Data di Pubblicazione:
2013
Citazione:
Prognostic value of indeterminable anaerobic threshold in heart failure / P. Agostoni, U. Corrà, G. Cattadori, F. Veglia, E. Battaia, R..L. Gioia, A.B. Scardovi, M. Emdin, M. Metra, G. Sinagra, G. Limongelli, R. Raimondo, F. Re, M. Guazzi, R. Belardinelli, G. Parati, D. Magrì, C. Fiorentini, M. Cicoira, E. Salvioni, M. Giovannardi, A. Mezzani, D. Scrutinio, A..D. Lenarda, V. Mantegazza, R. Ricci, A. Apostolo, A. Iorio, S. Paolillo, P. Palermo, M. Contini, C. Vassanelli, C. Passino, M.F. Piepoli. - In: CIRCULATION. HEART FAILURE. - ISSN 1941-3289. - 6:5(2013 Sep 01), pp. 977.987-977.987. [10.1161/CIRCHEARTFAILURE.113.000471]
Abstract:
BACKGROUND:
In patients with heart failure (HF), during maximal cardiopulmonary exercise test, anaerobic threshold (AT) is not always identified. We evaluated whether this finding has a prognostic meaning.
METHODS AND RESULTS:
We recruited and prospectively followed up, in 14 dedicated HF units, 3058 patients with systolic (left ventricular ejection fraction <40%) HF in stable clinical conditions, New York Heart Association class I to III, who underwent clinical, laboratory, echocardiographic, and cardiopulmonary exercise test investigations at study enrollment. We excluded 921 patients who did not perform a maximal exercise, based on lack of achievement of anaerobic metabolism (peak respiratory quotient ≤1.05). Primary study end point was a composite of cardiovascular death and urgent cardiac transplant, and secondary end point was all-cause death. Median follow-up was 3.01 (1.39-4.98) years. AT was identified in 1935 out of 2137 patients (90.54%). At multivariable logistic analysis, failure in detecting AT resulted significantly in reduced peak oxygen uptake and higher metabolic exercise and cardiac and kidney index score value, a powerful prognostic composite HF index (P<0.001). At multivariable analysis, the following variables were significantly associated with primary study end point: peak oxygen uptake (% pred; P<0.001; hazard ratio [HR]=0.977; confidence interval [CI]=0.97-0.98), ventilatory efficiency slope (P=0.01; HR=1.02; CI=1.01-1.03), hemoglobin (P<0.05; HR=0.931; CI=0.87-1.00), left ventricular ejection fraction (P<0.001; HR=0.948; CI=0.94-0.96), renal function (modification of diet in renal disease; P<0.001; HR=0.990; CI=0.98-0.99), sodium (P<0.05; HR=0.967; CI=0.94-0.99), and AT nonidentification (P<0.05; HR=1.41; CI=1.06-1.89). Nonidentification of AT remained associated to prognosis also when compared with metabolic exercise and cardiac and kidney index score (P<0.01; HR=1.459; CI=1.09-1.10). Similar results were obtained for the secondary study end point.
CONCLUSIONS:
The inability to identify AT most often occurs in patients with severe HF, and it has an independent prognostic role in HF
Tipologia IRIS:
01 - Articolo su periodico
Keywords:
exercise; follow-up studies; heart failure; oxygen; prognosis
Elenco autori:
P. Agostoni, U. Corrà, G. Cattadori, F. Veglia, E. Battaia, R..L. Gioia, A.B. Scardovi, M. Emdin, M. Metra, G. Sinagra, G. Limongelli, R. Raimondo, F. Re, M. Guazzi, R. Belardinelli, G. Parati, D. Magrì, C. Fiorentini, M. Cicoira, E. Salvioni, M. Giovannardi, A. Mezzani, D. Scrutinio, A..D. Lenarda, V. Mantegazza, R. Ricci, A. Apostolo, A. Iorio, S. Paolillo, P. Palermo, M. Contini, C. Vassanelli, C. Passino, M.F. Piepoli, M. Piepoli
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