Fiori Emiliano, Corradetti Sara, Gallo Giovanna, Palazzuoli Alberto, Pagliaro Antonio, Molle Roberta, Tiberi Pier Giorgio, Salvioni Elisabetta, Piotti Arianna, Gugliandolo Paola, Agostoni Piergiuseppe, Magrì Damiano, Barbato Emanuele
Department of Clinical and Molecular Medicine, Sapienza University, 00189 Rome, Italy.
Cardiovascular Center Aalst, AZORG-Clinic, 9300 Aalst, Belgium.
Diagnostics (Basel). 2025 Sep 17;15(18):2366. doi: 10.3390/diagnostics15182366.
Cardiopulmonary exercise testing (CPET) is a well-established tool for risk stratification in patients with heart failure (HF); however, its utility is limited in routine clinical practice due to the associated cost and technical demands. The hemodynamic gain index (HGI), a non-metabolic parameter derived from systolic blood pressure and heart rate changes during exercise, has been demonstrated to play a promising role in HF populations. In this study, we aimed both to validate the prognostic value of the HGI and to evaluate a novel metric, heart hemodynamic reserve (HHR), in patients with HF and left ventricular ejection fraction (LVEF) below 50%. We retrospectively enrolled 479 consecutive patients with HF and reduced or mildly reduced LVEF who underwent maximal, symptom-limited CPET at three Italian university hospitals between 2012 and 2024. The HGI and HHR were computed using resting and peak exercise hemodynamic data. HHR is defined as the product of systolic blood pressure and heart rate reserve with exercise, normalized for the age-predicted maximum heart rate. The primary endpoint was a composite of cardiovascular death, urgent heart transplantation (HTx), or left ventricular assist device (LVAD) implantation. Prognostic associations were assessed using multivariable Cox regression and area under the receiver operating characteristic curves (AUCs). During a median follow-up of 3.25 years, the composite outcome occurred in 56 patients (11.5%). Both the HGI and HHR were independently associated with the prespecified endpoint (HGI HR: 0.41, 95% CI: 0.20-0.83, = 0.013; HHR HR: 0.89, 95% CI: 0.83-0.96, = 0.004), with HHR showing a slightly higher prognostic accuracy than the HGI (AUC 0.78 vs. 0.74; = 0.033). Both the HGI and HHR are independent prognostic markers in HF patients with LVEF < 50%. Their non-metabolic derivation makes them valuable tools for risk stratification in settings where CPET is unavailable.
心肺运动试验（CPET）是心力衰竭（HF）患者风险分层的一种成熟工具；然而，由于相关成本和技术要求，其在常规临床实践中的应用受到限制。血流动力学增益指数（HGI）是一种从运动期间收缩压和心率变化得出的非代谢参数，已被证明在HF人群中发挥着有前景的作用。在本研究中，我们旨在验证HGI的预后价值，并评估一种新指标——心脏血流动力学储备（HHR），用于左心室射血分数（LVEF）低于50%的HF患者。我们回顾性纳入了2012年至2024年间在三家意大利大学医院接受最大症状限制CPET的479例连续的HF患者，其LVEF降低或轻度降低。使用静息和运动峰值血流动力学数据计算HGI和HHR。HHR定义为运动时收缩压和心率储备的乘积，并根据年龄预测的最大心率进行标准化。主要终点是心血管死亡、紧急心脏移植（HTx）或左心室辅助装置（LVAD）植入的复合终点。使用多变量Cox回归和受试者操作特征曲线下面积（AUC）评估预后关联。在中位随访3.25年期间，56例患者（11.5%）发生了复合结局。HGI和HHR均与预设终点独立相关（HGI HR：0.41，95%CI：0.20 - 0.83，P = 0.013；HHR HR：0.89，95%CI：0.83 - 0.96，P = 0.004），HHR显示出比HGI略高的预后准确性（AUC 0.78对0.74；P = 0.033）。HGI和HHR都是LVEF < 50%的HF患者的独立预后标志物。它们的非代谢推导使其成为在无法进行CPET的情况下进行风险分层的有价值工具。
