Background: A decreased hypercapnic ventilatory response of the overweight patients would lower the ventilation equivalent of carbon dioxide (VE/VCO) slope but worsen prognosis. The aim of this study was to compare the prognostic ability of the VE/VCO slope and peak oxygen consumption (pVO) between normal and overweight heart failure (HF) patients.
Methods: Prospective evaluation of ambulatory patients with reduced left ventricular ejection fraction who underwent baseline assessment with a cardiopulmonary exercise test. The primary endpoint was cardiac death or urgent heart transplantation in the 5-year period of follow-up. The predictive power of VE/VCO slope and pVO were compared (area under the curve (AUC) analysis and Hanley & McNeil test), in the subgroups of patients with body mass index (BMI) of 18.5-24.9 kg/m and ≥ 25 kg/m. Statistical differences with a value < 0.05 were considered significant.
Results: There were 270 enrolled patients, with a mean BMI of 27 ± 4 kg/m. No differences between normal and overweight patients (38.0% vs 29.8%, P=0.170) were found during the 5-year period for the primary endpoint. The VE/VCO slope was non-inferior to pVO in both groups at 1, 3 and 5 years of follow-up. The comparison of VE/VCO slope between groups revealed a significant lower AUC at 3 (0.921 vs 0.787, P=0.022) and 5 years (0.898 vs 0.787, P=0.044) of follow-up for overweight patients.
Conclusion: Despite VE/VCO slope provides a discriminative power at least as good as pVO for predicting adverse events in both normal and overweight HF patients, a significant lower predictive power was found in overweight patients.
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ESC Heart Fail
January 2025
Department of Cardiology, Angiology and Intensive Care Medicine, Deutsches Herzzentrum der Charité, Berlin, Germany.
Aims: Patients with heart failure with preserved ejection fraction represent half of the heart failure patients nowadays, an at least steady trend due to the aging of the population. We investigated whether the parameters obtained from cardiopulmonary exercise testing (CPET) correlated with the prognosis of these patients. This prospective observational cohort study assesses the relationship between the CPET parameters peakVO and VE/VCO slope and the number of heart failure hospitalizations or cardiovascular death of these patients.
View Article and Find Full Text PDFEur Heart J Open
January 2025
Division of Cardiology, Department of Medicine, Université de Montréal, Montreal Heart Institute, 5000 Belanger Street, Montreal, Quebec, Canada H1T 1C8.
Aims: To better characterize functional consequences of the presence of COPD on cardiorespiratory fitness in patients with HF.
Methods And Results: Patients with any clinical indication for cardiopulmonary exercise testing (CPET) were included in the international FRIEND registry. Diagnosis of COPD was confirmed by a ratio of forced expiratory volume in 1 s and forced vital capacity (FEV/FVC) < 0.
Acta Anaesthesiol Scand
January 2025
Department of Cardiothoracic and Vascular Surgery in Östergötland, and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden.
Background: Ventilation as a function of elimination of CO during incremental exercise (VE/VCO slope) has been shown to be a valuable predictor of complications and death after major non-cardiac surgery. VE/VCO slope and partial pressure of end-tidal carbon dioxide (PetCO) are both affected by ventilation/perfusion mismatch, but research on the utility of PetCO for risk stratification in major abdominal surgery is limited.
Aim: We aimed to determine the correlation between VE/VCO slope and PetCO measured during preoperative cardiopulmonary exercise testing (CPET) and its association with major cardiopulmonary complications (MCPCs) or death following oesophageal and other major abdominal cancer surgeries.
Rev Esp Cardiol (Engl Ed)
November 2024
Servicio de Cardiología, Hospital Universitario de Canarias, San Cristóbal de La Laguna, Santa Cruz de Tenerife, Spain; Instituto de Investigación Sanitaria de Canarias, Santa Cruz de Tenerife, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Departamento de Medicina Interna, Universidad de La Laguna, Servicio de Cardiología, Hospital Universitario de Canarias, Santa Cruz de Tenerife, Spain.
ESC Heart Fail
November 2024
Centro Cardiologico Monzino, IRCCS, Milan, Italy.
Aims: Amyloid cardiomyopathy is caused by the deposition of light chain (AL) or transthyretin amyloid (ATTR) fibrils, that leads to a restrictive cardiomyopathy, often resulting in heart failure (HF) with preserved or reduced ejection fraction. This study aimed to determine whether cardiac output reduction or ventilation inefficiency plays a predominant role in limiting exercise in patients with amyloid cardiomyopathy.
Methods: We conducted a multicentre prospective study in patients with AL or ATTR cardiomyopathy who underwent cardiopulmonary exercise testing across four centres.
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