Heart failure prognosis over time

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.

Data from 6,083 HF patients, – enrolled in the MECKI score database between 1993 and 2015, – were retrospectively analysed in a new study, comparing the 10-year survival 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.

According to the results, 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.

Reference

1. Paolillo S, Veglia F, Salvioni E, Corrà U, Piepoli M, Lagioia R, Limongelli G, Sinagra G, Cattadori G, Scardovi AB, Metra M, Senni M, Bonomi A, Scrutinio D, Raimondo R, Emdin M, Magrì D, Parati G, Re F, Cicoira M, Minà C, Correale M, Frigerio M, Bussotti M, Battaia E, Guazzi M, Badagliacca R, Di Lenarda A, Maggioni A, Passino C, Sciomer S, Pacileo G, Mapelli M, Vignati C, Clemenza F, Binno S, Lombardi C, Filardi PP, Agostoni P; MECKI Score Research Group (see Appendix). Heart failure prognosis over time: how the prognostic role of oxygen consumption and ventilatory efficiency during exercise has changed in the last 20 years. Eur J Heart Fail 2019 Jan 11. doi: 10.1002/ejhf.1364. [Epub ahead of print] Go to PubMed