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Optimizing exercise testing‐based risk stratification to predict poor prognosis after acute heart failure

AIMS: The timely selection of severe heart failure (HF) patients for cardiac transplantation and advanced HF therapy is challenging. Peak oxygen consumption (VO(2)) values obtained by the cardiopulmonary exercise testing are used to determine the transplant recipient list. This study reassessed the...

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Autores principales: Chen, Shyh‐Ming, Wu, Po‐Jui, Wang, Lin‐Yi, Wei, Chin‐Ling, Cheng, Cheng‐I, Fang, Hsiu‐Yu, Fang, Yen‐Nan, Chen, Yung‐Lung, Huang, David Kwan‐Ru, Lee, Fan‐Yen, Chen, Mien‐Cheng
Formato: Online Artículo Texto
Lenguaje:English
Publicado: John Wiley and Sons Inc. 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10053263/
https://www.ncbi.nlm.nih.gov/pubmed/36460605
http://dx.doi.org/10.1002/ehf2.14240
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author Chen, Shyh‐Ming
Wu, Po‐Jui
Wang, Lin‐Yi
Wei, Chin‐Ling
Cheng, Cheng‐I
Fang, Hsiu‐Yu
Fang, Yen‐Nan
Chen, Yung‐Lung
Huang, David Kwan‐Ru
Lee, Fan‐Yen
Chen, Mien‐Cheng
author_facet Chen, Shyh‐Ming
Wu, Po‐Jui
Wang, Lin‐Yi
Wei, Chin‐Ling
Cheng, Cheng‐I
Fang, Hsiu‐Yu
Fang, Yen‐Nan
Chen, Yung‐Lung
Huang, David Kwan‐Ru
Lee, Fan‐Yen
Chen, Mien‐Cheng
author_sort Chen, Shyh‐Ming
collection PubMed
description AIMS: The timely selection of severe heart failure (HF) patients for cardiac transplantation and advanced HF therapy is challenging. Peak oxygen consumption (VO(2)) values obtained by the cardiopulmonary exercise testing are used to determine the transplant recipient list. This study reassessed the prognostic predictability of peak VO(2) and compared it with the Heart Failure Survival Score (HFSS) in the modern optimized guideline‐directed medical therapy (GDMT) era. METHODS AND RESULTS: We retrospectively selected 377 acute HF patients discharged from the hospital. The primary outcome was a composite of all‐cause mortality, or urgent cardiac transplantation. We divided these patients into the more GDMT (two or more types of GDMT) and less GDMT groups (fewer than two types of GDMT) and compared the performance of their peak VO(2) and HFSS in predicting primary outcomes. The median follow‐up period was 3.3 years. The primary outcome occurred in 57 participants. Peak VO(2) outperformed HFSS when predicting 1 year (0.81 vs. 0.61; P = 0.017) and 2 year (0.78 vs. 0.58; P < 0.001) major outcomes. The cutoff peak VO(2) for predicting a 20% risk of a major outcome within 2 years was 10.2 (11.8–7.0) for the total cohort. Multivariate Cox regression analyses showed that peak VO(2), sodium, previous implantable cardioverter defibrillator (ICD) implantation, and estimated glomerular filtration rate were significant predictors of major outcomes. CONCLUSIONS: Optimizing the cutoff value of peak VO(2) is required in the current GDMT era for advanced HF therapy. Other clinical factors such as ICD use, hyponatraemia, and chronic kidney disease could also be used to predict poor prognosis. The improvement of resource allocation and patient outcomes could be achieved by careful selection of appropriate patients for advanced HF therapies, such as cardiac transplantation.
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spelling pubmed-100532632023-03-30 Optimizing exercise testing‐based risk stratification to predict poor prognosis after acute heart failure Chen, Shyh‐Ming Wu, Po‐Jui Wang, Lin‐Yi Wei, Chin‐Ling Cheng, Cheng‐I Fang, Hsiu‐Yu Fang, Yen‐Nan Chen, Yung‐Lung Huang, David Kwan‐Ru Lee, Fan‐Yen Chen, Mien‐Cheng ESC Heart Fail Original Articles AIMS: The timely selection of severe heart failure (HF) patients for cardiac transplantation and advanced HF therapy is challenging. Peak oxygen consumption (VO(2)) values obtained by the cardiopulmonary exercise testing are used to determine the transplant recipient list. This study reassessed the prognostic predictability of peak VO(2) and compared it with the Heart Failure Survival Score (HFSS) in the modern optimized guideline‐directed medical therapy (GDMT) era. METHODS AND RESULTS: We retrospectively selected 377 acute HF patients discharged from the hospital. The primary outcome was a composite of all‐cause mortality, or urgent cardiac transplantation. We divided these patients into the more GDMT (two or more types of GDMT) and less GDMT groups (fewer than two types of GDMT) and compared the performance of their peak VO(2) and HFSS in predicting primary outcomes. The median follow‐up period was 3.3 years. The primary outcome occurred in 57 participants. Peak VO(2) outperformed HFSS when predicting 1 year (0.81 vs. 0.61; P = 0.017) and 2 year (0.78 vs. 0.58; P < 0.001) major outcomes. The cutoff peak VO(2) for predicting a 20% risk of a major outcome within 2 years was 10.2 (11.8–7.0) for the total cohort. Multivariate Cox regression analyses showed that peak VO(2), sodium, previous implantable cardioverter defibrillator (ICD) implantation, and estimated glomerular filtration rate were significant predictors of major outcomes. CONCLUSIONS: Optimizing the cutoff value of peak VO(2) is required in the current GDMT era for advanced HF therapy. Other clinical factors such as ICD use, hyponatraemia, and chronic kidney disease could also be used to predict poor prognosis. The improvement of resource allocation and patient outcomes could be achieved by careful selection of appropriate patients for advanced HF therapies, such as cardiac transplantation. John Wiley and Sons Inc. 2022-12-02 /pmc/articles/PMC10053263/ /pubmed/36460605 http://dx.doi.org/10.1002/ehf2.14240 Text en © 2022 The Authors. ESC Heart Failure published by John Wiley & Sons Ltd on behalf of European Society of Cardiology. https://creativecommons.org/licenses/by-nc/4.0/This is an open access article under the terms of the http://creativecommons.org/licenses/by-nc/4.0/ (https://creativecommons.org/licenses/by-nc/4.0/) License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes.
spellingShingle Original Articles
Chen, Shyh‐Ming
Wu, Po‐Jui
Wang, Lin‐Yi
Wei, Chin‐Ling
Cheng, Cheng‐I
Fang, Hsiu‐Yu
Fang, Yen‐Nan
Chen, Yung‐Lung
Huang, David Kwan‐Ru
Lee, Fan‐Yen
Chen, Mien‐Cheng
Optimizing exercise testing‐based risk stratification to predict poor prognosis after acute heart failure
title Optimizing exercise testing‐based risk stratification to predict poor prognosis after acute heart failure
title_full Optimizing exercise testing‐based risk stratification to predict poor prognosis after acute heart failure
title_fullStr Optimizing exercise testing‐based risk stratification to predict poor prognosis after acute heart failure
title_full_unstemmed Optimizing exercise testing‐based risk stratification to predict poor prognosis after acute heart failure
title_short Optimizing exercise testing‐based risk stratification to predict poor prognosis after acute heart failure
title_sort optimizing exercise testing‐based risk stratification to predict poor prognosis after acute heart failure
topic Original Articles
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10053263/
https://www.ncbi.nlm.nih.gov/pubmed/36460605
http://dx.doi.org/10.1002/ehf2.14240
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