Renal function and peak exercise oxygen consumption in chronic heart failure with reduced left ventricular ejection fraction

Background: Chronic kidney disease is associated with sympathetic activation and muscle abnormalities, which may contribute to decreased exercise capacity. We investigated the correlation of renal function with peak exercise oxygen consumption (V˙O2) in heart failure (HF) patients. Methods and Results: We recruited 2,938 systolic HF patients who underwent clinical, laboratory, echocardiographic and cardiopulmonary exercise testing. The patients were stratified according to estimated glomerular filtration rate (eGFR). Mean follow-up was 3.7 years. The primary outcome was a composite of cardiovascular death and urgent heart transplantation at 3 years. On multivariable regression, eGFR was predictor of peakV˙O2 (P<0.0001). Other predictors were age, sex, body mass index, HF etiology, NYHA class, atrial fibrillation, resting heart rate, Btype natriuretic peptide, hemoglobin, and treatment. After adjusting for significant covariates, the hazard ratio for primary outcome associated with peakVO2 <12 ml ・ kg−1 ・ min−1 was 1.75 (95% confidence interval (CI): 1.06–2.91; P=0.0292) in patients with eGFR ≥60, 1.77 (0.87–3.61; P=0.1141) in those with eGFR of 45–59, and 2.72 (1.01– 7.37; P=0.0489) in those with eGFR <45 ml ・ min−1 ・ 1.73 m−2. The area under the receiver-operating characteristic curve for peakV˙O2 <12 ml ・ kg−1 ・ min−1 was 0.63 (95% CI: 0.54–0.71), 0.67 (0.56–0.78), and 0.57 (0.47–0.69), respectively. Testing for interaction was not significant. Conclusions: Renal dysfunction is correlated with peakV O2. A peakV O2 cutoff of 12 ml ・ kg–1 ・ min–1 offers limited prognostic information in HF patients with more severely impaired renal function

Heart failure prognosis over time: how the prognostic role of oxygen consumption and ventilatory efficiency during exercise has changed in the last 20 years

Aims Exercise-derived parameters, specifically peak exercise oxygen uptake (peak VO2) and minute ventilation/carbon dioxide relationship slope (VE/VCO2 slope), have a pivotal prognostic value in heart failure (HF). It is unknown how the prognostic threshold of peak VO2 and VE/VCO2 slope has changed over the last 20 years in parallel with HF prognosis improvement. Methods and results Data from 6083 HF patients (81% male, age 61 +/- 13 years), enrolled in the MECKI score database between 1993 and 2015, were retrospectively analysed. By enrolment year, four groups were generated: group 1 1993-2000 (n = 440), group 2 2001-2005 (n = 1288), group 3 2006-2010 (n = 2368), and group 4 2011-2015 (n = 1987). We compared the 10-year survival of groups and analysed how the overall risk (cardiovascular death, urgent heart transplantation, or left ventricular assist device implantation) changed over time according to peak VO2 and VE/VCO2 slope and to major clinical and therapeutic variables. At 10 years, a progressively higher survival from group 1 to group 3 was observed, with no further improvement afterwards. A 20% risk for peak VO2 15 mL/min/kg (95% confidence interval 16-13), 9 (11-8), 4 (4-2) and 5 (7-4) was observed in group 1, 2, 3, and 4, respectively, while the VE/VCO2 slope value for a 20% risk was 32 (37-29), 47 (51-43), 59 (64-55), and 57 (63-52), respectively. Conclusions Heart failure prognosis improved over time up to 2010 in a HF population followed by experienced centres. The peak VO2 and VE/VCO2 slope cut-offs identifying a definite risk progressively decreased and increased over time, respectively. The prognostic threshold of peak VO2 and VE/VCO2 slope must be updated whenever HF prognosis improves

Dose-dependent efficacy of β-blocker in patients with chronic heart failure and atrial fibrillation

41nononenoneCampodonico, Jeness; Piepoli, Massimo; Clemenza, Francesco; Bonomi, Alice; Paolillo, Stefania; Salvioni, Elisabetta; Corrà, Ugo; Binno, Simone; Veglia, Fabrizio; Lagioia, Rocco; Sinagra, Gianfranco; Cattadori, Gaia; Scardovi, Angela B.; Metra, Marco; Senni, Michele; Scrutinio, Domenico; Raimondo, Rosa; Emdin, Michele; Magrì, Damiano; Parati, Gianfranco; Re, Federica; Cicoira, Mariantonietta; Minà, Chiara; Limongelli, Giuseppe; Correale, Michele; Frigerio, Maria; Bussotti, Maurizio; Perna, Enrico; Battaia, Elisa; Guazzi, Marco; Badagliacca, Roberto; Di Lenarda, Andrea; Maggioni, Aldo; Passino, Claudio; Sciomer, Susanna; Pacileo, Giuseppe; Mapelli, Massimo; Vignati, Carlo; Lombardi, Carlo; Filardi, Pasquale Perrone; Agostoni, PiergiuseppeCampodonico, Jeness; Piepoli, Massimo; Clemenza, Francesco; Bonomi, Alice; Paolillo, Stefania; Salvioni, Elisabetta; Corrà, Ugo; Binno, Simone; Veglia, Fabrizio; Lagioia, Rocco; Sinagra, Gianfranco; Cattadori, Gaia; Scardovi, Angela B.; Metra, Marco; Senni, Michele; Scrutinio, Domenico; Raimondo, Rosa; Emdin, Michele; Magrì, Damiano; Parati, Gianfranco; Re, Federica; Cicoira, Mariantonietta; Minà, Chiara; Limongelli, Giuseppe; Correale, Michele; Frigerio, Maria; Bussotti, Maurizio; Perna, Enrico; Battaia, Elisa; Guazzi, Marco; Badagliacca, Roberto; Di Lenarda, Andrea; Maggioni, Aldo; Passino, Claudio; Sciomer, Susanna; Pacileo, Giuseppe; Mapelli, Massimo; Vignati, Carlo; Lombardi, Carlo; Filardi, Pasquale Perrone; Agostoni, Piergiusepp

Mineralocorticoid receptor antagonists for heart failure: a real-life observational study

Mineralocorticoid receptor antagonists (MRAs) have been demonstrated to improve outcomes in reduced ejection fraction heart failure (HFrEF) patients. However, MRAs added to conventional treatment may lead to worsening of renal function and hyperkalaemia. We investigated, in a population-based analysis, the long-term effects of MRA treatment in HFrEF patients

Heart failure and anemia: Effects on prognostic variables

Anemia is frequent in heart failure (HF), and it is associated with higher mortality. The predictive power of established HF prognostic parameters in anemic HF patients is unknown

Prognostic role of β-blocker selectivity and dosage regimens in heart failure patients. Insights from the MECKI score database

52noAIMS: The use of β-blockers represents a milestone in the treatment of heart failure with reduced ejection fraction (HFrEF). Few studies have compared β-blockers in HFrEF, and there is little data on the effects of different doses. The present study aimed to investigate in a large database of HFrEF patients (MECKI score database) the association of β-blocker treatment with a composite outcome of cardiovascular death, urgent heart transplantation or left ventricular assist device implantation, addressing the role of β-selectivity and dosage regimens. METHODS AND RESULTS: In 5242 HFrEF patients, we investigated the role of: (i) β-blocker treatment vs. non-β-blocker treatment, (ii) β1-/β2-receptor-blockers vs. β1-selective blockers, and (iii) daily β-blocker dose. Patients were followed for 3.58 years, and 1101 events (18.3%) were observed; 4435 patients (86.8%) were on β-blockers, while 807 (13.2%) were not. At 5 years, β-blocker-patients showed a better outcome than non-β-blocker-subjects [hazard ratio (HR) 0.48, P 2 5 mg carvedilol equivalent daily dose, n = 1005) patients than in both medium dose (12.5-25 mg, n = 1431) and low dose (<12.5 mg, n = 1960) (HR 1.97, P < 0.001; HR 1.95, P = 0.001, respectively), with no differences between the last two groups (HR 0.84, P = ns). CONCLUSION: In a large population of chronic HFrEF patients, β-blockers were associated with a more favourable prognosis without any difference between β1- and β2-receptor-blockers vs. β1-selective blockers. A better outcome was observed in subjects receiving a high daily dose.reservedmixedPaolillo, Stefania; Mapelli, Massimo; Bonomi, Alice; Corrà, Ugo; Piepoli, Massimo; Veglia, Fabrizio; Salvioni, Elisabetta; Gentile, Piero; Lagioia, Rocco; Metra, Marco; Limongelli, Giuseppe; Sinagra, Gianfranco; Cattadori, Gaia; Scardovi, Angela B.; Carubelli, Valentina; Scrutino, Domenico; Badagliacca, Roberto; Raimondo, Rosa; Emdin, Michele; Magrì, Damiano; Correale, Michele; Parati, Gianfranco; Caravita, Sergio; Spadafora, Emanuele; Re, Federica; Cicoira, Mariantonietta; Frigerio, Maria; Bussotti, Maurizio; Minà, Chiara; Oliva, Fabrizio; Battaia, Elisa; Belardinelli, Romualdo; Mezzani, Alessandro; Pastormerlo, Luigi; Di Lenarda, Andrea; Passino, Claudio; Sciomer, Susanna; Iorio, Annamaria; Zambon, Elena; Guazzi, Marco; Pacileo, Giuseppe; Ricci, Roberto; Contini, Mauro; Apostolo, Anna; Palermo, Pietro; Clemenza, Francesco; Marchese, Giovanni; Binno, Simone; Lombardi, Carlo; Passantino, Andrea; Perrone Filardi, Pasquale; Agostoni, PiergiuseppePaolillo, Stefania; Mapelli, Massimo; Bonomi, Alice; Corrà, Ugo; Piepoli, Massimo; Veglia, Fabrizio; Salvioni, Elisabetta; Gentile, Piero; Lagioia, Rocco; Metra, Marco; Limongelli, Giuseppe; Sinagra, Gianfranco; Cattadori, Gaia; Scardovi, Angela B.; Carubelli, Valentina; Scrutino, Domenico; Badagliacca, Roberto; Raimondo, Rosa; Emdin, Michele; Magrì, Damiano; Correale, Michele; Parati, Gianfranco; Caravita, Sergio; Spadafora, Emanuele; Re, Federica; Cicoira, Mariantonietta; Frigerio, Maria; Bussotti, Maurizio; Minà, Chiara; Oliva, Fabrizio; Battaia, Elisa; Belardinelli, Romualdo; Mezzani, Alessandro; Pastormerlo, Luigi; Di Lenarda, Andrea; Passino, Claudio; Sciomer, Susanna; Iorio, Annamaria; Zambon, Elena; Guazzi, Marco; Pacileo, Giuseppe; Ricci, Roberto; Contini, Mauro; Apostolo, Anna; Palermo, Pietro; Clemenza, Francesco; Marchese, Giovanni; Binno, Simone; Lombardi, Carlo; Passantino, Andrea; Perrone Filardi, Pasquale; Agostoni, Piergiusepp

Heart failure and anemia: Effects on prognostic variables

Anemia is frequent in heart failure (HF), and it is associated with higher mortality. The predictive power of established HF prognostic parameters in anemic HF patients is unknown

Heart failure prognosis over time: how the prognostic role of oxygen consumption and ventilatory efficiency during exercise has changed in the last 20 years

AIMS: Exercise-derived parameters, specifically peak exercise oxygen uptake (peak VO2 ) and minute ventilation/carbon dioxide relationship slope (VE/VCO2 slope), have a pivotal prognostic value in heart failure (HF). It is unknown how the prognostic threshold of peak VO2 and VE/VCO2 slope has changed over the last 20\u2009years in parallel with HF prognosis improvement. METHODS AND RESULTS: Data from 6083 HF patients (81% male, age 61\u2009\ub1\u200913\u2009years), enrolled in the MECKI score database between 1993 and 2015, were retrospectively analysed. By enrolment year, four groups were generated: group 1 1993-2000 (n\u2009=\u2009440), group 2 2001-2005 (n\u2009=\u20091288), group 3 2006-2010 (n\u2009=\u20092368), and group 4 2011-2015 (n\u2009=\u20091987). We compared the 10-year survival of groups and analysed how the overall risk (cardiovascular death, urgent heart transplantation, or left ventricular assist device implantation) changed over time according to peak VO2 and VE/VCO2 slope and to major clinical and therapeutic variables. At 10\u2009years, a progressively higher survival from group 1 to group 3 was observed, with no further improvement afterwards. A 20% risk for peak VO2 15\u2009mL/min/kg (95% confidence interval 16-13), 9 (11-8), 4 (4-2) and 5 (7-4) was observed in group 1, 2, 3, and 4, respectively, while the VE/VCO2 slope value for a 20% risk was 32 (37-29), 47 (51-43), 59 (64-55), and 57 (63-52), respectively. CONCLUSIONS: Heart failure prognosis improved over time up to 2010 in a HF population followed by experienced centres. The peak VO2 and VE/VCO2 slope cut-offs identifying a definite risk progressively decreased and increased over time, respectively. The prognostic threshold of peak VO2 and VE/VCO2 slope must be updated whenever HF prognosis improves

Stress Echocardiography in Italian Echocardiographic Laboratories: A Survey of the Italian Society of Echocardiography and Cardiovascular Imaging

Background: The Italian Society of Echography and Cardiovascular Imaging (SIECVI) conducted a national survey to understand the volumes of activity, modalities and stressors used during stress echocardiography (SE) in Italy. Methods: We analyzed echocardiography laboratory activities over a month (November 2022). Data were retrieved through an electronic survey based on a structured questionnaire, uploaded on the SIECVI website. Results: Data were obtained from 228 echocardiographic laboratories, and SE examinations were performed in 179 centers (80.6%): 87 centers (47.5%) were in the northern regions of Italy, 33 centers (18.4%) were in the central regions, and 61 (34.1%) in the southern regions. We annotated a total of 4057 SE. We divided the SE centers into three groups, according to the numbers of SE performed: &lt;10 SE (low-volume activity, 40 centers), between 10 and 39 SE (moderate volume activity, 102 centers) and &gt;= 40 SE (high volume activity, 37 centers). Dipyridamole was used in 139 centers (77.6%); exercise in 120 centers (67.0%); dobutamine in 153 centers (85.4%); pacing in 37 centers (21.1%); and adenosine in 7 centers (4.0%). We found a significant difference between the stressors used and volume of activity of the centers, with a progressive increase in the prevalence of number of stressors from low to high volume activity (P = 0.033). The traditional evaluation of regional wall motion of the left ventricle was performed in all centers, with combined assessment of coronary flow velocity reserve (CFVR) in 90 centers (50.3%): there was a significant difference in the centers with different volume of SE activity: the incidence of analysis of CFVR was significantly higher in high volume centers compared to low - moderate - volume (32.5%, 41.0% and 73.0%, respectively, P &lt; 0.001). The lung ultrasound (LUS) was assessed in 67 centers (37.4%). Furthermore for LUS, we found a significant difference in the centers with different volume of SE activity: significantly higher in high volume centers compared to low - moderate - volume (25.0%, 35.3% and 56.8%, respectively, P &lt; 0.001). Conclusions: This nationwide survey demonstrated that SE was significantly widespread and practiced throughout Italy. In addition to the traditional indication to coronary artery disease based on regional wall motion analysis, other indications are emerging with an increase in the use of LUS and CFVR, especially in high-volume centers