Magrì Damiano, Gallo Giovanna, Piepoli Massimo, Salvioni Elisabetta, Mapelli Massimo, Vignati Carlo, Fiori Emiliano, Muthukkattil Melwyn Luis, Corrà Ugo, Metra Marco, Paolillo Stefania, Maruotti Antonello, Di Loro Pierfrancesco Alaimo, Senni Michele, Lagioia Rocco, Scrutinio Domenico, Emdin Michele, Passino Claudio, Parati Gianfranco, Sinagra Gianfranco, Correale Michele, Badagliacca Roberto, Sciomer Susanna, Di Lenarda Andrea, Agostoni Piergiuseppe, Filardi Pasquale Perrone
Department of Clinical and Molecular Medicine, Azienda Ospedaliera Sant'Andrea, 'Sapienza' Università degli Studi di Roma, Via di Grottarossa 1035-1039, 00189 Roma, Italy.
Department of Biomedical Science for Health, University of Milan, Via Festa del Perdono 7, 20122 Milan, Italy, and Clinical Cardiology, IRCCS Policlinico San Donato, Via Morandi 30, 20097 San Donato Milanese, Milan, Italy.
Eur J Prev Cardiol. 2024 Jan 25;31(2):263-271. doi: 10.1093/eurjpc/zwad338.
Chronotropic incompetence (CI) is a strong predictor of outcome in heart failure with reduced ejection fraction, however no data on its clinical and prognostic impacts in heart failure with mildly reduced ejection fraction (HFmrEF) are available. Therefore, the study aims to investigate, in a large multicentre HFmrEF cohort, the prevalence of CI as well as its relationship with exercise capacity and its prognostic role over the cardiopulmonary exercise testing (CPET) parameters.
Within the Metabolic Exercise combined with Cardiac and Kidney Indexes (MECKI) database, we analysed data of 864 HFmrEF out of 1164 stable outpatients who performed a maximal CPET at the cycle ergometer and who had no significant rhythm disorders or comorbidities. The primary study endpoint was cardiovascular (CV) death. All-cause death was also explored. Chronotropic incompetence prevalence differed depending on the method (peak heart rate, pHR% vs. pHR reserve, pHRR%) and the cut-off adopted (pHR% from ≤75% to ≤60% and pHRR% ≤ 65% to ≤50%), ranging from 11% to 62%. A total of 84 (9.7%) CV deaths were collected, with 39 (4.5%) occurring within 5 years. At multivariate analysis, both pHR% [hazard ratio 0.97 (0.95-0.99), P < 0.05] and pHRR% [hazard ratio 0.977 (0.961-0.993), P < 0.01] were associated with the primary endpoint. A pHR% ≤ 75% and a pHRR% ≤ 50% represented the most accurate cut-off values in predicting the outcome.
The study suggests an association between blunted exercise-HR response, functional capacity, and CV death risk among patients with HFmrEF. Whether the CI presence might be adopted in daily HFmrEF management needs to be addressed in larger prospective studies.
变时性功能不全（CI）是射血分数降低的心力衰竭患者预后的有力预测指标，但尚无关于其在射血分数轻度降低的心力衰竭（HFmrEF）中的临床和预后影响的数据。因此，本研究旨在在一个大型多中心HFmrEF队列中，调查CI的患病率及其与运动能力的关系，以及其在心肺运动试验（CPET）参数方面的预后作用。
在代谢运动联合心脏和肾脏指数（MECKI）数据库中，我们分析了1164名稳定门诊患者中的864例HFmrEF患者的数据，这些患者在自行车测力计上进行了最大CPET，且无明显节律紊乱或合并症。主要研究终点是心血管（CV）死亡。还探讨了全因死亡。根据方法（峰值心率，pHR%与pHR储备，pHRR%）和采用的临界值（pHR%从≤75%至≤60%，pHRR%从≤65%至≤50%），变时性功能不全患病率有所不同，范围从11%至62%。共收集到84例（9.7%）CV死亡，其中39例（4.5%）在5年内发生。在多变量分析中，pHR%[风险比0.97（0.95 - 0.99），P < 0.05]和pHRR%[风险比0.977（0.961 - 0.993），P < 0.01]均与主要终点相关。pHR%≤ 75%和pHRR%≤50%是预测预后最准确的临界值。
该研究表明，HFmrEF患者运动时心率反应迟钝、功能能力与CV死亡风险之间存在关联。CI的存在是否可用于HFmrEF的日常管理，需要在更大规模的前瞻性研究中加以探讨。
