliacca R, Raimondo R, Emdin M, Magrì D, Correale M, Parati G, Caravita S, Spadafora E, Re F, Cicoira M, Frigerio M, Bussotti M, Minà C, Oliva F, Battaia E, Belardinelli R, Mezzani A, Pastormerlo L, Di Lenarda A, Passino C, Sciomer S, Iorio A, Zambon E, Guazzi M, Pacileo G, Ricci R, Contini M, Apostolo A, Palermo P, Clemenza F, Marchese G, Binno S, Lombardi C, Passantino A, Perrone Filardi P, Agostoni P. Prognostic role of β-blocker selectivity and dosage regimens in heart failure patients. Insights from the MECKI score database. Eur J Heart Fail 2017; 19:904-914. [PMID: 28233458 DOI: 10.1002/ejhf.775] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2016] [Revised: 12/17/2016] [Accepted: 12/22/2016] [Indexed: 12/11/2022] Open
Abstract
AIMS The use of β-blockers represents a milestone in the treatment of heart failure with reduced ejection fraction (HFrEF). Few studies have compared β-blockers in HFrEF, and there is little data on the effects of different doses. The present study aimed to investigate in a large database of HFrEF patients (MECKI score database) the association of β-blocker treatment with a composite outcome of cardiovascular death, urgent heart transplantation or left ventricular assist device implantation, addressing the role of β-selectivity and dosage regimens. METHODS AND RESULTS In 5242 HFrEF patients, we investigated the role of: (i) β-blocker treatment vs. non-β-blocker treatment, (ii) β1-/β2-receptor-blockers vs. β1-selective blockers, and (iii) daily β-blocker dose. Patients were followed for 3.58 years, and 1101 events (18.3%) were observed; 4435 patients (86.8%) were on β-blockers, while 807 (13.2%) were not. At 5 years, β-blocker-patients showed a better outcome than non-β-blocker-subjects [hazard ratio (HR) 0.48, P < 0.0001], while also considering potential confounders. A comparable prognosis was observed at 5 years in the β1-/β2-receptor-blocker (n = 2219) vs. β1-selective group (n = 2216) (HR 0.95, P = ns). A better prognosis was observed in high-dose (>2 5 mg carvedilol equivalent daily dose, n = 1005) patients than in both medium dose (12.5-25 mg, n = 1431) and low dose (<12.5 mg, n = 1960) (HR 1.97, P < 0.001; HR 1.95, P = 0.001, respectively), with no differences between the last two groups (HR 0.84, P = ns). CONCLUSION In a large population of chronic HFrEF patients, β-blockers were associated with a more favourable prognosis without any difference between β1- and β2-receptor-blockers vs. β1-selective blockers. A better outcome was observed in subjects receiving a high daily dose.
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Affiliation(s)
- Stefania Paolillo
- IRCCS SDN, Naples, Italy.,Centro Cardiologico Monzino, IRCCS, Milan, Italy
| | | | - Alice Bonomi
- Centro Cardiologico Monzino, IRCCS, Milan, Italy
| | - Ugo Corrà
- Division of Cardiac Rehabilitation, Salvatore Maugeri Foundation, IRCCS, Scientific Institute of Veruno, Veruno, Italy
| | - Massimo Piepoli
- Cardiac Department, Guglielmo da Saliceto Hospital, Piacenza, Italy
| | | | | | - Piero Gentile
- Cardiovascular Department, Ospedali Riuniti and University of Trieste, Trieste, Italy
| | - Rocco Lagioia
- Division of Cardiology, Salvatore Maugeri Foundation, IRCCS, Scientific Institute of Cassano Murge, Bari, Italy
| | - Marco Metra
- Cardiology, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Giuseppe Limongelli
- Cardiology SUN, Monaldi Hospital (Azienda dei Colli), Second University of Naples, Naples, Italy
| | - Gianfranco Sinagra
- Cardiovascular Department, Ospedali Riuniti and University of Trieste, Trieste, Italy
| | - Gaia Cattadori
- Cardiac Rehabilitation, San Giuseppe Hospital, Multimedica Spa, IRCCS, Milan, Italy
| | | | - Valentina Carubelli
- Cardiology, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Domenico Scrutino
- Division of Cardiology, Salvatore Maugeri Foundation, IRCCS, Scientific Institute of Cassano Murge, Bari, Italy
| | - Roberto Badagliacca
- Department of Cardiovascular, Respiratory, Nephrology, Anesthesiology, and Geriatric Sciences, 'Sapienza' University of Rome, Rome, Italy
| | - Rosa Raimondo
- Salvatore Maugeri, Foundation IRCCS, Scientific Institute of Tradate, Italy
| | - Michele Emdin
- Life Science Institute, Scuola Superiore Sant'Anna, Pisa, Italy.,Gabriele Monasterio, Foundation CNR-Regione Toscana, Pisa, Italy
| | - Damiano Magrì
- Department of Clinical and Molecular Medicine, Sant'Andrea Hospital, 'Sapienza' University of Rome, Rome, Italy
| | | | - Gianfranco Parati
- Department of Cardiovascular, Neural and Metabolic Sciences, San Luca Hospital, Istituto Auxologico Italiano, Milan, Italy.,Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Sergio Caravita
- Department of Cardiovascular, Neural and Metabolic Sciences, San Luca Hospital, Istituto Auxologico Italiano, Milan, Italy
| | | | - Federica Re
- Cardiology Division, Cardiac Arrhythmia Centre and Cardiomyopathies Unit, San Camillo-Forlanini Hospital, Rome, Italy
| | | | - Maria Frigerio
- 'A. De Gasperis' Cardio Center, Niguarda Hospital, Milan, Italy
| | - Maurizio Bussotti
- Cardiac Rehabilitation Unit, Salvatore Maugeri, Foundation, IRCCS, Scientific Institute of Milan, Milan, Italy
| | - Chiara Minà
- Department for the Treatment and Study of Cardiothoracic Diseases and Cardiothoracic Transplantation IRCCS - ISMETT, Palermo, Italy
| | - Fabrizio Oliva
- 'A. De Gasperis' Cardio Center, Niguarda Hospital, Milan, Italy
| | - Elisa Battaia
- Department of Cardiology, S. Chiara Hospital, Trento, Italy
| | | | - Alessandro Mezzani
- Division of Cardiac Rehabilitation, Salvatore Maugeri Foundation, IRCCS, Scientific Institute of Veruno, Veruno, Italy
| | | | - Andrea Di Lenarda
- Cardiovascular Center, Health Authority n. 1 and University of Trieste, Trieste, Italy
| | - Claudio Passino
- Life Science Institute, Scuola Superiore Sant'Anna, Pisa, Italy.,Gabriele Monasterio, Foundation CNR-Regione Toscana, Pisa, Italy
| | - Susanna Sciomer
- Department of Cardiovascular, Respiratory, Nephrology, Anesthesiology, and Geriatric Sciences, 'Sapienza' University of Rome, Rome, Italy
| | | | - Elena Zambon
- Cardiovascular Department, Ospedali Riuniti and University of Trieste, Trieste, Italy
| | - Marco Guazzi
- Cardiology University Department, Heart Failure Unit and Cardiopulmonary Laboratory, IRCCS Policlinico San Donato, San Donato, Milan, Italy
| | - Giuseppe Pacileo
- Cardiology SUN, Monaldi Hospital (Azienda dei Colli), Second University of Naples, Naples, Italy
| | - Roberto Ricci
- Cardiology Division, Santo Spirito Hospital, Rome, Italy
| | | | | | | | - Francesco Clemenza
- Department for the Treatment and Study of Cardiothoracic Diseases and Cardiothoracic Transplantation IRCCS - ISMETT, Palermo, Italy
| | - Giovanni Marchese
- Department of Clinical and Molecular Medicine, Sant'Andrea Hospital, 'Sapienza' University of Rome, Rome, Italy
| | - Simone Binno
- Cardiac Department, Guglielmo da Saliceto Hospital, Piacenza, Italy
| | - Carlo Lombardi
- Cardiology, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Andrea Passantino
- Division of Cardiology, Salvatore Maugeri Foundation, IRCCS, Scientific Institute of Cassano Murge, Bari, Italy
| | | | - Piergiuseppe Agostoni
- Centro Cardiologico Monzino, IRCCS, Milan, Italy.,Department of Clinical Sciences and Community Health, Cardiovascular Section, University of Milan, Milan, Italy
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25
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Cattadori G, Agostoni P, Corrà U, Sinagra G, Veglia F, Salvioni E, Bonomi A, La Gioia R, Scardovi AB, Ferraironi A, Emdin M, Metra M, Di Lenarda A, Limongelli G, Raimondo R, Re F, Guazzi M, Belardinelli R, Parati G, Caravita S, Magrì D, Lombardi C, Frigerio M, Oliva F, Girola D, Mezzani A, Farina S, Mapelli M, Scrutinio D, Pacileo G, Apostolo A, Iorio A, Paolillo S, Filardi PP, Gargiulo P, Bussotti M, Marchese G, Correale M, Badagliacca R, Sciomer S, Palermo P, Contini M, Giannuzzi P, Battaia E, Cicoira M, Clemenza F, Minà C, Binno S, Passino C, Piepoli MF. Heart failure and anemia: Effects on prognostic variables. Eur J Intern Med 2017; 37:56-63. [PMID: 27692931 DOI: 10.1016/j.ejim.2016.09.011] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2016] [Revised: 07/21/2016] [Accepted: 09/14/2016] [Indexed: 12/15/2022]
Abstract
BACKGROUND Anemia is frequent in heart failure (HF), and it is associated with higher mortality. The predictive power of established HF prognostic parameters in anemic HF patients is unknown. METHODS Clinical, laboratory, echocardiographic and cardiopulmonary-exercise-test (CPET) data were analyzed in 3913 HF patients grouped according to hemoglobin (Hb) values. 248 (6%), 857 (22%), 2160 (55%) and 648 (17%) patients had very low (<11g/dL), low (11-12 for females, 11-13 for males), normal (12-15 for females, 13-15 for males) and high (>15) Hb, respectively. RESULTS Median follow-up was 1363days (606-1883). CPETs were always performed safely. Hb was related to prognosis (Hazard ratio (HR)=0.864). No prognostic difference was observed between normal and high Hb groups. Peak oxygen consumption (VO2), ventilatory efficiency (VE/VCO2 slope), plasma sodium concentration, ejection fraction (LVEF), kidney function and Hb were independently related to prognosis in the entire population. Considering Hb groups separately, peakVO2 (very low Hb HR=0.549, low Hb HR=0.613, normal Hb HR=0.618, high Hb HR=0.542) and LVEF (very low Hb HR=0.49, low Hb HR=0.692, normal Hb HR=0.697, high Hb HR=0.694) maintained their prognostic roles. High VE/VCO2 slope was associated with poor prognosis only in patients with low and normal Hb. CONCLUSIONS Anemic HF patients have a worse prognosis, but CPET can be safely performed. PeakVO2 and LVEF, but not VE/VCO2 slope, maintain their prognostic power also in HF patients with Hb<11g/dL, suggesting CPET use and a multiparametric approach in HF patients with low Hb. However, the prognostic effect of an anemia-oriented follow-up is unknown.
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Affiliation(s)
- Gaia Cattadori
- Centro Cardiologico Monzino, IRCCS, Milano, Italy; Unità Operativa Cardiologia Riabilitativa, Ospedale S. Giuseppe, Multimedica Spa, IRCCS, Milano, Italy; Scuola Superiore S. Anna, Pisa, Italy
| | - Piergiuseppe Agostoni
- Centro Cardiologico Monzino, IRCCS, Milano, Italy; Dipartimento di Scienze Cliniche e di Comunità, Sezione Cardiovascolare, Università di Milano, Italy.
| | - Ugo Corrà
- Divisione di Cardiologia Riabilitativa, Fondazione Salvatore Maugeri, Istituto Scientifico di Veruno, IRCCS, Veruno, Italy
| | - Gianfranco Sinagra
- Cardiovascular Department, Ospedali Riuniti and University of Trieste, Trieste, Italy
| | | | | | - Alice Bonomi
- Centro Cardiologico Monzino, IRCCS, Milano, Italy
| | - Rocco La Gioia
- Division of Cardiology, "S. Maugeri" Foundation, Institute of Cassano Murge, IRCCS, Bari, Italy
| | - Angela B Scardovi
- UOC Cardiologia Ospedale S. Spirito, Roma Lungotevere in Sassia 3, Roma, Italy
| | | | - Michele Emdin
- Fondazione Gabriele Monasterio, CNR-Regione Toscana, Pisa, Italy; Life Science Institute, Scuola Superiore Sant'Anna, Pisa, Italy
| | - Marco Metra
- Cardiology, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Andrea Di Lenarda
- Centro Cardiovascolare, Azienda per i Servizi Sanitari n°1, Trieste, Italy
| | - Giuseppe Limongelli
- Cardiologia SUN, Ospedale Monaldi (Azienda dei Colli), Seconda Università di Napoli, Napoli, Italy
| | - Rosa Raimondo
- Fondazione Salvatore Maugeri, Istituto Scientifico di Tradate, Dipartimento di Medicina e Riabilitazione Cardiorespiratoria Unità Operativa di Cardiologia Riabilitativa, IRCCS, Tradate, Italy
| | - Federica Re
- Cardiology Division, Cardiac Arrhythmia Center and Cardiomyopathies Unit, San Camillo-Forlanini Hospital, Roma, Italy
| | - Marco Guazzi
- Department of Medical Sciences, Cardiology, I.R.C.C.S. San Donato Hospital, University of Milan, San Donato Milanese, Milano, Italy
| | | | - Gianfranco Parati
- Dept of Clinical Medicine and Prevention, University of Milano Bicocca & Dept of Cardiology, S. Luca Hospital, Istituto Auxologico Italiano, Milano, Italy
| | - Sergio Caravita
- Dept of Clinical Medicine and Prevention, University of Milano Bicocca & Dept of Cardiology, S. Luca Hospital, Istituto Auxologico Italiano, Milano, Italy
| | - Damiano Magrì
- Dipartimento di Medicina Clinica e Molecolare, "Sapienza" Università degli Studi di Roma, Roma, Italy
| | - Carlo Lombardi
- Cardiology, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Maria Frigerio
- Dipartimento Cardiologico "A. De Gasperis", Ospedale Cà Granda- A.O. Niguarda, Milano, Italy
| | - Fabrizio Oliva
- Dipartimento Cardiologico "A. De Gasperis", Ospedale Cà Granda- A.O. Niguarda, Milano, Italy
| | - Davide Girola
- Unità Operativa Cardiologia Riabilitativa, Ospedale S. Giuseppe, Multimedica Spa, IRCCS, Milano, Italy
| | - Alessandro Mezzani
- Divisione di Cardiologia Riabilitativa, Fondazione Salvatore Maugeri, Istituto Scientifico di Veruno, IRCCS, Veruno, Italy
| | | | | | - Domenico Scrutinio
- Division of Cardiology, "S. Maugeri" Foundation, Institute of Cassano Murge, IRCCS, Bari, Italy
| | - Giuseppe Pacileo
- Cardiologia SUN, Ospedale Monaldi (Azienda dei Colli), Seconda Università di Napoli, Napoli, Italy
| | | | | | | | | | | | - Maurizio Bussotti
- Cardiac Rehabilitation Unit, Fondazione Salvatore Maugeri, Scientific Institute of Milan, IRCCS, Milan, Italy
| | - Giovanni Marchese
- Cardiac Rehabilitation Unit, Fondazione Salvatore Maugeri, Scientific Institute of Milan, IRCCS, Milan, Italy
| | | | - Roberto Badagliacca
- Dipartimento di Scienze Cardiovascolari, Respiratorie, Nefrologiche, Anestesioloigiche e Geriatriche, "Sapienza", Rome University, Rome, Italy
| | - Susanna Sciomer
- Dipartimento di Scienze Cardiovascolari, Respiratorie, Nefrologiche, Anestesioloigiche e Geriatriche, "Sapienza", Rome University, Rome, Italy
| | | | | | - Pantaleo Giannuzzi
- Divisione di Cardiologia Riabilitativa, Fondazione Salvatore Maugeri, Istituto Scientifico di Veruno, IRCCS, Veruno, Italy
| | - Elisa Battaia
- Department of Medicine, Section of Cardiology, University of Verona, Verona, Italy
| | | | - Francesco Clemenza
- Department for the Treatment and Study of Cardiothoracic Diseases and Cardiothoracic Transplantation IRCCS-ISMETT, Palermo, Italy
| | - Chiara Minà
- Department for the Treatment and Study of Cardiothoracic Diseases and Cardiothoracic Transplantation IRCCS-ISMETT, Palermo, Italy
| | - Simone Binno
- UOC Cardiologia, G da Saliceto Hospital, Piacenza, Italy
| | - Claudio Passino
- Fondazione Gabriele Monasterio, CNR-Regione Toscana, Pisa, Italy; Life Science Institute, Scuola Superiore Sant'Anna, Pisa, Italy
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26
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Corrà U, Agostoni P, Giordano A, Cattadori G, Battaia E, La Gioia R, Scardovi AB, Emdin M, Metra M, Sinagra G, Limongelli G, Raimondo R, Re F, Guazzi M, Belardinelli R, Parati G, Magrì D, Fiorentini C, Cicoira M, Salvioni E, Giovannardi M, Veglia F, Mezzani A, Scrutinio D, Di Lenarda A, Ricci R, Apostolo A, Iorio AM, Paolillo S, Palermo P, Contini M, Vassanelli C, Passino C, Giannuzzi P, Piepoli MF. Sex Profile and Risk Assessment With Cardiopulmonary Exercise Testing in Heart Failure: Propensity Score Matching for Sex Selection Bias. Can J Cardiol 2016; 32:754-9. [DOI: 10.1016/j.cjca.2015.09.010] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2015] [Revised: 09/10/2015] [Accepted: 09/15/2015] [Indexed: 01/20/2023] Open
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27
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Piepoli MF, Corrà U, Veglia F, Bonomi A, Salvioni E, Cattadori G, Metra M, Lombardi C, Sinagra G, Limongelli G, Raimondo R, Re F, Magrì D, Belardinelli R, Parati G, Minà C, Scardovi AB, Guazzi M, Cicoira M, Scrutinio D, Di Lenarda A, Bussotti M, Frigerio M, Correale M, Villani GQ, Paolillo S, Passino C, Agostoni P. Exercise tolerance can explain the obesity paradox in patients with systolic heart failure: data from the MECKI Score Research Group. Eur J Heart Fail 2016; 18:545-53. [DOI: 10.1002/ejhf.534] [Citation(s) in RCA: 53] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2015] [Revised: 01/08/2016] [Accepted: 01/09/2016] [Indexed: 11/12/2022] Open
Affiliation(s)
- Massimo F. Piepoli
- Heart Failure Unit, Cardiology Department; G da Saliceto Hospital; Piacenza Italy
| | - Ugo Corrà
- Divisione di Cardiologia Riabilitativa, Fondazione Salvatore Maugeri, IRCCS; Istituto Scientifico di Veruno; Veruno Italy
| | | | - Alice Bonomi
- Centro Cardiologico Monzino, IRCCS; Milano Italy
| | | | - Gaia Cattadori
- Centro Cardiologico Monzino, IRCCS; Milano Italy
- Unità Operativa Cardiologia Riabilitativa, Ospedale S.Giuseppe, Multimedica Spa, IRCCS; Milano Italy
| | - Marco Metra
- Cardiology, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health; University of Brescia; Italy
| | - Carlo Lombardi
- Cardiology, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health; University of Brescia; Italy
| | - Gianfranco Sinagra
- Cardiovascular Department; Ospedali Riuniti and University of Trieste; Trieste Italy
| | - Giuseppe Limongelli
- Cardiologia SUN, Ospedale Monaldi (Azienda dei Colli); Seconda Università di Napoli; Napoli Italy
| | - Rosa Raimondo
- Salvatore Maugeri Foundation, IRCCS, Istituto Scientifico di Tradate, Dipartimento di Medicina e Riabilitazione Cardiorespiratoria Unità Operativa di Cardiologia Riabilitativa; Tradate Italy
| | - Federica Re
- Cardiology Division, Cardiac Arrhythmia Center and Cardiomyopathies Unit, St.Camillo-Forlanini Hospital; Roma Italy
| | - Damiano Magrì
- Department of Clinical and Molecular Medicine; La Sapienza University; Roma Italy
| | | | - Gianfranco Parati
- Department of Health Science; University of Milano Bicocca and Department of Cardiology, S.Luca Hospital, Istituto Auxologico Italiano; Milano Italy
| | - Chiara Minà
- ISMETT (Mediterranean Institute for Transplantation and Advanced Specialized Therapies), Palermo; Italy
| | | | - Marco Guazzi
- Department of Medical Sciences, Cardiology, IRCCS San Donato Hospital; University of Milan; San Donato Milanese Italy
| | | | - Domenico Scrutinio
- Division of Cardiology, Salvatore Maugeri Foundation; IRCCS, Institute of Cassano Murge; Bari Italy
| | | | - Maurizio Bussotti
- Division of Cardiology, Salvatore Maugeri Foundation; IRCCS, Institute of Milan; Milan Italy
| | - Maria Frigerio
- Cardiologic Department ‘A. De Gasperis’, Ospedale Cà Granda-A.O. Niguarda; Milano Italy
| | | | | | | | - Claudio Passino
- Centro Cardiologico Monzino, IRCCS; Milano Italy
- Gabriele Monasterio Foundation, CNR-Regione Toscana; Pisa Italy
- Scuola Superiore S. Anna; Pisa Italy
| | - Piergiuseppe Agostoni
- Centro Cardiologico Monzino, IRCCS; Milano Italy
- Department of Clinical Sciences and Community Health, Cardiovascular Section; University of Milano; Milano Italy
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Paolillo S, Agostoni P, Masarone D, Corrà U, Passino C, Scrutinio D, Correale M, Cattadori G, Metra M, Girola D, Piepoli MF, Salvioni E, Giovannardi M, Iorio A, Emdin M, Raimondo R, Re F, Cicoira M, Belardinelli R, Guazzi M, Clemenza F, Parati G, Scardovi AB, Di Lenarda A, La Gioia R, Frigerio M, Lombardi C, Gargiulo P, Sinagra G, Pacileo G, Perrone-Filardi P, Limongelli G. Prognostic role of atrial fibrillation in patients affected by chronic heart failure. Data from the MECKI score research group. Eur J Intern Med 2015; 26:515-20. [PMID: 26026698 DOI: 10.1016/j.ejim.2015.04.023] [Citation(s) in RCA: 15] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2015] [Revised: 04/22/2015] [Accepted: 04/27/2015] [Indexed: 12/21/2022]
Abstract
BACKGROUND Atrial fibrillation (AF) is common in heart failure (HF). It is unclear whether AF has an independent prognostic role in HF. The aim of the present study was to assess the prognostic role of AF in HF patients with reduced ejection fraction (EF). METHODS HF patients were followed in 17 centers for 3.15years (1.51-5.24). Study endpoints were the composite of cardiovascular (CV) death and heart transplant (HTX) and all-cause death. Data analysis was performed considering the entire population and a 1 to 1 match between sinus rhythm (SR) and AF patients. Match process was done for age±5, gender, left ventricle EF±5, peakVO2±3 (ml/min/kg) and recruiting center. RESULTS A total of 3447 patients (SR=2882, AF=565) were included in the study. Considering the entire population, CV death and HTX occurred in 114 (20%) AF vs. 471 (16%) SR (p=0.026) and all-cause death in 130 (23%) AF vs. 554 (19.2%) SR patients (p=0.039). At univariable Cox analysis, AF was significantly related to prognosis. Applying a multivariable model based on all variables significant at univariable analysis (EF, peakVO2, ventilation/carbon dioxide relationship slope, sodium, kidney function, hemoglobin, beta-blockers and digoxin) AF was no longer associated with adverse outcomes. Matching procedure resulted in 338 couples. CV death and HTX occurred in 63 (18.6%) AF vs. 74 (21.9%) SR (p=0.293) and all-cause death in 71 (21%) AF vs. 80 (23.6%) SR (p=0.406), with no survival differences between groups. CONCLUSION In systolic HF AF is a marker of disease severity but not an independent prognostic indicator.
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Affiliation(s)
- Stefania Paolillo
- Department of Advanced Biomedical Sciences, "Federico II" University, Napoli, Italy
| | - Piergiuseppe Agostoni
- Centro Cardiologico Monzino, IRCCS, Milano, Italy; Department of Clinical Sciences and Community Health, Università di Milano, Milano, Italy.
| | - Daniele Masarone
- Cardiologia SUN, Ospedale Monaldi (Azienda dei Colli), Seconda Università di Napoli, Napoli, Italy
| | - Ugo Corrà
- Divisione di Cardiologia Riabilitativa, Fondazione Salvatore Maugeri, IRCCS, Istituto Scientifico di Veruno, Veruno, Italy
| | - Claudio Passino
- Fondazione Gabriele Monasterio, CNR-Regione Toscana, Pisa, Italy; Scuola Superiore S. Anna, Pisa, Italy
| | - Domenico Scrutinio
- Division of Cardiology, "S. Maugeri" Foundation, IRCCS, Institute of Cassano Murge, Bari, Italy
| | | | | | - Marco Metra
- Cardiology, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - Davide Girola
- Dipartimento Cardiologico "A. De Gasperis", Ospedale Cà Granda-A.O. Niguarda, Milano, Italy
| | | | | | | | - Annamaria Iorio
- Cardiovascular Department, Ospedali Riuniti and University of Trieste, Trieste, Italy
| | - Michele Emdin
- Fondazione Gabriele Monasterio, CNR-Regione Toscana, Pisa, Italy
| | - Rosa Raimondo
- Fondazione Salvatore Maugeri, IRCCS, Istituto Scientifico di Tradate, Dipartimento di Medicina e Riabilitazione Cardiorespiratoria Unità Operativa di Cardiologia Riabilitativa, Tradate, Varese, Italy
| | - Federica Re
- Cardiology Division, Cardiac Arrhythmia Center and Cardiomyopathies Unit, San Camillo-Forlanini Hospital, Roma, Italy
| | | | | | - Marco Guazzi
- Heart Failure Unit, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Francesco Clemenza
- Heart Failure Unit, ISMETT (Mediterranean Institute for Transplantation and Advanced Specialized Therapies), Palermo, Italy
| | - Gianfranco Parati
- Department of Health Science, University of Milano Bicocca & Department of Cardiology, San Luca Hospital, Istituto Auxologico Italiano, Milano, Italy
| | | | - Andrea Di Lenarda
- Centro Cardiovascolare, Azienda per i Servizi Sanitari no. 1, Trieste, Italy
| | - Rocco La Gioia
- Division of Cardiology, "S. Maugeri" Foundation, IRCCS, Institute of Cassano Murge, Bari, Italy
| | - Maria Frigerio
- Dipartimento Cardiologico "A. De Gasperis", Ospedale Cà Granda-A.O. Niguarda, Milano, Italy
| | - Carlo Lombardi
- Department of Cardiology, University of Foggia, Foggia, Italy
| | - Paola Gargiulo
- SDN Foundation, Institute of Diagnostic and Nuclear Development, Napoli, Italy
| | - Gianfranco Sinagra
- Cardiovascular Department, Ospedali Riuniti and University of Trieste, Trieste, Italy
| | - Giuseppe Pacileo
- Cardiologia SUN, Ospedale Monaldi (Azienda dei Colli), Seconda Università di Napoli, Napoli, Italy
| | | | - Giuseppe Limongelli
- Cardiologia SUN, Ospedale Monaldi (Azienda dei Colli), Seconda Università di Napoli, Napoli, Italy
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Scrutinio D, Agostoni P, Gesualdo L, Corrà U, Mezzani A, Piepoli M, Di Lenarda A, Iorio A, Passino C, Magrì D, Masarone D, Battaia E, Girola D, Re F, Cattadori G, Parati G, Sinagra G, Villani GQ, Limongelli G, Pacileo G, Guazzi M, Metra M, Frigerio M, Cicoira M, Minà C, Malfatto G, Caravita S, Bussotti M, Salvioni E, Veglia F, Correale M, Scardovi AB, Emdin M, Giannuzzi P, Gargiulo P, Giovannardi M, Perrone-Filardi P, Raimondo R, Ricci R, Paolillo S, Farina S, Belardinelli R, Passantino A, La Gioia R. Renal Function and Peak Exercise Oxygen Consumption in Chronic Heart Failure With Reduced Left Ventricular Ejection Fraction. Circ J 2015; 79:583-91. [DOI: 10.1253/circj.cj-14-0806] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Domenico Scrutinio
- Division of Cardiology, “S. Maugeri” Foundation, IRCCS, Institute of Cassano Murge
| | - Piergiuseppe Agostoni
- Centro Cardiologico Monzino, IRCCS
- Department of Clinical Sciences and Community Health, Cardiovascular Section, University of Milano
| | - Loreto Gesualdo
- Renal, Dialysis and Transplant Unit, Department of Emergency and Organ Transplantation, University of Bari
| | - Ugo Corrà
- Division of Cardiology Rehabilitation, “S. Maugeri” Foundation, IRCCS, Scientific Institute of Veruno
| | - Alessandro Mezzani
- Division of Cardiology Rehabilitation, “S. Maugeri” Foundation, IRCCS, Scientific Institute of Veruno
| | | | - Andrea Di Lenarda
- Cardiovascular Center, Health Authority no.°1 and University of Trieste
| | - Annamaria Iorio
- Cardiovascular Department, Ospedali Riuniti and University of Trieste
| | - Claudio Passino
- Gabriele Monasterio Foundation, CNR-Regione Toscana
- Scuola Superiore S. Anna
| | - Damiano Magrì
- Department of Clinical and Molecular Medicine, Azienda Ospedaliera Sant’Andrea, “Sapienza” University of Roma
| | - Daniele Masarone
- Cardiology SUN, Monaldi Hospital (Azienda dei Colli), Second University of Napoli
| | - Elisa Battaia
- Section of Cardiology, Department of Medicine, University of Verona
| | - Davide Girola
- Cardiologic Department “A. De Gasperis”, Cà Granda-A.O. Hospital Niguarda
| | - Federica Re
- Cardiology Division, Cardiac Arrhythmia Center and Cardiomyopathies Unit, San Camillo-Forlanini Hospital
| | | | - Gianfranco Parati
- Department of Health Science, University of Milano Bicocca & Department of Cardiology, San Luca Hospital, Istituto Auxologico Italiano
| | | | | | - Giuseppe Limongelli
- Cardiology SUN, Monaldi Hospital (Azienda dei Colli), Second University of Napoli
| | - Giuseppe Pacileo
- Cardiology SUN, Monaldi Hospital (Azienda dei Colli), Second University of Napoli
| | - Marco Guazzi
- Heart Failure Unit, IRCCS Policlinico San Donato
| | - Marco Metra
- Cardiology, Department of Medical and Surgical Specialities, Radiological Sciences, and Public Health, University of Brescia
| | - Maria Frigerio
- Cardiologic Department “A. De Gasperis”, Cà Granda-A.O. Hospital Niguarda
| | | | - Chiara Minà
- ISMETT (Mediterranean Institute for Transplantation and Advanced Specialized Therapies)
| | - Gabriella Malfatto
- Department of Health Science, University of Milano Bicocca & Department of Cardiology, San Luca Hospital, Istituto Auxologico Italiano
| | - Sergio Caravita
- Department of Health Science, University of Milano Bicocca & Department of Cardiology, San Luca Hospital, Istituto Auxologico Italiano
| | - Maurizio Bussotti
- Division of Cardiology, Salvatore Maugeri Foundation, IRCCS, Institute of Milan
| | | | | | | | | | | | - Pantaleo Giannuzzi
- Division of Cardiology Rehabilitation, “S. Maugeri” Foundation, IRCCS, Scientific Institute of Veruno
| | - Paola Gargiulo
- SDN Foundation, Institute of Diagnostic and Nuclear Development
| | | | | | - Rosa Raimondo
- “S. Maugeri” Foundation, IRCCS, Institute of Tradate, Department of Medicine and Cardiorespiratory Rehabilitation, Unit of Cardiac Rehabilitation, Tradate
| | | | - Stefania Paolillo
- Department of Advanced Biomedical Sciences, “Federico II” University
| | | | | | - Andrea Passantino
- Division of Cardiology, “S. Maugeri” Foundation, IRCCS, Institute of Cassano Murge
| | - Rocco La Gioia
- Division of Cardiology, “S. Maugeri” Foundation, IRCCS, Institute of Cassano Murge
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Carubelli V, Metra M, Corrà U, Magrì D, Passino C, Lombardi C, Scrutinio D, Correale M, Cattadori G, Piepoli MF, Salvioni E, Giovannardi M, Raimondo R, Cicoira M, Belardinelli R, Guazzi M, Limongelli G, Clemenza F, Parati G, Scardovi AB, Di Lenarda A, Bussotti M, La Gioia R, Agostoni P. Exercise Performance Is a Prognostic Indicator in Elderly Patients With Chronic Heart Failure – Application of Metabolic Exercise Cardiac Kidney Indexes Score –. Circ J 2015; 79:2608-15. [DOI: 10.1253/circj.cj-15-0026] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Valentina Carubelli
- Division of Cardiology, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University and Civil Hospital of Brescia
| | - Marco Metra
- Division of Cardiology, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University and Civil Hospital of Brescia
| | - Ugo Corrà
- Division of Cardiology Rehabilitation, “S. Maugeri” Foundation, IRCCS, Scientific Institute of Veruno
| | - Damiano Magrì
- Department of Clinical and Molecular Medicine, Azienda Ospedaliera Sant’Andrea, “Sapienza” University of Rome
| | - Claudio Passino
- Gabriele Monasterio Foundation, CNR-Regione Toscana
- Scuola Superiore S. Anna
| | - Carlo Lombardi
- Division of Cardiology, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University and Civil Hospital of Brescia
| | - Domenico Scrutinio
- Division of Cardiology, “S. Maugeri” Foundation, IRCCS, Institute of Cassano Murge
| | | | | | | | | | | | - Rosa Raimondo
- “S. Maugeri” Foundation, IRCCS, Institute of Tradate, Department of Medicine and Cardiorespiratory Rehabilitation, Unit of Cardiac Rehabilitation
| | | | | | - Marco Guazzi
- Heart Failure Unit, IRCCS Policlinico San Donato
| | - Giuseppe Limongelli
- Cardiology SUN, Monaldi Hospital (Azienda dei Colli), Second University of Naples
| | - Francesco Clemenza
- ISMETT (Mediterranean Institute for Transplantation and Advanced Specialized Therapies)
| | - Gianfranco Parati
- Department of Health Science, University of Milan Bicocca & Department of Cardiology, San Luca Hospital, Istituto Auxologico Italiano
| | | | - Andrea Di Lenarda
- Cardiovascular Center, Health Authority no.°1 and University of Trieste
| | - Maurizio Bussotti
- Division of Cardiology, Salvatore Maugeri Foundation, IRCCS, Institute of Milan
| | - Rocco La Gioia
- Division of Cardiology, “S. Maugeri” Foundation, IRCCS, Institute of Cassano Murge
| | - Piergiuseppe Agostoni
- Centro Cardiologico Monzino, IRCCS
- Department of Clinical Sciences and Community Health, University of Milan
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Magrì D, Agostoni P, Corrà U, Passino C, Scrutinio D, Perrone-Filardi P, Correale M, Cattadori G, Metra M, Girola D, Piepoli MF, Iorio A, Emdin M, Raimondo R, Re F, Cicoira M, Belardinelli R, Guazzi M, Limongelli G, Clemenza F, Parati G, Frigerio M, Casenghi M, Scardovi AB, Ferraironi A, Di Lenarda A, Bussotti M, Apostolo A, Paolillo S, La Gioia R, Gargiulo P, Palermo P, Minà C, Farina S, Battaia E, Maruotti A, Pacileo G, Contini M, Oliva F, Ricci R, Sinagra G. Deceptive meaning of oxygen uptake measured at the anaerobic threshold in patients with systolic heart failure and atrial fibrillation. Eur J Prev Cardiol 2014; 22:1046-55. [DOI: 10.1177/2047487314551546] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2014] [Accepted: 08/26/2014] [Indexed: 01/23/2023]
Affiliation(s)
- Damiano Magrì
- Department of Clinical and Molecular Medicine, “La Sapienza” University of Rome, Italy
- Centro Cardiologico Monzino, IRCCS, Italy
| | - Piergiuseppe Agostoni
- Centro Cardiologico Monzino, IRCCS, Italy
- Department of Clinical Sciences and Community Health, University of Milano, Italy
| | - Ugo Corrà
- Divisione di Cardiologia Riabilitativa, Fondazione Salvatore Maugeri, IRCCS, Istituto Scientifico di Veruno, Italy
| | - Claudio Passino
- Fondazione Gabriele Monasterio, CNR-Regione Toscana, Italy
- Scuola Superiore S. Anna, Italy
| | - Domenico Scrutinio
- Division of Cardiology, “S. Maugeri” Foundation, IRCCS, Institute of Cassano Murge, Italy
| | | | | | | | - Marco Metra
- Cardiology, Department of Medical and Surgical Specialities, Radiological Sciences, and Public Health, University of Brescia, Italy
| | - Davide Girola
- Dipartimento Cardiologico “A. De Gasperis”, Ospedale Cà Granda- A.O. Niguarda, Italy
| | | | - AnnaMaria Iorio
- Cardiovascular Department, Ospedali Riuniti and University of Trieste, Italy
| | - Michele Emdin
- Fondazione Gabriele Monasterio, CNR-Regione Toscana, Italy
| | - Rosa Raimondo
- Fondazione Salvatore Maugeri, IRCCS, Istituto Scientifico di Tradate, Italy
| | - Federica Re
- Cardiology Division, Cardiac Arrhythmia Center and Cardiomyopathies Unit, San Camillo-Forlanini Hospital, Italy
| | | | | | - Marco Guazzi
- Heart Failure Unit, IRCCS Policlinico San Donato, Italy
| | - Giuseppe Limongelli
- Cardiologia SUN, Ospedale Monaldi (Azienda dei Colli), Seconda Università di Napoli, Italy
| | - Francesco Clemenza
- Mediterranean Institute for Transplantation and Advanced Specialized Therapies, Italy
| | | | - Maria Frigerio
- Dipartimento Cardiologico “A. De Gasperis”, Ospedale Cà Granda- A.O. Niguarda, Italy
| | - Matteo Casenghi
- Department of Clinical and Molecular Medicine, “La Sapienza” University of Rome, Italy
| | | | | | | | - Maurizio Bussotti
- Division of Cardiology, Salvatore Maugeri Foundation, IRCCS, Institute of Milan, Italy
| | | | - Stefania Paolillo
- Department of Advanced Biomedical Sciences, “Federico II” University, Italy
| | - Rocco La Gioia
- Division of Cardiology, “S. Maugeri” Foundation, IRCCS, Institute of Cassano Murge, Italy
| | - Paola Gargiulo
- SDN Foundation, Institute of Diagnostic and Nuclear Development, Napoli, Italy
| | | | - Chiara Minà
- Mediterranean Institute for Transplantation and Advanced Specialized Therapies, Italy
| | | | - Elisa Battaia
- Section of Cardiology, Department of Medicine, University of Verona, Italy
| | - Antonello Maruotti
- Southampton Statistical Sciences Research Institute & School of Mathematics, University of Southampton, United Kingdom
- Department of Politic Sciences, Università “Roma Tre”, Italy
| | - Giuseppe Pacileo
- Cardiologia SUN, Ospedale Monaldi (Azienda dei Colli), Seconda Università di Napoli, Italy
| | | | - Fabrizio Oliva
- Dipartimento Cardiologico “A. De Gasperis”, Ospedale Cà Granda- A.O. Niguarda, Italy
| | | | - Gianfranco Sinagra
- Cardiovascular Department, Ospedali Riuniti and University of Trieste, Italy
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Scrutinio D, Mastropasqua F, Guida P, Ammirati E, Ricci V, Raimondo R, Frigerio M, Lagioia R, Oliva F. Renal Dysfunction and Accuracy of N-Terminal Pro-B-Type Natriuretic Peptide in Predicting Mortality for Hospitalized Patients With Heart Failure. Circ J 2014; 78:2439-46. [DOI: 10.1253/circj.cj-14-0405] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Domenico Scrutinio
- Division of Cardiology and Cardiac Rehabilitation, “S. Maugeri” Foundation, IRCCS, Institute of Cassano Murge
| | - Filippo Mastropasqua
- Division of Cardiology and Cardiac Rehabilitation, “S. Maugeri” Foundation, IRCCS, Institute of Cassano Murge
| | - Pietro Guida
- Division of Cardiology and Cardiac Rehabilitation, “S. Maugeri” Foundation, IRCCS, Institute of Cassano Murge
| | - Enrico Ammirati
- Cardiothoracic and Vascular Department, Niguarda Cà Granda Hospital
- San Raffaele Scientific Institute and University
| | - Vitoantonio Ricci
- Division of Cardiology and Cardiac Rehabilitation, “S. Maugeri” Foundation, IRCCS, Institute of Cassano Murge
| | - Rosa Raimondo
- Division of Cardiology and Cardiac Rehabilitation, “S. Maugeri” Foundation, IRCCS, Institute of Tradate
| | - Maria Frigerio
- Cardiothoracic and Vascular Department, Niguarda Cà Granda Hospital
| | - Rocco Lagioia
- Division of Cardiology and Cardiac Rehabilitation, “S. Maugeri” Foundation, IRCCS, Institute of Cassano Murge
| | - Fabrizio Oliva
- Cardiothoracic and Vascular Department, Niguarda Cà Granda Hospital
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Scrutinio D, Ammirati E, Guida P, Passantino A, Raimondo R, Guida V, Sarzi Braga S, Canova P, Mastropasqua F, Frigerio M, Lagioia R, Oliva F. The ADHF/NT-proBNP risk score to predict 1-year mortality in hospitalized patients with advanced decompensated heart failure. J Heart Lung Transplant 2013; 33:404-11. [PMID: 24485712 DOI: 10.1016/j.healun.2013.12.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2013] [Revised: 10/24/2013] [Accepted: 12/11/2013] [Indexed: 10/25/2022] Open
Abstract
BACKGROUND The acute decompensated heart failure/N-terminal pro-B-type natriuretic peptide (ADHF/NT-proBNP) score is a validated risk scoring system that predicts mortality in hospitalized heart failure patients with a wide range of left ventricular ejection fractions (LVEFs). We sought to assess discrimination and calibration of the score when applied to patients with advanced decompensated heart failure (AHF). METHODS We studied 445 patients hospitalized for AHF, defined by the presence of severe symptoms of worsening HF at admission, severely depressed LVEF, and the need for intravenous diuretic and/or inotropic drugs. The primary outcome was cumulative (in-hospital and post-discharge) mortality and post-discharge 1-year mortality. Separate analyses were performed for patients aged ≤ 70 years. A Seattle Heart Failure Score (SHFS) was calculated for each patient discharged alive. RESULTS During follow-up, 144 patients (32.4%) died, and 69 (15.5%) underwent heart transplantation (HT) or ventricular assist device (VAD) implantation. After accounting for the competing events (VAD/HT), the ADHF/NT-proBNP score's C-statistic for cumulative mortality was 0.738 in the overall cohort and 0.771 in patients aged ≤ 70 years. The C-statistic for post-discharge mortality was 0.741 and 0.751, respectively. Adding prior (≤6 months) hospitalizations for HF to the score increased the C-statistic for post-discharge mortality to 0.759 in the overall cohort and to 0.774 in patients aged ≤ 70 years. Predicted and observed mortality rates by quartiles of score were highly correlated. The SHFS demonstrated adequate discrimination but underestimated the risk. The ADHF/NT-proBNP risk calculator is available at http://www.fsm.it/fsm/file/NTproBNPscore.zip. CONCLUSIONS Our data suggest that the ADHF/NT-proBNP score may efficiently predict mortality in patients hospitalized with AHF.
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Affiliation(s)
- Domenico Scrutinio
- Division of Cardiology and Cardiac Rehabilitation, "S. Maugeri" Foundation, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Institute of Cassano Murge. Bari.
| | - Enrico Ammirati
- Cardiothoracic and Vascular Department, Niguarda Ca' Granda Hospital, Milan; San Raffaele Scientific Institute and University, Milan
| | - Pietro Guida
- Division of Cardiology and Cardiac Rehabilitation, "S. Maugeri" Foundation, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Institute of Cassano Murge. Bari
| | - Andrea Passantino
- Division of Cardiology and Cardiac Rehabilitation, "S. Maugeri" Foundation, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Institute of Cassano Murge. Bari
| | - Rosa Raimondo
- Division of Cardiology and Cardiac Rehabilitation, "S. Maugeri" Foundation, IRCCS, Institute of Tradate, Varese, Italy
| | - Valentina Guida
- Cardiothoracic and Vascular Department, Niguarda Ca' Granda Hospital, Milan
| | - Simona Sarzi Braga
- Division of Cardiology and Cardiac Rehabilitation, "S. Maugeri" Foundation, IRCCS, Institute of Tradate, Varese, Italy
| | - Paolo Canova
- Cardiothoracic and Vascular Department, Niguarda Ca' Granda Hospital, Milan
| | - Filippo Mastropasqua
- Division of Cardiology and Cardiac Rehabilitation, "S. Maugeri" Foundation, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Institute of Cassano Murge. Bari
| | - Maria Frigerio
- Cardiothoracic and Vascular Department, Niguarda Ca' Granda Hospital, Milan
| | - Rocco Lagioia
- Division of Cardiology and Cardiac Rehabilitation, "S. Maugeri" Foundation, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Institute of Cassano Murge. Bari
| | - Fabrizio Oliva
- Cardiothoracic and Vascular Department, Niguarda Ca' Granda Hospital, Milan
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Agostoni P, Corrà U, Cattadori G, Veglia F, Battaia E, La Gioia R, Scardovi AB, Emdin M, Metra M, Sinagra G, Limongelli G, Raimondo R, Re F, Guazzi M, Belardinelli R, Parati G, Magrì D, Fiorentini C, Cicoira M, Salvioni E, Giovannardi M, Mezzani A, Scrutinio D, Di Lenarda A, Mantegazza V, Ricci R, Apostolo A, Iorio A, Paolillo S, Palermo P, Contini M, Vassanelli C, Passino C, Piepoli MF. Prognostic Value of Indeterminable Anaerobic Threshold in Heart Failure. Circ Heart Fail 2013; 6:977-87. [DOI: 10.1161/circheartfailure.113.000471] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Affiliation(s)
- Piergiuseppe Agostoni
- From the Centro Cardiologico Monzino, IRCCS, Milano, Italy (P.A., G.C., F.V., E.B., C.F., E.S., M.G., V.M., A.A., P.P., M.C.); Department of Clinical Sciences and Community Health, Cardiovascular Section, Università di Milano, Milano, Italy (P.A., C.F.); Department of Respiratory and Critical Care Medicine, University of Washington, Seattle, WA (P.A.); Divisione di Cardiologia Riabilitativa, Fondazione Salvatore Maugeri, IRCCS, Istituto Scientifico di Veruno, Veruno, Italy (U.C., A.M.); Section of
| | - Ugo Corrà
- From the Centro Cardiologico Monzino, IRCCS, Milano, Italy (P.A., G.C., F.V., E.B., C.F., E.S., M.G., V.M., A.A., P.P., M.C.); Department of Clinical Sciences and Community Health, Cardiovascular Section, Università di Milano, Milano, Italy (P.A., C.F.); Department of Respiratory and Critical Care Medicine, University of Washington, Seattle, WA (P.A.); Divisione di Cardiologia Riabilitativa, Fondazione Salvatore Maugeri, IRCCS, Istituto Scientifico di Veruno, Veruno, Italy (U.C., A.M.); Section of
| | - Gaia Cattadori
- From the Centro Cardiologico Monzino, IRCCS, Milano, Italy (P.A., G.C., F.V., E.B., C.F., E.S., M.G., V.M., A.A., P.P., M.C.); Department of Clinical Sciences and Community Health, Cardiovascular Section, Università di Milano, Milano, Italy (P.A., C.F.); Department of Respiratory and Critical Care Medicine, University of Washington, Seattle, WA (P.A.); Divisione di Cardiologia Riabilitativa, Fondazione Salvatore Maugeri, IRCCS, Istituto Scientifico di Veruno, Veruno, Italy (U.C., A.M.); Section of
| | - Fabrizio Veglia
- From the Centro Cardiologico Monzino, IRCCS, Milano, Italy (P.A., G.C., F.V., E.B., C.F., E.S., M.G., V.M., A.A., P.P., M.C.); Department of Clinical Sciences and Community Health, Cardiovascular Section, Università di Milano, Milano, Italy (P.A., C.F.); Department of Respiratory and Critical Care Medicine, University of Washington, Seattle, WA (P.A.); Divisione di Cardiologia Riabilitativa, Fondazione Salvatore Maugeri, IRCCS, Istituto Scientifico di Veruno, Veruno, Italy (U.C., A.M.); Section of
| | - Elisa Battaia
- From the Centro Cardiologico Monzino, IRCCS, Milano, Italy (P.A., G.C., F.V., E.B., C.F., E.S., M.G., V.M., A.A., P.P., M.C.); Department of Clinical Sciences and Community Health, Cardiovascular Section, Università di Milano, Milano, Italy (P.A., C.F.); Department of Respiratory and Critical Care Medicine, University of Washington, Seattle, WA (P.A.); Divisione di Cardiologia Riabilitativa, Fondazione Salvatore Maugeri, IRCCS, Istituto Scientifico di Veruno, Veruno, Italy (U.C., A.M.); Section of
| | - Rocco La Gioia
- From the Centro Cardiologico Monzino, IRCCS, Milano, Italy (P.A., G.C., F.V., E.B., C.F., E.S., M.G., V.M., A.A., P.P., M.C.); Department of Clinical Sciences and Community Health, Cardiovascular Section, Università di Milano, Milano, Italy (P.A., C.F.); Department of Respiratory and Critical Care Medicine, University of Washington, Seattle, WA (P.A.); Divisione di Cardiologia Riabilitativa, Fondazione Salvatore Maugeri, IRCCS, Istituto Scientifico di Veruno, Veruno, Italy (U.C., A.M.); Section of
| | - Angela B. Scardovi
- From the Centro Cardiologico Monzino, IRCCS, Milano, Italy (P.A., G.C., F.V., E.B., C.F., E.S., M.G., V.M., A.A., P.P., M.C.); Department of Clinical Sciences and Community Health, Cardiovascular Section, Università di Milano, Milano, Italy (P.A., C.F.); Department of Respiratory and Critical Care Medicine, University of Washington, Seattle, WA (P.A.); Divisione di Cardiologia Riabilitativa, Fondazione Salvatore Maugeri, IRCCS, Istituto Scientifico di Veruno, Veruno, Italy (U.C., A.M.); Section of
| | - Michele Emdin
- From the Centro Cardiologico Monzino, IRCCS, Milano, Italy (P.A., G.C., F.V., E.B., C.F., E.S., M.G., V.M., A.A., P.P., M.C.); Department of Clinical Sciences and Community Health, Cardiovascular Section, Università di Milano, Milano, Italy (P.A., C.F.); Department of Respiratory and Critical Care Medicine, University of Washington, Seattle, WA (P.A.); Divisione di Cardiologia Riabilitativa, Fondazione Salvatore Maugeri, IRCCS, Istituto Scientifico di Veruno, Veruno, Italy (U.C., A.M.); Section of
| | - Marco Metra
- From the Centro Cardiologico Monzino, IRCCS, Milano, Italy (P.A., G.C., F.V., E.B., C.F., E.S., M.G., V.M., A.A., P.P., M.C.); Department of Clinical Sciences and Community Health, Cardiovascular Section, Università di Milano, Milano, Italy (P.A., C.F.); Department of Respiratory and Critical Care Medicine, University of Washington, Seattle, WA (P.A.); Divisione di Cardiologia Riabilitativa, Fondazione Salvatore Maugeri, IRCCS, Istituto Scientifico di Veruno, Veruno, Italy (U.C., A.M.); Section of
| | - Gianfranco Sinagra
- From the Centro Cardiologico Monzino, IRCCS, Milano, Italy (P.A., G.C., F.V., E.B., C.F., E.S., M.G., V.M., A.A., P.P., M.C.); Department of Clinical Sciences and Community Health, Cardiovascular Section, Università di Milano, Milano, Italy (P.A., C.F.); Department of Respiratory and Critical Care Medicine, University of Washington, Seattle, WA (P.A.); Divisione di Cardiologia Riabilitativa, Fondazione Salvatore Maugeri, IRCCS, Istituto Scientifico di Veruno, Veruno, Italy (U.C., A.M.); Section of
| | - Giuseppe Limongelli
- From the Centro Cardiologico Monzino, IRCCS, Milano, Italy (P.A., G.C., F.V., E.B., C.F., E.S., M.G., V.M., A.A., P.P., M.C.); Department of Clinical Sciences and Community Health, Cardiovascular Section, Università di Milano, Milano, Italy (P.A., C.F.); Department of Respiratory and Critical Care Medicine, University of Washington, Seattle, WA (P.A.); Divisione di Cardiologia Riabilitativa, Fondazione Salvatore Maugeri, IRCCS, Istituto Scientifico di Veruno, Veruno, Italy (U.C., A.M.); Section of
| | - Rosa Raimondo
- From the Centro Cardiologico Monzino, IRCCS, Milano, Italy (P.A., G.C., F.V., E.B., C.F., E.S., M.G., V.M., A.A., P.P., M.C.); Department of Clinical Sciences and Community Health, Cardiovascular Section, Università di Milano, Milano, Italy (P.A., C.F.); Department of Respiratory and Critical Care Medicine, University of Washington, Seattle, WA (P.A.); Divisione di Cardiologia Riabilitativa, Fondazione Salvatore Maugeri, IRCCS, Istituto Scientifico di Veruno, Veruno, Italy (U.C., A.M.); Section of
| | - Federica Re
- From the Centro Cardiologico Monzino, IRCCS, Milano, Italy (P.A., G.C., F.V., E.B., C.F., E.S., M.G., V.M., A.A., P.P., M.C.); Department of Clinical Sciences and Community Health, Cardiovascular Section, Università di Milano, Milano, Italy (P.A., C.F.); Department of Respiratory and Critical Care Medicine, University of Washington, Seattle, WA (P.A.); Divisione di Cardiologia Riabilitativa, Fondazione Salvatore Maugeri, IRCCS, Istituto Scientifico di Veruno, Veruno, Italy (U.C., A.M.); Section of
| | - Marco Guazzi
- From the Centro Cardiologico Monzino, IRCCS, Milano, Italy (P.A., G.C., F.V., E.B., C.F., E.S., M.G., V.M., A.A., P.P., M.C.); Department of Clinical Sciences and Community Health, Cardiovascular Section, Università di Milano, Milano, Italy (P.A., C.F.); Department of Respiratory and Critical Care Medicine, University of Washington, Seattle, WA (P.A.); Divisione di Cardiologia Riabilitativa, Fondazione Salvatore Maugeri, IRCCS, Istituto Scientifico di Veruno, Veruno, Italy (U.C., A.M.); Section of
| | - Romualdo Belardinelli
- From the Centro Cardiologico Monzino, IRCCS, Milano, Italy (P.A., G.C., F.V., E.B., C.F., E.S., M.G., V.M., A.A., P.P., M.C.); Department of Clinical Sciences and Community Health, Cardiovascular Section, Università di Milano, Milano, Italy (P.A., C.F.); Department of Respiratory and Critical Care Medicine, University of Washington, Seattle, WA (P.A.); Divisione di Cardiologia Riabilitativa, Fondazione Salvatore Maugeri, IRCCS, Istituto Scientifico di Veruno, Veruno, Italy (U.C., A.M.); Section of
| | - Gianfranco Parati
- From the Centro Cardiologico Monzino, IRCCS, Milano, Italy (P.A., G.C., F.V., E.B., C.F., E.S., M.G., V.M., A.A., P.P., M.C.); Department of Clinical Sciences and Community Health, Cardiovascular Section, Università di Milano, Milano, Italy (P.A., C.F.); Department of Respiratory and Critical Care Medicine, University of Washington, Seattle, WA (P.A.); Divisione di Cardiologia Riabilitativa, Fondazione Salvatore Maugeri, IRCCS, Istituto Scientifico di Veruno, Veruno, Italy (U.C., A.M.); Section of
| | - Damiano Magrì
- From the Centro Cardiologico Monzino, IRCCS, Milano, Italy (P.A., G.C., F.V., E.B., C.F., E.S., M.G., V.M., A.A., P.P., M.C.); Department of Clinical Sciences and Community Health, Cardiovascular Section, Università di Milano, Milano, Italy (P.A., C.F.); Department of Respiratory and Critical Care Medicine, University of Washington, Seattle, WA (P.A.); Divisione di Cardiologia Riabilitativa, Fondazione Salvatore Maugeri, IRCCS, Istituto Scientifico di Veruno, Veruno, Italy (U.C., A.M.); Section of
| | - Cesare Fiorentini
- From the Centro Cardiologico Monzino, IRCCS, Milano, Italy (P.A., G.C., F.V., E.B., C.F., E.S., M.G., V.M., A.A., P.P., M.C.); Department of Clinical Sciences and Community Health, Cardiovascular Section, Università di Milano, Milano, Italy (P.A., C.F.); Department of Respiratory and Critical Care Medicine, University of Washington, Seattle, WA (P.A.); Divisione di Cardiologia Riabilitativa, Fondazione Salvatore Maugeri, IRCCS, Istituto Scientifico di Veruno, Veruno, Italy (U.C., A.M.); Section of
| | - Mariantonietta Cicoira
- From the Centro Cardiologico Monzino, IRCCS, Milano, Italy (P.A., G.C., F.V., E.B., C.F., E.S., M.G., V.M., A.A., P.P., M.C.); Department of Clinical Sciences and Community Health, Cardiovascular Section, Università di Milano, Milano, Italy (P.A., C.F.); Department of Respiratory and Critical Care Medicine, University of Washington, Seattle, WA (P.A.); Divisione di Cardiologia Riabilitativa, Fondazione Salvatore Maugeri, IRCCS, Istituto Scientifico di Veruno, Veruno, Italy (U.C., A.M.); Section of
| | - Elisabetta Salvioni
- From the Centro Cardiologico Monzino, IRCCS, Milano, Italy (P.A., G.C., F.V., E.B., C.F., E.S., M.G., V.M., A.A., P.P., M.C.); Department of Clinical Sciences and Community Health, Cardiovascular Section, Università di Milano, Milano, Italy (P.A., C.F.); Department of Respiratory and Critical Care Medicine, University of Washington, Seattle, WA (P.A.); Divisione di Cardiologia Riabilitativa, Fondazione Salvatore Maugeri, IRCCS, Istituto Scientifico di Veruno, Veruno, Italy (U.C., A.M.); Section of
| | - Marta Giovannardi
- From the Centro Cardiologico Monzino, IRCCS, Milano, Italy (P.A., G.C., F.V., E.B., C.F., E.S., M.G., V.M., A.A., P.P., M.C.); Department of Clinical Sciences and Community Health, Cardiovascular Section, Università di Milano, Milano, Italy (P.A., C.F.); Department of Respiratory and Critical Care Medicine, University of Washington, Seattle, WA (P.A.); Divisione di Cardiologia Riabilitativa, Fondazione Salvatore Maugeri, IRCCS, Istituto Scientifico di Veruno, Veruno, Italy (U.C., A.M.); Section of
| | - Alessandro Mezzani
- From the Centro Cardiologico Monzino, IRCCS, Milano, Italy (P.A., G.C., F.V., E.B., C.F., E.S., M.G., V.M., A.A., P.P., M.C.); Department of Clinical Sciences and Community Health, Cardiovascular Section, Università di Milano, Milano, Italy (P.A., C.F.); Department of Respiratory and Critical Care Medicine, University of Washington, Seattle, WA (P.A.); Divisione di Cardiologia Riabilitativa, Fondazione Salvatore Maugeri, IRCCS, Istituto Scientifico di Veruno, Veruno, Italy (U.C., A.M.); Section of
| | - Domenico Scrutinio
- From the Centro Cardiologico Monzino, IRCCS, Milano, Italy (P.A., G.C., F.V., E.B., C.F., E.S., M.G., V.M., A.A., P.P., M.C.); Department of Clinical Sciences and Community Health, Cardiovascular Section, Università di Milano, Milano, Italy (P.A., C.F.); Department of Respiratory and Critical Care Medicine, University of Washington, Seattle, WA (P.A.); Divisione di Cardiologia Riabilitativa, Fondazione Salvatore Maugeri, IRCCS, Istituto Scientifico di Veruno, Veruno, Italy (U.C., A.M.); Section of
| | - Andrea Di Lenarda
- From the Centro Cardiologico Monzino, IRCCS, Milano, Italy (P.A., G.C., F.V., E.B., C.F., E.S., M.G., V.M., A.A., P.P., M.C.); Department of Clinical Sciences and Community Health, Cardiovascular Section, Università di Milano, Milano, Italy (P.A., C.F.); Department of Respiratory and Critical Care Medicine, University of Washington, Seattle, WA (P.A.); Divisione di Cardiologia Riabilitativa, Fondazione Salvatore Maugeri, IRCCS, Istituto Scientifico di Veruno, Veruno, Italy (U.C., A.M.); Section of
| | - Valentina Mantegazza
- From the Centro Cardiologico Monzino, IRCCS, Milano, Italy (P.A., G.C., F.V., E.B., C.F., E.S., M.G., V.M., A.A., P.P., M.C.); Department of Clinical Sciences and Community Health, Cardiovascular Section, Università di Milano, Milano, Italy (P.A., C.F.); Department of Respiratory and Critical Care Medicine, University of Washington, Seattle, WA (P.A.); Divisione di Cardiologia Riabilitativa, Fondazione Salvatore Maugeri, IRCCS, Istituto Scientifico di Veruno, Veruno, Italy (U.C., A.M.); Section of
| | - Roberto Ricci
- From the Centro Cardiologico Monzino, IRCCS, Milano, Italy (P.A., G.C., F.V., E.B., C.F., E.S., M.G., V.M., A.A., P.P., M.C.); Department of Clinical Sciences and Community Health, Cardiovascular Section, Università di Milano, Milano, Italy (P.A., C.F.); Department of Respiratory and Critical Care Medicine, University of Washington, Seattle, WA (P.A.); Divisione di Cardiologia Riabilitativa, Fondazione Salvatore Maugeri, IRCCS, Istituto Scientifico di Veruno, Veruno, Italy (U.C., A.M.); Section of
| | - Anna Apostolo
- From the Centro Cardiologico Monzino, IRCCS, Milano, Italy (P.A., G.C., F.V., E.B., C.F., E.S., M.G., V.M., A.A., P.P., M.C.); Department of Clinical Sciences and Community Health, Cardiovascular Section, Università di Milano, Milano, Italy (P.A., C.F.); Department of Respiratory and Critical Care Medicine, University of Washington, Seattle, WA (P.A.); Divisione di Cardiologia Riabilitativa, Fondazione Salvatore Maugeri, IRCCS, Istituto Scientifico di Veruno, Veruno, Italy (U.C., A.M.); Section of
| | - AnnaMaria Iorio
- From the Centro Cardiologico Monzino, IRCCS, Milano, Italy (P.A., G.C., F.V., E.B., C.F., E.S., M.G., V.M., A.A., P.P., M.C.); Department of Clinical Sciences and Community Health, Cardiovascular Section, Università di Milano, Milano, Italy (P.A., C.F.); Department of Respiratory and Critical Care Medicine, University of Washington, Seattle, WA (P.A.); Divisione di Cardiologia Riabilitativa, Fondazione Salvatore Maugeri, IRCCS, Istituto Scientifico di Veruno, Veruno, Italy (U.C., A.M.); Section of
| | - Stefania Paolillo
- From the Centro Cardiologico Monzino, IRCCS, Milano, Italy (P.A., G.C., F.V., E.B., C.F., E.S., M.G., V.M., A.A., P.P., M.C.); Department of Clinical Sciences and Community Health, Cardiovascular Section, Università di Milano, Milano, Italy (P.A., C.F.); Department of Respiratory and Critical Care Medicine, University of Washington, Seattle, WA (P.A.); Divisione di Cardiologia Riabilitativa, Fondazione Salvatore Maugeri, IRCCS, Istituto Scientifico di Veruno, Veruno, Italy (U.C., A.M.); Section of
| | - Pietro Palermo
- From the Centro Cardiologico Monzino, IRCCS, Milano, Italy (P.A., G.C., F.V., E.B., C.F., E.S., M.G., V.M., A.A., P.P., M.C.); Department of Clinical Sciences and Community Health, Cardiovascular Section, Università di Milano, Milano, Italy (P.A., C.F.); Department of Respiratory and Critical Care Medicine, University of Washington, Seattle, WA (P.A.); Divisione di Cardiologia Riabilitativa, Fondazione Salvatore Maugeri, IRCCS, Istituto Scientifico di Veruno, Veruno, Italy (U.C., A.M.); Section of
| | - Mauro Contini
- From the Centro Cardiologico Monzino, IRCCS, Milano, Italy (P.A., G.C., F.V., E.B., C.F., E.S., M.G., V.M., A.A., P.P., M.C.); Department of Clinical Sciences and Community Health, Cardiovascular Section, Università di Milano, Milano, Italy (P.A., C.F.); Department of Respiratory and Critical Care Medicine, University of Washington, Seattle, WA (P.A.); Divisione di Cardiologia Riabilitativa, Fondazione Salvatore Maugeri, IRCCS, Istituto Scientifico di Veruno, Veruno, Italy (U.C., A.M.); Section of
| | - Corrado Vassanelli
- From the Centro Cardiologico Monzino, IRCCS, Milano, Italy (P.A., G.C., F.V., E.B., C.F., E.S., M.G., V.M., A.A., P.P., M.C.); Department of Clinical Sciences and Community Health, Cardiovascular Section, Università di Milano, Milano, Italy (P.A., C.F.); Department of Respiratory and Critical Care Medicine, University of Washington, Seattle, WA (P.A.); Divisione di Cardiologia Riabilitativa, Fondazione Salvatore Maugeri, IRCCS, Istituto Scientifico di Veruno, Veruno, Italy (U.C., A.M.); Section of
| | - Claudio Passino
- From the Centro Cardiologico Monzino, IRCCS, Milano, Italy (P.A., G.C., F.V., E.B., C.F., E.S., M.G., V.M., A.A., P.P., M.C.); Department of Clinical Sciences and Community Health, Cardiovascular Section, Università di Milano, Milano, Italy (P.A., C.F.); Department of Respiratory and Critical Care Medicine, University of Washington, Seattle, WA (P.A.); Divisione di Cardiologia Riabilitativa, Fondazione Salvatore Maugeri, IRCCS, Istituto Scientifico di Veruno, Veruno, Italy (U.C., A.M.); Section of
| | - Massimo F. Piepoli
- From the Centro Cardiologico Monzino, IRCCS, Milano, Italy (P.A., G.C., F.V., E.B., C.F., E.S., M.G., V.M., A.A., P.P., M.C.); Department of Clinical Sciences and Community Health, Cardiovascular Section, Università di Milano, Milano, Italy (P.A., C.F.); Department of Respiratory and Critical Care Medicine, University of Washington, Seattle, WA (P.A.); Divisione di Cardiologia Riabilitativa, Fondazione Salvatore Maugeri, IRCCS, Istituto Scientifico di Veruno, Veruno, Italy (U.C., A.M.); Section of
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Pedretti RFE, Laporta A, Masnaghetti S, Raimondo R, Salerno M, Santoro F, Vaninetti R. [Prevention of sudden death in heart failure patients: cardiac resynchronization therapy with or without defibrillation back-up]. G Ital Cardiol (Rome) 2010; 11:134S-136S. [PMID: 21416844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
The prevalence and incidence of heart failure are progressively increasing in both Europe and the United States. Despite many advances in diagnosis and therapy, morbidity and mortality remain high and long-term prognosis is still poor in most heart failure patients. The use of implantable devices, cardiac resynchronization therapy and implantable cardioverter-defibrillators plays a pivotal role in the treatment of heart failure. Cardiac resynchronization therapy improves survival and reduces cardiac mortality due to either sudden or non-sudden death. In clinical practice, patients with an indication for cardiac resynchronization therapy should be carefully evaluated in view of a potential concomitant indication for defibrillator implantation. The combination of the two therapies may have maximal beneficial effects on prognosis.
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Affiliation(s)
- Roberto F E Pedretti
- U.O. di Cardiologia, IRCCS Fondazione Salvatore Maugeri, Istituto Scientifico di Tradate, Tradate (VA).
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Pedretti RFE, Sarzi Braga S, Vaninetti R, Laporta A, Masnaghetti S, Raimondo R, Rubin D, Santoro F, Salerno M. [Risk stratification for sudden cardiac death: from the electrophysiological study to T-wave alternans]. G Ital Cardiol (Rome) 2008; 9:33S-39S. [PMID: 19195304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
T-wave alternans is a change, in the microvolt range, of T-wave amplitude on an ABABAB sequence. At present, various groups of patients have been evaluated, including those with myocardial infarction, congestive heart failure, implantable cardioverter-defibrillators and a clinical indication for programmed ventricular stimulation. In all clinical conditions analyzed, T-wave alternans analysis demonstrated a good diagnostic accuracy, suggesting a possible clinical use of the test in these settings.
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Affiliation(s)
- Roberto F E Pedretti
- U.O. di Cardiologia, IRCCS Fondazione Salvatore Maugeri, Istituto Scientifico di Tradate, Tradate (VA).
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Guazzi M, Vicenzi M, Raimondo R, Sarzi S, Pedretti R, Arena R. Ventilatory Abnormalities during Exercise Are Associated with Doppler-Estimated Left Ventricular Filling Pressure and Ejection Fraction in Patients with Heart Failure. J Card Fail 2007. [DOI: 10.1016/j.cardfail.2007.06.351] [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: 10/23/2022]
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Guazzi M, Vicenzi M, Raimondo R, Sarzi S, Pedretti R, Arena R. A Prognostic Comparison of Echocardiography vs. Cardiopulmonary-Derived Variables in Patients with Heart Failure. J Card Fail 2007. [DOI: 10.1016/j.cardfail.2007.06.585] [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: 10/22/2022]
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Guazzi M, Raimondo R, Vicenzi M, Arena R, Proserpio C, Sarzi Braga S, Pedretti R. Exercise oscillatory ventilation may predict sudden cardiac death in heart failure patients. J Am Coll Cardiol 2007; 50:299-308. [PMID: 17659196 DOI: 10.1016/j.jacc.2007.03.042] [Citation(s) in RCA: 90] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2007] [Revised: 02/26/2007] [Accepted: 03/05/2007] [Indexed: 01/27/2023]
Abstract
OBJECTIVES The purpose of this study was to test the ability of cardiopulmonary exercise testing (CPET)-derived variables as sudden cardiac death (SCD) predictors. BACKGROUND The CPET variables, such as peak oxygen uptake (VO2), ventilatory requirement to carbon dioxide (CO2) production (VE/VCO2) slope, and exercise oscillatory breathing (EOB), are strong predictors of overall mortality in chronic heart failure (CHF) patients. Even though up to 50% of CHF patients die from SCD, it is unknown whether any of these variables predicts SCD. METHODS One hundred fifty-six CHF patients (mean age: 60.9 +/- 9.4 years; mean ejection fraction: 34.9 +/- 10.6%) underwent CPET. Subjects were tracked for sudden versus pump-failure cardiac mortality over 27.8 +/- 25.2 months. RESULTS Seventeen patients died from SCD, and 17 died from cardiac pump failure. Survivors showed significantly higher peak VO2 (16.8 +/- 4.5 ml x kg(-1) x min(-1)) and lower VE/VCO2 slope (32.8 +/- 6.4) and prevalence of EOB (20.3%), compared with subjects who experienced arrhythmic (13.5 +/- 3.2 ml x kg(-1) x min(-1); 41.5 +/- 11.4; 100%) or nonarrhythmic (14.1 +/- 4.7 ml x kg(-1) x min(-1); 38.1 +/- 7.3; 47.1%) deaths (p < 0.05). At Cox regression analysis, all variables were significant univariate predictors of both sudden and pump failure death (p < 0.01). Multivariate analysis, including left ventricular (LV) ejection fraction, LV end systolic volume, and LV mass selected EOB, was the strongest predictor of both overall mortality (chi-square: 38.7, p < 0.001) and SCD (chi-square: 44.7, p < 0.001), whereas VE/VCO2 slope was the strongest ventilatory predictor of pump failure death (chi-square: 11.8, p = 0.001). CONCLUSIONS Exercise oscillatory breathing is an independent predictor of SCD in patients with CHF and might help as an additional marker for prioritization of antiarrhythmic strategies.
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Affiliation(s)
- Marco Guazzi
- Cardiopulmonary Unit, Cardiology Division, University of Milano, San Paolo Hospital, Milano, Italy.
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