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Cardiopulmonary Exercise Testing in the Age of New Heart Failure Therapies: Still a Powerful Tool?

Background: New therapies with prognostic benefits have been recently introduced in heart failure with reduced ejection fraction (HFrEF) management. The aim of this study was to evaluate the prognostic power of current listing criteria for heart transplantation (HT) in an HFrEF cohort submitted to c...

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Autores principales: Garcia Brás, Pedro, Gonçalves, António Valentim, Reis, João Ferreira, Moreira, Rita Ilhão, Pereira-da-Silva, Tiago, Rio, Pedro, Timóteo, Ana Teresa, Silva, Sofia, Soares, Rui M., Ferreira, Rui Cruz
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10452308/
https://www.ncbi.nlm.nih.gov/pubmed/37626705
http://dx.doi.org/10.3390/biomedicines11082208
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author Garcia Brás, Pedro
Gonçalves, António Valentim
Reis, João Ferreira
Moreira, Rita Ilhão
Pereira-da-Silva, Tiago
Rio, Pedro
Timóteo, Ana Teresa
Silva, Sofia
Soares, Rui M.
Ferreira, Rui Cruz
author_facet Garcia Brás, Pedro
Gonçalves, António Valentim
Reis, João Ferreira
Moreira, Rita Ilhão
Pereira-da-Silva, Tiago
Rio, Pedro
Timóteo, Ana Teresa
Silva, Sofia
Soares, Rui M.
Ferreira, Rui Cruz
author_sort Garcia Brás, Pedro
collection PubMed
description Background: New therapies with prognostic benefits have been recently introduced in heart failure with reduced ejection fraction (HFrEF) management. The aim of this study was to evaluate the prognostic power of current listing criteria for heart transplantation (HT) in an HFrEF cohort submitted to cardiopulmonary exercise testing (CPET) between 2009 and 2014 (group A) and between 2015 and 2018 (group B). Methods: Consecutive patients with HFrEF who underwent CPET were followed-up for cardiac death and urgent HT. Results: CPET was performed in 487 patients. The composite endpoint occurred in 19.4% of group A vs. 7.4% of group B in a 36-month follow-up. Peak VO(2) (pVO(2)) and VE/VCO(2) slope were the strongest independent predictors of mortality. International Society for Heart and Lung Transplantation (ISHLT) thresholds of pVO(2) ≤ 12 mL/kg/min (≤14 if intolerant to β-blockers) and VE/VCO(2) slope > 35 presented a similar and lower Youden index, respectively, in group B compared to group A, and a lower positive predictive value. pVO(2) ≤ 10 mL/kg/min and VE/VCO(2) slope > 40 outperformed the traditional cut-offs. An ischemic etiology subanalysis showed similar results. Conclusion: ISHLT thresholds showed a lower overall prognostic effectiveness in a contemporary HFrEF population. Novel parameters may be needed to improve risk stratification.
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spelling pubmed-104523082023-08-26 Cardiopulmonary Exercise Testing in the Age of New Heart Failure Therapies: Still a Powerful Tool? Garcia Brás, Pedro Gonçalves, António Valentim Reis, João Ferreira Moreira, Rita Ilhão Pereira-da-Silva, Tiago Rio, Pedro Timóteo, Ana Teresa Silva, Sofia Soares, Rui M. Ferreira, Rui Cruz Biomedicines Article Background: New therapies with prognostic benefits have been recently introduced in heart failure with reduced ejection fraction (HFrEF) management. The aim of this study was to evaluate the prognostic power of current listing criteria for heart transplantation (HT) in an HFrEF cohort submitted to cardiopulmonary exercise testing (CPET) between 2009 and 2014 (group A) and between 2015 and 2018 (group B). Methods: Consecutive patients with HFrEF who underwent CPET were followed-up for cardiac death and urgent HT. Results: CPET was performed in 487 patients. The composite endpoint occurred in 19.4% of group A vs. 7.4% of group B in a 36-month follow-up. Peak VO(2) (pVO(2)) and VE/VCO(2) slope were the strongest independent predictors of mortality. International Society for Heart and Lung Transplantation (ISHLT) thresholds of pVO(2) ≤ 12 mL/kg/min (≤14 if intolerant to β-blockers) and VE/VCO(2) slope > 35 presented a similar and lower Youden index, respectively, in group B compared to group A, and a lower positive predictive value. pVO(2) ≤ 10 mL/kg/min and VE/VCO(2) slope > 40 outperformed the traditional cut-offs. An ischemic etiology subanalysis showed similar results. Conclusion: ISHLT thresholds showed a lower overall prognostic effectiveness in a contemporary HFrEF population. Novel parameters may be needed to improve risk stratification. MDPI 2023-08-06 /pmc/articles/PMC10452308/ /pubmed/37626705 http://dx.doi.org/10.3390/biomedicines11082208 Text en © 2023 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Garcia Brás, Pedro
Gonçalves, António Valentim
Reis, João Ferreira
Moreira, Rita Ilhão
Pereira-da-Silva, Tiago
Rio, Pedro
Timóteo, Ana Teresa
Silva, Sofia
Soares, Rui M.
Ferreira, Rui Cruz
Cardiopulmonary Exercise Testing in the Age of New Heart Failure Therapies: Still a Powerful Tool?
title Cardiopulmonary Exercise Testing in the Age of New Heart Failure Therapies: Still a Powerful Tool?
title_full Cardiopulmonary Exercise Testing in the Age of New Heart Failure Therapies: Still a Powerful Tool?
title_fullStr Cardiopulmonary Exercise Testing in the Age of New Heart Failure Therapies: Still a Powerful Tool?
title_full_unstemmed Cardiopulmonary Exercise Testing in the Age of New Heart Failure Therapies: Still a Powerful Tool?
title_short Cardiopulmonary Exercise Testing in the Age of New Heart Failure Therapies: Still a Powerful Tool?
title_sort cardiopulmonary exercise testing in the age of new heart failure therapies: still a powerful tool?
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10452308/
https://www.ncbi.nlm.nih.gov/pubmed/37626705
http://dx.doi.org/10.3390/biomedicines11082208
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