MagrÌ Damiano, Piepoli Massimo, CorrÀ Ugo, Gallo Giovanna, Maruotti Antonello, Vignati Carlo, Salvioni Elisabetta, Mapelli Massimo, Paolillo Stefania, Perrone Filardi Pasquale, Girola Davide, Metra Marco, Scardovi Angela B, Lagioia Rocco, Limongelli Giuseppe, Senni Michele, Scrutinio Domenico, Emdin Michele, Passino Claudio, Lombardi Carlo, Cattadori Gaia, Parati Gianfranco, Cicoira Mariantonietta, Correale Michele, Frigerio Maria, Clemenza Francesco, Bussotti Maurizio, Guazzi Marco, Badagliacca Roberto, Sciomer Susanna, DI Lenarda Andrea, Maggioni Aldo, Sinagra Gianfranco, Volpe Massimo, Agostoni Piergiuseppe
Department of Clinical and Molecular Medicine, Azienda Ospedaliera Sant'Andrea, "Sapienza" Università degli Studi di Roma, Roma, Italy.
UOC Cardiologia, G da Saliceto Hospital, Piacenza, Italy.
J Card Fail. 2020 Nov;26(11):932-943. doi: 10.1016/j.cardfail.2020.04.021. Epub 2020 May 17.
Heart failure with midrange ejection fraction (HFmrEF) represents a heterogeneous category where phenotype, as well as prognostic assessment, remains debated. The present study explores a specific HFmrEF subset, namely those who recovered from a reduced EF (rec-HFmrEF) and, particularly, it focuses on the possible additive prognostic role of cardiopulmonary exercise testing.
We analyzed data from 4535 patients with HFrEF and 1176 patients with rec-HFmrEF from the Metabolic Exercise combined with Cardiac and Kidney Indexes database. The end point was cardiovascular death at 5 years. The median follow-up was 1343 days (25th-75th range 627-2403 days). Cardiovascular death occurred in 552 HFrEF and 61 rec-HFmrEF patients. The multivariate analysis confirmed an independent role of the MECKI score's variables in HFrEF (C-index = 0.744) whereas, in the rec-HFmrEF group, only age and peak oxygen uptake (pVO) remained associated to the end point (C-index = 0.745). A peak oxygen uptake of ≤55% of predicted and a ventilatory efficiency of ≥31 resulted as the most accurate cut-off values in the outcome prediction.
Present data support the cardiopulmonary exercise test and, particularly, the peak oxygen uptake, as a useful tool in the rec-HFmrEF prognostic assessment. A peak VO of ≤55% predicted and ventilatory efficiency of ≥31 might help to identify a high-risk rec-HFmrEF subgroup.
射血分数中等范围的心力衰竭（HFmrEF）是一个异质性类别，其表型以及预后评估仍存在争议。本研究探讨了一个特定的HFmrEF亚组，即那些射血分数从降低状态恢复的患者（rec-HFmrEF），特别关注心肺运动试验可能的附加预后作用。
我们分析了来自代谢运动联合心脏和肾脏指数数据库的4535例射血分数降低的心力衰竭（HFrEF）患者和1176例rec-HFmrEF患者的数据。终点为5年时的心血管死亡。中位随访时间为1343天（第25 - 75百分位数范围为627 - 2403天）。552例HFrEF患者和61例rec-HFmrEF患者发生了心血管死亡。多变量分析证实了MECKI评分变量在HFrEF中的独立作用（C指数 = 0.744），而在rec-HFmrEF组中，只有年龄和峰值摄氧量（pVO）与终点相关（C指数 = 0.745）。预测峰值摄氧量≤55%和通气效率≥31是结局预测中最准确的临界值。
目前的数据支持心肺运动试验，特别是峰值摄氧量，作为rec-HFmrEF预后评估的有用工具。预测峰值VO≤55%和通气效率≥31可能有助于识别高风险的rec-HFmrEF亚组。
