scholarly journals Risk stratification in heart failure with mild reduced ejection fraction

2020 ◽  
Vol 27 (2_suppl) ◽  
pp. 59-64
Author(s):  
Damiano Magrì ◽  
Giovanna Gallo ◽  
Gianfranco Parati ◽  
Mariantonietta Cicoira ◽  
Michele Senni
Keyword(s):  
Heart Failure ◽  
Ejection Fraction ◽  
Oxygen Uptake ◽  
Risk Stratification ◽  
Exercise Test ◽  
Peak Oxygen Uptake ◽  
Cardiopulmonary Exercise Test ◽  
Recent Contribution ◽  
Reduced Ejection Fraction ◽  
Cardiopulmonary Exercise

Heart failure with mid-range ejection fraction represents a heterogeneous and relatively young heart failure category accounting for nearly 20–30% of the overall heart failure population. Due to its complex phenotype, a reliable clinical picture of heart failure with mid-range ejection fraction patients as well as a definite risk stratification are still relevant unsolved issues. In such a context, there is growing interest in a comprehensive functional assessment by means of a cardiopulmonary exercise test, yet considered a cornerstone in the clinical management of patients with heart failure and reduced ejection fraction. Indeed, the cardiopulmonary exercise test has also been found to be particularly useful in the heart failure with mid-range ejection fraction category, several cardiopulmonary exercise test-derived parameters being associated with a poor outcome. In particular, a recent contribution by the metabolic exercise combined with cardiac and kidney indexes research group showed an independent association between the peak oxygen uptake and pure cardiovascular mortality in a large cohort of recovered heart failure with mid-range ejection fraction patients. Contextually, the same study supplied an easy approach to identify a high-risk heart failure with mid-range ejection fraction subset by using a combination of peak oxygen uptake and ventilatory efficiency cut-off values, namely 55% of the maximum predicted and 31, respectively. Thus, looking at the above-mentioned promising results and waiting for specific trials, it is reasonable to consider cardiopulmonary exercise test assessment as part of the heart failure with mid-range ejection fraction work-up in order to identify those patients with an unfavourable functional profile who probably deserve a close clinical follow-up and, probably, more aggressive therapeutic strategies.

scholarly journals How Patients With Heart Failure Perform Daily Life Activities

2020 ◽  
Vol 13 (11) ◽  
Author(s):  
Massimo Mapelli ◽  
Elisabetta Salvioni ◽  
Alice Bonomi ◽  
Paola Gugliandolo ◽  
Fabiana De Martino ◽  
...  
Keyword(s):  
Heart Failure ◽  
Ejection Fraction ◽  
Oxygen Uptake ◽  
Exercise Test ◽  
Cardiopulmonary Exercise Test ◽  
Peak Oxygen Consumption ◽  
Borg Scale ◽  
Walking Test ◽  
Cardiopulmonary Exercise ◽  
Stable Conditions

Background: Cardiopulmonary exercise test and 6-minute walking test are frequently used tools to evaluate physical performance in heart failure (HF), but they do neither represent activities of daily living (ADLs) nor fully reproduce patients’ symptoms. We assessed differences in task oxygen uptake, both as absolute value and as percentage of peak oxygen consumption (peakVO 2 ), ventilation efficiency (VE/VCO 2 ratio), and dyspnea intensity (Borg scale) in HF and healthy subjects during standard ADLs and other common physical actions. Methods: Healthy and HF subjects (ejection fraction <45%, stable conditions) underwent cardiopulmonary exercise test. All of them, carrying a wearable metabolic cart, performed a 6-minute walking test, two 4-minute treadmill exercises (at 2 and 3 km/h), and ADLs: ADL1 (getting dressed), ADL2 (folding 8 towels), ADL3 (putting away 6 bottles), ADL4 (making a bed), ADL5 (sweeping the floor for 4 minutes), ADL6 (climbing 1 flight of stairs carrying a load). Results: Sixty patients with HF (age 65.2±12.1 years; ejection fraction 30.4±6.7%, peakVO 2 14.2±4.0 mL/[min·kg]) and 40 healthy volunteers (58.9±8.2 years, peakVO 2 28.1±7.4 mL/[min·kg]) were enrolled. For each exercise, patients showed higher VE/VCO 2 ratio, percentage of peakVO 2 , and Borg scale value than controls, while absolute values of task oxygen uptake and exercise duration were lower and higher, respectively, in all activities, except for treadmill (fixed execution time and intensity). Differently from Borg Scale data, metabolic values and exercise time length changed in parallel with HF severity, except for ADL duration in very short (ADL3) and composite (ADL1) activities. Borg scale values correlated with percentage of peakVO 2 . Conclusions: During ADLs, patients self-regulated activities in parallel with HF severity by decreasing intensity (VO 2 ) and prolonging the effort.

Abstract 18836: Differences in Cardiopulmonary Exercise Test Data and Prognosis in Black and White Men with Heart Failure: the Henry Ford HospITal CardioPulmonary EXercise Testing (FIT-CPX) Project

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Matthew A Saval ◽  
Clinton A Brawner ◽  
Ali Shafiq ◽  
Heather E Aldred ◽  
Raakesh Hassan ◽  
...  
Keyword(s):  
Heart Failure ◽  
Ejection Fraction ◽  
Risk Stratification ◽  
Exercise Test ◽  
Black Male ◽  
Composite Endpoint ◽  
Cardiopulmonary Exercise Test ◽  
Cardiopulmonary Exercise ◽  
Black Patients ◽  
Male Patients

Introduction: Numerous metrics from the cardiopulmonary exercise test (CPX) are associated with outcomes among patients with heart failure with reduced ejection fraction (HFrEF). Among patients with HFrEF, mortality rates differ by race; however, the influence of race on the association between common measures obtained during CPX and mortality has not been fully described. Purpose: Retrospective analysis to describe the relationship between key CPX measures and the composite endpoint of mortality, left ventricular assist device (LVAD), or cardiac transplant (CT) in white and black men with HFrEF. Methods: Self-identified white and black male patients (n= 761; age= 55 ± 12 y; BMI= 30.6±6.6) with a CPX between 1997 and 2010 and confirmed HFrEF (ejection fraction [EF] ≤ 40%) were identified. Endpoint data was obtained through 2011. The association with the composite endpoint was evaluated separately for 7 key CPX measures with adjustment for age, hypertension, beta-blocker therapy, EF, and ischemic etiology using Cox regression stratified by race. Results: During a median follow-up of 3.5 y there were 195 (54%) and 193 (48%) events for white and black patients, respectively. All CPX variables were associated (p<0.05) with the composite endpoint in both white and black patients (Table). The greatest Wald statistic among white patients was % predicted peak oxygen uptake (ppVO 2 ) at 76.2, and among black patients it was ventilatory efficiency (V E -VCO 2 slope) at 90.8. Conclusion: Among white and black male patients, % predicted peak VO 2 and V E -VCO 2 slope, respectively, were most strongly associated with the combined end point of mortality, LVAD or CT. These data suggest that risk stratification using CPX variables may differ by race. Further research is needed to determine if race-specific methods of CPX-based risk stratification are needed.

scholarly journals Cardiopulmonary Exercise Test in heart failure: A Sine qua non

2020 ◽  
Vol 9 (2) ◽  
pp. 1-8 ◽  
Author(s):  
Stefanos Sakellaropoulos ◽  
Dimitra Lekaditi ◽  
Stefano Svab
Keyword(s):  
Heart Failure ◽  
Exercise Test ◽  
Exercise Physiology ◽  
Cardiopulmonary Exercise Testing ◽  
Critical Evaluation ◽  
Research Area ◽  
Cardiopulmonary Exercise Test ◽  
Exercise Intolerance ◽  
Reduced Ejection Fraction ◽  
Cardiopulmonary Exercise

A robust literature, over the last years, supports the indication of cardiopulmonary exercise testing (CPET) in patients with cardiovascular diseases. Understanding exercise physiology is a crucial component of the critical evaluation of exercise intolerance. Shortness of breath and exercise limitation is often treated with an improper focus, partly because the pathophysiology is not well understood in the frame of the diagnostic spectrum of each subspecialty. A vital field and research area have been cardiopulmonary exercise test in heart failure with preserved/reduced ejection fraction, evaluation of heart failure patients as candidates for LVAD-Implantation, as well as for LVAD-Explantation and ultimately for heart transplantation. All the CPET variables provide synergistic prognostic discrimination. However, Peak VO2 serves as the most critical parameter for risk stratification and prediction of survival rate.

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