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Prognostic significance of peak oxygen consumption≤10ml/kg/min in heart failure: Context vs. criteria.
MedLine Citation:
PMID:  23684598     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
BACKGROUND: Both heart failure (HF) treatment and management may distort or enhance the predictive accuracy of low peak oxygen consumption (pVO2≤10ml/kg/min), blurring the identification of specific patients in whom heart transplantation (HT) could make a clinical difference. The aim of this study was to re-evaluate the prognostic significance of pVO2≤10ml/kg/min in systolic HF in light of changes in medical treatment and management. METHODS: Two-year outcomes were compared across the "millennium dawn" (MD) between two HF cohorts with pVO2≤10ml/kg/min and gas exchange ratio>1.10: 116 patients were recorded between 1994 and 1999 (pre-MD: mean pVO2 8.6±1.1ml/kg/min) and 90 between 2001 and 2008 (post-MD: mean pVO2 8.8±1.0ml/kg/min). Cardiac-related death was considered an event and event censoring was interrupted at 24months for surviving patients. RESULTS: Patients across the MD had the same age, NYHA class, left ventricular ejection fraction and pVO2 (pre-MD: mean pVO2 8.6±1.1; post-MD: mean pVO2 8.8±1.0ml/kg/min: NS). Seventy-one patients (34%) died: 51 (44%) in the pre-MD and 20 (22%) in the post-MD group (p<0.01). The post-MD group showed a better mean 1-year (83% vs. 68%; χ(2)=5.17, p=0.0229) and 2-year survival (77% vs. 56%; χ(2)=8.87, p=0.0029) compared to pre-MD patients. CONCLUSIONS: Two-year outcome of HF patients with pVO2≤10ml/kg/min has significantly improved in the post-MD era, suggesting the HT indication should not rely on a single CPET parameter, rather on a multifactorial clinical approach.
Authors:
Ugo Corrà; Andrea Giordano; Alessandro Mezzani; Massimo Pistono; Marco Gnemmi; Kentaro Kamiya; Pantaleo Giannuzzi
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2013-5-16
Journal Detail:
Title:  International journal of cardiology     Volume:  -     ISSN:  1874-1754     ISO Abbreviation:  Int. J. Cardiol.     Publication Date:  2013 May 
Date Detail:
Created Date:  2013-5-20     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8200291     Medline TA:  Int J Cardiol     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Copyright Information:
Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.
Affiliation:
Division of Cardiology, Salvatore Maugeri Foundation, IRCCS, Veruno (NO), Italy. Electronic address: ucorra@fsm.it.
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