Exercise oscillatory ventilation and prognosis in heart failure patients with reduced and mid‐range ejection fraction. (28th November 2019)

• Record Type: Journal Article
• Authors: Rovai, Sara; Corrà, Ugo; Piepoli, Massimo; Vignati, Carlo; Salvioni, Elisabetta; Bonomi, Alice; Mattavelli, Irene; Arcari, Luca; Scardovi, Angela B.; Perrone Filardi, Pasquale; Lagioia, Rocco; Paolillo, Stefania; Magrì, Damiano; Limongelli, Giuseppe; Metra, Marco; Senni, Michele; Scrutinio, Domenico; Raimondo, Rosa; Emdin, Michele; Lombardi, Carlo; Cattadori, Gaia; Parati, Gianfranco; Re, Federica; Cicoira, Mariantonietta; Villani, Giovanni Q.; Minà, Chiara; Correale, Michele; Frigerio, Maria; Perna, Enrico; Mapelli, Massimo; Magini, Alessandra; Clemenza, Francesco; Bussotti, Maurizio; Battaia, Elisa; Guazzi, Marco; Bandera, Francesco; Badagliacca, Roberto; Di Lenarda, Andrea; Pacileo, Giuseppe; Maggioni, Aldo; Passino, Claudio; Sciomer, Susanna; Sinagra, Gianfranco; Agostoni, Piergiuseppe;
• Is Part Of: European journal of heart failure. Volume 21:Number 12(2019)
• Page Start: 1586
• Page End: 1595
• Publication Date: 2019-11-28
• Subjects: Exercise oscillatory ventilation -- Heart failure with mid‐range ejection fraction -- Cardiopulmonary exercise test -- Prognosis; Heart failure -- Periodicals; Heart Failure -- Periodicals; Insuffisance cardiaque -- Périodiques; Heart failure; Periodicals; 616.129005
• DOI: 10.1002/ejhf.1595
• Languages: English
• ISSNs: 1388-9842

Abstract

Abstract: Aims: Exercise oscillatory ventilation (EOV) is a pivotal cardiopulmonary exercise test parameter for the prognostic evaluation of patients with chronic heart failure (HF). It has been described in patients with HF with reduced ejection fraction (<40%, HFrEF) and with HF with preserved ejection fraction (>50%, HFpEF), but no data are available for patients with HF with mid‐range ejection fraction (40–49%, HFmrEF). The aim of the study was to evaluate the prognostic role of EOV in HFmrEF patients. Methods and results: We analysed 1239 patients with HFmrEF and 4482 patients with HFrEF, enrolled in the MECKI score database, with a 2‐year follow‐up. The study endpoint was the composite of cardiovascular death, urgent heart transplant, and ventricular assist device implantation. We identified EOV in 968 cases (16% and 17% of cases in HFmrEF and HFrEF, respectively). HFrEF EOV+ patients were significantly older, and their parameters suggested a more severe HF than HFrEF EOV− patients. A similar behaviour was found in HFmrEF EOV+ vs. EOV− patients. Kaplan–Meier analysis, irrespective of ejection fraction, showed that EOV is associated with a worse survival, and that patients with HFrEF and HFmrEF EOV+ had a significantly worse outcome than the EOV− of the same ejection fraction groups. EOV‐associated survival differences in HFmrEF patients started after 18 months of follow‐up. Conclusion: Exercise oscillatory ventilation has a similar prevalence and ominous prognostic value in both HFmrEF and HFrEF patients, indicating a group of patients in need of a more intensive follow‐up and a more aggressive therapy. In HFmrEF, the survival curves between EOV+ and EOV− patients diverged only after 18 months.