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.

Gender and age normalization and ventilation efficiency during exercise in heart failure with reduced ejection fraction / Salvioni, E.; Corra, U.; Piepoli, M.; Rovai, S.; Correale, M.; Paolillo, S.; Pasquali, M.; Magri, 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, A. B.; Filardi, P. P.; 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.. - In: ESC HEART FAILURE. - ISSN 2055-5822. - 7:1(2020), pp. 371-380. [10.1002/ehf2.12582]

Gender and age normalization and ventilation efficiency during exercise in heart failure with reduced ejection fraction

Corra U.;Piepoli M.;Paolillo S.;Cangiano L.;Filardi P. P.;Piccioli L.;
2020

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.
2020
Gender and age normalization and ventilation efficiency during exercise in heart failure with reduced ejection fraction / Salvioni, E.; Corra, U.; Piepoli, M.; Rovai, S.; Correale, M.; Paolillo, S.; Pasquali, M.; Magri, 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, A. B.; Filardi, P. P.; 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.. - In: ESC HEART FAILURE. - ISSN 2055-5822. - 7:1(2020), pp. 371-380. [10.1002/ehf2.12582]
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/11588/813182
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