Cardiology Unit, Department of Clinical and Molecular Medicine, Sapienza University of Rome, Sant'Andrea Hospital, Italy.
Department of Cardiovascular Neural and Metabolic Sciences, Istituto Auxologico Italiano, IRCCS, S.Luca Hospital, Italy.
Eur J Prev Cardiol. 2020 Dec;27(2_suppl):59-64. doi: 10.1177/2047487320951104.
Heart failure with mid-range ejection fraction represents a heterogeneous and relatively young heart failure category accounting for nearly 20-30% of the overall heart failure population. Due to its complex phenotype, a reliable clinical picture of heart failure with mid-range ejection fraction patients as well as a definite risk stratification are still relevant unsolved issues. In such a context, there is growing interest in a comprehensive functional assessment by means of a cardiopulmonary exercise test, yet considered a cornerstone in the clinical management of patients with heart failure and reduced ejection fraction. Indeed, the cardiopulmonary exercise test has also been found to be particularly useful in the heart failure with mid-range ejection fraction category, several cardiopulmonary exercise test-derived parameters being associated with a poor outcome. In particular, a recent contribution by the metabolic exercise combined with cardiac and kidney indexes research group showed an independent association between the peak oxygen uptake and pure cardiovascular mortality in a large cohort of recovered heart failure with mid-range ejection fraction patients. Contextually, the same study supplied an easy approach to identify a high-risk heart failure with mid-range ejection fraction subset by using a combination of peak oxygen uptake and ventilatory efficiency cut-off values, namely 55% of the maximum predicted and 31, respectively. Thus, looking at the above-mentioned promising results and waiting for specific trials, it is reasonable to consider cardiopulmonary exercise test assessment as part of the heart failure with mid-range ejection fraction work-up in order to identify those patients with an unfavourable functional profile who probably deserve a close clinical follow-up and, probably, more aggressive therapeutic strategies.
射血分数中间值的心衰代表了一种异质性的、相对年轻的心衰类型，占整体心衰人群的近 20-30%。由于其复杂的表型，射血分数中间值心衰患者的可靠临床特征以及明确的风险分层仍然是尚未解决的问题。在这种情况下，人们对心肺运动试验进行全面的功能评估越来越感兴趣，而心肺运动试验被认为是心衰和射血分数降低患者临床管理的基石。事实上，心肺运动试验在射血分数中间值心衰类别中也被发现特别有用，一些心肺运动试验衍生参数与预后不良相关。特别是，代谢运动与心脏和肾脏指数研究小组的一项最新研究表明，在一个大型射血分数中间值心衰患者恢复队列中，峰值摄氧量与纯心血管死亡率之间存在独立关联。相关地，同一项研究提供了一种简单的方法，可以通过峰值摄氧量和通气效率截断值的组合来识别高危射血分数中间值心衰亚组，即分别为最大预测值的 55%和 31%。因此，鉴于上述有前景的结果和等待特定试验，将心肺运动试验评估视为射血分数中间值心衰检查的一部分是合理的，以便识别那些功能不良的患者，这些患者可能需要密切的临床随访和可能更积极的治疗策略。
