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1. Pick Your Threshold: A Comparison Among Different Methods of Anaerobic Threshold Evaluation in Heart Failure Prognostic Assessment

Author

Farina, Stefania, Pezzuto, Beatrice, Apostolo, Anna, Palermo, Pietro, Contini, Mauro, Gugliandolo, Paola, Mattavelli, Irene, Della Rocca, Michele, Gallo, Giovanna, Moscucci, Federica, Iorio, Anita, Halasz, Geza, Capelli, Bruno, Binno, Simone, Pacileo, Giuseppe, Valente, Fabio, Vastarella, Rossella, Zaffalon, Denise, Carriere, Cosimo, Masè, Marco, Cittar, Marco, Di Lenarda, Andrea, Caravita, Sergio, Viganò, Elena, Marchese, Giovanni, Ricci, Roberto, Arcari, Luca, Scrutinio, Domenico, Battaia, Elisa, Moretti, Michele, Matassini, Maria Vittoria, Shkoza, Matilda, Herberg, Roland, Cittadini, Antonio, Salzano, Andrea, Marra, Alberto, Lafranca, Eluisa, Vitale, Giuseppe, Salvioni, Elisabetta, Mapelli, Massimo, Bonomi, Alice, Magrì, Damiano, Piepoli, Massimo, Frigerio, Maria, Paolillo, Stefania, Corrà, Ugo, Raimondo, Rosa, Lagioia, Rocco, Badagliacca, Roberto, Filardi, Pasquale Perrone, Senni, Michele, Correale, Michele, Cicoira, Mariantonietta, Perna, Enrico, Metra, Marco, Guazzi, Marco, Limongelli, Giuseppe, Sinagra, Gianfranco, Parati, Gianfranco, Cattadori, Gaia, Bandera, Francesco, Bussotti, Maurizio, Re, Federica, Vignati, Carlo, Lombardi, Carlo, Scardovi, Angela B., Sciomer, Susanna, Passantino, Andrea, Emdin, Michele, Passino, Claudio, Santolamazza, Caterina, Girola, Davide, De Martino, Fabiana, and Agostoni, Piergiuseppe

Published
2022
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3. Pick Your Threshold

Author

Salvioni, Elisabetta, primary, Mapelli, Massimo, additional, Bonomi, Alice, additional, Magrì, Damiano, additional, Piepoli, Massimo, additional, Frigerio, Maria, additional, Paolillo, Stefania, additional, Corrà, Ugo, additional, Raimondo, Rosa, additional, Lagioia, Rocco, additional, Badagliacca, Roberto, additional, Filardi, Pasquale Perrone, additional, Senni, Michele, additional, Correale, Michele, additional, Cicoira, Mariantonietta, additional, Perna, Enrico, additional, Metra, Marco, additional, Guazzi, Marco, additional, Limongelli, Giuseppe, additional, Sinagra, Gianfranco, additional, Parati, Gianfranco, additional, Cattadori, Gaia, additional, Bandera, Francesco, additional, Bussotti, Maurizio, additional, Re, Federica, additional, Vignati, Carlo, additional, Lombardi, Carlo, additional, Scardovi, Angela B., additional, Sciomer, Susanna, additional, Passantino, Andrea, additional, Emdin, Michele, additional, Passino, Claudio, additional, Santolamazza, Caterina, additional, Girola, Davide, additional, Zaffalon, Denise, additional, De Martino, Fabiana, additional, Agostoni, Piergiuseppe, additional, Farina, Stefania, additional, Pezzuto, Beatrice, additional, Apostolo, Anna, additional, Palermo, Pietro, additional, Contini, Mauro, additional, Gugliandolo, Paola, additional, Mattavelli, Irene, additional, Della Rocca, Michele, additional, Gallo, Giovanna, additional, Moscucci, Federica, additional, Iorio, Anita, additional, Halasz, Geza, additional, Capelli, Bruno, additional, Binno, Simone, additional, Pacileo, Giuseppe, additional, Valente, Fabio, additional, Vastarella, Rossella, additional, Carriere, Cosimo, additional, Masè, Marco, additional, Cittar, Marco, additional, Di Lenarda, Andrea, additional, Caravita, Sergio, additional, Viganò, Elena, additional, Marchese, Giovanni, additional, Ricci, Roberto, additional, Arcari, Luca, additional, Scrutinio, Domenico, additional, Battaia, Elisa, additional, Moretti, Michele, additional, Matassini, Maria Vittoria, additional, Shkoza, Matilda, additional, Herberg, Roland, additional, Cittadini, Antonio, additional, Salzano, Andrea, additional, Marra, Alberto, additional, Lafranca, Eluisa, additional, and Vitale, Giuseppe, additional

Published
2022
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4. Pick Your Threshold: A Comparison Among Different Methods of Anaerobic Threshold Evaluation in Heart Failure Prognostic Assessment.

Author

Salvioni, Elisabetta, Mapelli, Massimo, Bonomi, Alice, Magrì, Damiano, Piepoli, Massimo, Frigerio, Maria, Paolillo, Stefania, Corrà, Ugo, Raimondo, Rosa, Lagioia, Rocco, Badagliacca, Roberto, Filardi, Pasquale Perrone, Senni, Michele, Correale, Michele, Cicoira, Mariantonietta, Perna, Enrico, Metra, Marco, Guazzi, Marco, Limongelli, Giuseppe, and Sinagra, Gianfranco

Subjects
*HEART assist devices, *HEART failure, *EXERCISE tests, *ANAEROBIC threshold, *RECEIVER operating characteristic curves, *ABDOMINAL surgery, *HEART transplantation, *THORACIC surgery, *OXYGEN consumption, *PROGNOSIS
Abstract

Background: In clinical practice, anaerobic threshold (AT) is used to guide training and rehabilitation programs, to define risk of major thoracic or abdominal surgery, and to assess prognosis in heart failure (HF). AT of oxygen uptake (V.O2; V.O2AT) has been reported as an absolute value (V.O2ATabs), as a percentage of predicted peak V.O2 (V.O2AT%peak_pred), or as a percentage of observed peak V.O2 (V.O2AT%peak_obs). A direct comparison of the prognostic power among these different ways to report AT is missing.Research Question: What is the prognostic power of these different ways to report AT?Study Design and Methods: In this observational cohort study, we screened data of 7,746 patients with HF with a history of reduced ejection fraction (< 40%) recruited between 1998 and 2020 and enrolled in the Metabolic Exercise Combined With Cardiac and Kidney Indexes register. All patients underwent a maximum cardiopulmonary exercise test, executed using a ramp protocol on an electronically braked cycle ergometer.Results: This study considered 6,157 patients with HF with identified AT. Follow-up was median, 4.2 years (25th-75th percentiles, 1.9-5.0 years). Both V.O2ATabs (mean ± SD, 823 ± 305 mL/min) and V.O2AT%peak_pred (mean ± SD, 39.6 ± 13.9%), but not V.O2AT%peak_obs (mean ± SD, 69.2 ± 17.7%), well stratified the population regarding prognosis (composite end point: cardiovascular death, urgent heart transplant, or left ventricular assist device). Comparing area under the receiver operating characteristic curve (AUC) values, V.O2ATabs (0.680) and V.O2AT%peak_pred (0.688) performed similarly, whereas V.O2AT%peak_obs (0.538) was significantly weaker (P < .001). Moreover, the V.O2AT%peak_pred AUC value was the only one performing as well as the AUC based on peak V.O2 (0.710), with an even a higher AUC (0.637 vs 0.618, respectively) in the group with severe HF (peak V.O2 < 12 mL/min/kg). Finally, the combination of V.O2AT%peak_pred with peak V.O2 and V. per CO2 production shows the highest prognostic power.Interpretation: In HF, V.O2AT%peak_pred is the best way to report V.O2 at AT in relationship to prognosis, with a prognostic power comparable to that of peak V.O2 and, remarkably, in patients with severe HF. [ABSTRACT FROM AUTHOR]

Published
2022
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5. Reference Values for Peak Exercise Cardiac Output in Healthy Individuals

Author

Agostoni, Piergiuseppe, primary, Vignati, Carlo, additional, Gentile, Piero, additional, Boiti, Costanza, additional, Farina, Stefania, additional, Salvioni, Elisabetta, additional, Mapelli, Massimo, additional, Magrì, Damiano, additional, Paolillo, Stefania, additional, Corrieri, Nicoletta, additional, Sinagra, Gianfranco, additional, and Cattadori, Gaia, additional

Published
2017
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6. Pick Your Threshold: A Comparison Among Different Methods of Anaerobic Threshold Evaluation in Heart Failure Prognostic Assessment

Author

Elisabetta, Salvioni, Massimo, Mapelli, Alice, Bonomi, Damiano, Magrì, Massimo, Piepoli, Maria, Frigerio, Stefania, Paolillo, Ugo, Corrà, Rosa, Raimondo, Rocco, Lagioia, Roberto, Badagliacca, Pasquale Perrone, Filardi, Michele, Senni, Michele, Correale, Mariantonietta, Cicoira, Enrico, Perna, Marco, Metra, Marco, Guazzi, Giuseppe, Limongelli, Gianfranco, Sinagra, Gianfranco, Parati, Gaia, Cattadori, Francesco, Bandera, Maurizio, Bussotti, Federica, Re, Carlo, Vignati, Carlo, Lombardi, Angela B, Scardovi, Susanna, Sciomer, Andrea, Passantino, Michele, Emdin, Claudio, Passino, Caterina, Santolamazza, Davide, Girola, Denise, Zaffalon, Fabiana, De Martino, Piergiuseppe, Agostoni, Giuseppe, Vitale, Salvioni, Elisabetta, Mapelli, Massimo, Bonomi, Alice, Magrì, Damiano, Piepoli, Massimo, Frigerio, Maria, Paolillo, Stefania, Corrà, Ugo, Raimondo, Rosa, Lagioia, Rocco, Badagliacca, Roberto, Filardi, Pasquale Perrone, Senni, Michele, Correale, Michele, Cicoira, Mariantonietta, Perna, Enrico, Metra, Marco, Guazzi, Marco, Limongelli, Giuseppe, Sinagra, Gianfranco, Parati, Gianfranco, Cattadori, Gaia, Bandera, Francesco, Bussotti, Maurizio, Re, Federica, Vignati, Carlo, Lombardi, Carlo, Scardovi, Angela B, Sciomer, Susanna, Marra, Alberto, Passantino, Andrea, Emdin, Michele, Passino, Claudio, Santolamazza, Caterina, Girola, Davide, Zaffalon, Denise, De Martino, Fabiana, and Agostoni, Piergiuseppe

Subjects
Heart Failure, Oxygen Consumption, Anaerobic Threshold, Anaerobic threshold, cardiopulmonary exercise test, heart failure, prognosis, Exercise Test, Humans, Settore MED/11 - Malattie dell'Apparato Cardiovascolare, Prognosis
Abstract

Background: In clinical practice, anaerobic threshold (AT) is used to guide training and rehabilitation programs, to define risk of major thoracic or abdominal surgery, and to assess prognosis in heart failure (HF). AT of oxygen uptake (V.O2; V.O2AT) has been reported as an absolute value (V.O2ATabs), as a percentage of predicted peak V.O2 (V.O2AT%peak_pred), or as a percentage of observed peak V.O2 (V.O2AT%peak_obs). A direct comparison of the prognostic power among these different ways to report AT is missing. Research question: What is the prognostic power of these different ways to report AT? Study design and methods: In this observational cohort study, we screened data of 7,746 patients with HF with a history of reduced ejection fraction (< 40%) recruited between 1998 and 2020 and enrolled in the Metabolic Exercise Combined With Cardiac and Kidney Indexes register. All patients underwent a maximum cardiopulmonary exercise test, executed using a ramp protocol on an electronically braked cycle ergometer. Results: This study considered 6,157 patients with HF with identified AT. Follow-up was median, 4.2 years (25th-75th percentiles, 1.9-5.0 years). Both V.O2ATabs (mean ± SD, 823 ± 305 mL/min) and V.O2AT%peak_pred (mean ± SD, 39.6 ± 13.9%), but not V.O2AT%peak_obs (mean ± SD, 69.2 ± 17.7%), well stratified the population regarding prognosis (composite end point: cardiovascular death, urgent heart transplant, or left ventricular assist device). Comparing area under the receiver operating characteristic curve (AUC) values, V.O2ATabs (0.680) and V.O2AT%peak_pred (0.688) performed similarly, whereas V.O2AT%peak_obs (0.538) was significantly weaker (P < .001). Moreover, the V.O2AT%peak_pred AUC value was the only one performing as well as the AUC based on peak V.O2 (0.710), with an even a higher AUC (0.637 vs 0.618, respectively) in the group with severe HF (peak V.O2 < 12 mL/min/kg). Finally, the combination of V.O2AT%peak_pred with peak V.O2 and V. per CO2 production shows the highest prognostic power. Interpretation: In HF, V.O2AT%peak_pred is the best way to report V.O2 at AT in relationship to prognosis, with a prognostic power comparable to that of peak V.O2 and, remarkably, in patients with severe HF.

Published
2022

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