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1. Intravenous iron therapy improves the hypercapnic ventilatory response and sleep disordered breathing in chronic heart failure

Author

Caravita, S., Faini, A., Vignati, C., Pelucchi, S., Salvioni, E., Cattadori, G., Baratto, C., Torlasco, C., Contini, M., Villani, A., Malfatto, G., Perger, E., Lombardi, C., Piperno, A., Agostoni, P., Parati, G., Caravita, S, Faini, A, Vignati, C, Pelucchi, S, Salvioni, E, Cattadori, G, Baratto, C, Torlasco, C, Contini, M, Villani, A, Malfatto, G, Perger, E, Lombardi, C, Piperno, A, Agostoni, P, and Parati, G

Subjects
Male, Anemia, Iron-Deficiency, Iron, Chemoreflex, Stroke Volume, Anaemia, Heart failure, Settore MED/11 - Malattie dell'Apparato Cardiovascolare, Iron Deficiencies, Exercise, Sleep, Ferric Compounds, Ventricular Function, Left, Oxygen, Hemoglobins, Sleep Apnea Syndromes, Chronic Disease, Humans, Female, Maltose, Cardiology and Cardiovascular Medicine
Abstract

Aims: Intravenous iron therapy can improve symptoms in patients with heart failure, anaemia and iron deficiency. The mechanisms underlying such an improvement might involve chemoreflex sensing and nocturnal breathing patterns. Methods and results: Patients with heart failure, reduced left ventricular ejection fraction, anaemia (haemoglobin

Published
2022
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2. Heart failure prognosis over time: how the prognostic role of oxygen consumption and ventilatory efficiency during exercise has changed in the last 20 years

Author

Paolillo, S., Veglia, F., Salvioni, E., Corra, U., Piepoli, M., Lagioia, R., Limongelli, G., Sinagra, G., Cattadori, G., Scardovi, A. B., Metra, M., Senni, M., Bonomi, A., Scrutinio, D., Raimondo, R., Emdin, M., Magri, D., Parati, G., Re, F., Cicoira, M., Mina, C., Correale, M., Frigerio, M., Bussotti, M., Battaia, E., Guazzi, M., Badagliacca, R., Di Lenarda, A., Maggioni, A., Passino, C., Sciomer, S., Pacileo, G., Mapelli, M., Vignati, C., Clemenza, F., Binno, S., Lombardi, C., Filardi, P. P., Agostoni, P., Apostolo, A., Palermo, P., Contini, M., Farina, S., Mantegazza, V., Spadafora, E., Lattarulo, M. S., Giordano, A., Mezzani, A., Ricci, R., Ferraironi, A., Carubelli, V., Pietrucci, F., Malfatto, G., Caravita, Sergio, Vigano, E., Valente, F., Vastarella, R., Gravino, R., Roselli, T., Buono, A., De Maria, R., Passantino, A., Santoro, D., Campanale, S., Caputo, D., Bertipaglia, D., Confalonieri, M., Gentile, P., Zambon, E., Morosin, M., Carriere, C., Ferraretti, A., Marchese, G., Iorio, A., Pastormerlo, L., Gargiulo, P., Villani, G. Q., Oliva, F., Perna, E., Paolillo, Stefania, Veglia, Fabrizio, Salvioni, Elisabetta, Corrà, Ugo, Piepoli, Massimo, Lagioia, Rocco, Limongelli, Giuseppe, Sinagra, Gianfranco, Cattadori, Gaia, Scardovi, Angela B., Metra, Marco, Senni, Michele, Bonomi, Alice, Scrutinio, Domenico, Raimondo, Rosa, Emdin, Michele, Magrì, Damiano, Parati, Gianfranco, Re, Federica, Cicoira, Mariantonietta, Minà, Chiara, Correale, Michele, Frigerio, Maria, Bussotti, Maurizio, Battaia, Elisa, Guazzi, Marco, Badagliacca, Roberto, Di Lenarda, Andrea, Maggioni, Aldo, Passino, Claudio, Sciomer, Susanna, Pacileo, Giuseppe, Mapelli, Massimo, Vignati, Carlo, Clemenza, Francesco, Binno, Simone, Lombardi, Carlo, Filardi, Pasquale Perrone, Agostoni, Piergiuseppe, Apostolo, Anna, Palermo, Pietro, Contini, Mauro, Farina, Stefania, Mantegazza, Valentina, Spadafora, Emanuele, Lattarulo, Maria Silvia, Giordano, Andrea, Mezzani, Alessandro, Ricci, Roberto, Ferraironi, Alessandro, Carubelli, Valentina, Pietrucci, Francesca, Malfatto, Gabriella, Caravita, Sergio, Viganò, Elena, Valente, Fabio, Vastarella, Rossella, Gravino, Rita, Roselli, Teo, Buono, Andrea, De Maria, Renata, Passantino, Andrea, Santoro, Daniela, Campanale, Saba, Caputo, Domenica, Bertipaglia, Donatella, Confalonieri, Marco, Gentile, Piero, Zambon, Elena, Morosin, Marco, Carriere, Cosimo, Ferraretti, Armando, Marchese, Giovanni, Iorio, Annamaria, Pastormerlo, Luigi, Gargiulo, Paola, Villani, Giovanni Quinto, Oliva, Fabrizio, Perna, Enrico, Paolillo, S, Veglia, F, Salvioni, E, Corrà, U, Piepoli, M, Lagioia, R, Limongelli, G, Sinagra, G, Cattadori, G, Scardovi, A, Metra, M, Senni, M, Bonomi, A, Scrutinio, D, Raimondo, R, Emdin, M, Magrì, D, Parati, G, Re, F, Cicoira, M, Minà, C, Correale, M, Frigerio, M, Bussotti, M, Battaia, E, Guazzi, M, Badagliacca, R, Di Lenarda, A, Maggioni, A, Passino, C, Sciomer, S, Pacileo, G, Mapelli, M, Vignati, C, Clemenza, F, Binno, S, Lombardi, C, Perrone Filardi, P, Agostoni, P, Apostolo, A, Palermo, P, Contini, M, Farina, S, Mantegazza, V, Spadafora, E, Lattarulo, M, Giordano, A, Mezzani, A, Ricci, R, Ferraironi, A, Carubelli, V, Pietrucci, F, Malfatto, G, Caravita, S, Vigano', E, Valente, F, Vastarella, R, Gravino, R, Roselli, T, Buono, A, De Maria, R, Passantino, A, Santoro, D, Campanale, S, Caputo, D, Bertipaglia, D, Confalonieri, M, Gentile, P, Zambon, E, Morosin, M, Carriere, C, Ferraretti, A, Marchese, G, Iorio, A, Pastormerlo, L, Gargiulo, P, Villani, G, Oliva, F, Perna, E, Paolillo, S., Veglia, F., Salvioni, E., Corra, U., Piepoli, M., Lagioia, R., Limongelli, G., Sinagra, G., Cattadori, G., Scardovi, A. B., Metra, M., Senni, M., Bonomi, A., Scrutinio, D., Raimondo, R., Emdin, M., Magri, D., Parati, G., Re, F., Cicoira, M., Mina, C., Correale, M., Frigerio, M., Bussotti, M., Battaia, E., Guazzi, M., Badagliacca, R., Di Lenarda, A., Maggioni, A., Passino, C., Sciomer, S., Pacileo, G., Mapelli, M., Vignati, C., Clemenza, F., Binno, S., Lombardi, C., Filardi, P. P., Agostoni, P., Apostolo, A., Palermo, P., Contini, M., Farina, S., Mantegazza, V., Spadafora, E., Lattarulo, M. S., Giordano, A., Mezzani, A., Ricci, R., Ferraironi, A., Carubelli, V., Pietrucci, F., Malfatto, G., Caravita, S., Vigano, E., Valente, F., Vastarella, R., Gravino, R., Roselli, T., Buono, A., De Maria, R., Passantino, A., Santoro, D., Campanale, S., Caputo, D., Bertipaglia, D., Confalonieri, M., Gentile, P., Zambon, E., Morosin, M., Carriere, C., Ferraretti, A., Marchese, G., Iorio, A., Pastormerlo, L., Gargiulo, P., Villani, G. Q., Oliva, F., and Perna, E.

Subjects
Male, Prognosi, Cardiopulmonary exercise test, Heart failure, Peak oxygen uptake, Prognosis, VE/VCO2 slope, cardiopulmonary exercise test, heart failure, peak oxygen uptake, prognosis, ve/vco, 2, slope, disease progression, exercise test, female, follow-up studies, humans, male, middle aged, oxygen consumption, pulmonary ventilation, roc curve, respiratory function tests, retrospective studies, forecasting, Settore MED/11 - Malattie dell'Apparato Cardiovascolare, Follow-Up Studie, VE/VCO, Oxygen Consumption, Cardiology and Cardiovascular Medicine, Retrospective Studie, Humans, Respiratory Function Test, Retrospective Studies, VE/VCO 2 slope, Middle Aged, Respiratory Function Tests, ROC Curve, Disease Progression, Exercise Test, Female, Pulmonary Ventilation, Human, Follow-Up Studies, Forecasting
Abstract

Aims: Exercise-derived parameters, specifically peak exercise oxygen uptake (peak VO 2 ) and minute ventilation/carbon dioxide relationship slope (VE/VCO 2 slope), have a pivotal prognostic value in heart failure (HF). It is unknown how the prognostic threshold of peak VO 2 and VE/VCO 2 slope has changed over the last 20 years in parallel with HF prognosis improvement. Methods and results: Data from 6083 HF patients (81% male, age 61 ± 13 years), enrolled in the MECKI score database between 1993 and 2015, were retrospectively analysed. By enrolment year, four groups were generated: group 1 1993–2000 (n = 440), group 2 2001–2005 (n = 1288), group 3 2006–2010 (n = 2368), and group 4 2011–2015 (n = 1987). We compared the 10-year survival of groups and analysed how the overall risk (cardiovascular death, urgent heart transplantation, or left ventricular assist device implantation) changed over time according to peak VO 2 and VE/VCO 2 slope and to major clinical and therapeutic variables. At 10 years, a progressively higher survival from group 1 to group 3 was observed, with no further improvement afterwards. A 20% risk for peak VO 2 15 mL/min/kg (95% confidence interval 16–13), 9 (11–8), 4 (4–2) and 5 (7–4) was observed in group 1, 2, 3, and 4, respectively, while the VE/VCO 2 slope value for a 20% risk was 32 (37–29), 47 (51–43), 59 (64–55), and 57 (63–52), respectively. Conclusions: Heart failure prognosis improved over time up to 2010 in a HF population followed by experienced centres. The peak VO 2 and VE/VCO 2 slope cut-offs identifying a definite risk progressively decreased and increased over time, respectively. The prognostic threshold of peak VO 2 and VE/VCO 2 slope must be updated whenever HF prognosis improves.

Published
2019

3. Gender and age normalization and ventilation efficiency during exercise in heart failure with reduced ejection fraction

Author

Salvioni, E, Corrà, U, Piepoli, M, Rovai, S, Correale, M, Paolillo, S, Pasquali, M, Magrì, Damiano, Vitale, G, Fusini, L, Mapelli, M, Vignati, C, Lagioia, R, Raimondo, R, Sinagra, G, Boggio, F, Cangiano, L, Gallo, G, Magini, A, Contini, M, Palermo, P, Apostolo, A, Pezzuto, B, Bonomi, A, Scardovi, Ab, Filardi, Pp, Limongelli, G, Metra, M, Scrutinio, D, Emdin, M, Piccioli, L, Lombardi, C, Cattadori, G, Parati, G, Caravita, S, Re, F, Cicoira, M, Frigerio, M, Clemenza, F, Bussotti, M, Battaia, E, Guazzi, M, Bandera, F, Badagliacca, R, Di Lenarda, A, Pacileo, G, Passino, C, Sciomer, S, Ambrosio, G, Agostoni, P, MECKI score research, Group., Salvioni, E., Corra, U., Piepoli, M., Rovai, S., Correale, M., Paolillo, S., Pasquali, M., Magri, D., Vitale, G., Fusini, L., Mapelli, M., Vignati, C., Lagioia, R., Raimondo, R., Sinagra, G., Boggio, F., Cangiano, L., Gallo, G., Magini, A., Contini, M., Palermo, P., Apostolo, A., Pezzuto, B., Bonomi, A., Scardovi, A. B., Filardi, P. P., Limongelli, G., Metra, M., Scrutinio, D., Emdin, M., Piccioli, L., Lombardi, C., Cattadori, G., Parati, G., Caravita, S., Re, F., Cicoira, M., Frigerio, M., Clemenza, F., Bussotti, M., Battaia, E., Guazzi, M., Bandera, F., Badagliacca, R., Di Lenarda, A., Pacileo, G., Passino, C., Sciomer, S., Ambrosio, G., Agostoni, P., and Guarino, Raimondo

Subjects
Male, lcsh:Diseases of the circulatory (Cardiovascular) system, cardiopulmonary exercise test, heart failure, prognosis, ventilation efficiency, medicine.medical_treatment, Settore MED/11 - Malattie dell'Apparato Cardiovascolare, 030204 cardiovascular system & hematology, Ventricular Function, Left, 0302 clinical medicine, Original Research Articles, Original Research Article, 030212 general & internal medicine, Lung, Aged, 80 and over, education.field_of_study, Ejection fraction, Age Factors, Middle Aged, Net reclassification improvement, Italy, Cardiology, Female, Cardiology and Cardiovascular Medicine, Cardiopulmonary exercise test, Prognosis, Ventilation efficiency, Heart failure, Adult, medicine.medical_specialty, Adolescent, Prognosi, Population, Age and gender, Young Adult, 03 medical and health sciences, Oxygen Consumption, Sex Factors, Internal medicine, Linear regression, medicine, Humans, education, Exercise, Aged, Retrospective Studies, Cardiovascular mortality, business.industry, Stroke Volume, medicine.disease, lcsh:RC666-701, Ventricular assist device, Exercise Test, Morbidity, business, human activities, Follow-Up Studies, Forecasting
Abstract

Aims Ventilation vs. carbon dioxide production (VE/VCO2) is among the strongest cardiopulmonary exercise testing prognostic parameters in heart failure (HF). It is usually reported as an absolute value. The current definition of normal VE/VCO2 slope values is inadequate, since it was built from small groups of subjects with a particularly limited number of women and elderly. We aimed to define VE/VCO2 slope prediction formulas in a sizable population and to test whether the prognostic power of VE/VCO2 slope in HF was different if expressed as a percentage of the predicted value or as an absolute value. Methods and results We calculated the linear regressions between age and VE/VCO2 slope in 1136 healthy subjects (68% male, age 44.9 ± 14.5, range 13–83 years). We then applied age‐adjusted and sex‐adjusted formulas to predict VE/VCO2 slope to HF patients included in the metabolic exercise test data combined with cardiac and kidney indexes score database, which counts 6112 patients (82% male, age 61.4 ± 12.8, left ventricular ejection fraction 33.2 ± 10.5%, peakVO2 14.8 ± 4.9, mL/min/kg, VE/VCO2 slope 32.7 ± 7.7) from 24 HF centres. Finally, we evaluated whether the use of absolute values vs. percentages of predicted VE/VCO2 affected HF prognosis prediction (composite of cardiovascular mortality + urgent transplant or left ventricular assist device). We did so in the entire cardiac and kidney indexes score population and separately in HF patients with severe (peakVO2 < 14 mL/min/kg, n = 2919, 61.1 events/1000 pts/year) or moderate (peakVO2 ≥ 14 mL/min/kg, n = 3183, 19.9 events/1000 pts/year) HF. In the healthy population, we obtained the following equations: female, VE/VCO2 = 0.052 × Age + 23.808 (r = 0.192); male, VE/VCO2 = 0.095 × Age + 20.227 (r = 0.371) (P = 0.007). We applied these formulas to calculate the percentages of predicted VE/VCO2 values. The 2‐year survival prognostic power of VE/VCO2 slope was strong, and it was similar if expressed as absolute value or as a percentage of predicted value (AUCs 0.686 and 0.690, respectively). In contrast, in severe HF patients, AUCs significantly differed between absolute values (0.637) and percentages of predicted values (0.650, P = 0.0026). Moreover, VE/VCO2 slope expressed as a percentage of predicted value allowed to reclassify 6.6% of peakVO2 < 14 mL/min/kg patients (net reclassification improvement = 0.066, P = 0.0015). Conclusions The percentage of predicted VE/VCO2 slope value strengthens the prognostic power of VE/VCO2 in severe HF patients, and it should be preferred over the absolute value for HF prognostication. Furthermore, the widespread use of VE/VCO2 slope expressed as percentage of predicted value can improve our ability to identify HF patients at high risk, which is a goal of utmost clinical relevance.

Published
2020

4. Novel outcome measures for Charcot−Marie−Tooth disease: validation and reliability of the 6-min walk test and StepWatch™Activity Monitor and identification of the walking features related to higher quality of life

Author

Padua, L., Pazzaglia, C., Pareyson, D., Schenone, A., Aiello, A., Fabrizi, G. M., Cavallaro, T., Santoro, L., Manganelli, F., Gemignani, F., Vitetta, F., Quattrone, A., Mazzeo, A., Russo, M., Vita, G, Gentile, L, Messina, S, Stancanelli, C, L Vita, G, Iacovelli, C, Figliolia, D, Silipo, S, Cabrini, I, Pisciotta, C, Tozza, S, Contini, M, Padua, L., Pazzaglia, C., Pareyson, D., Schenone, A., Aiello, A., Fabrizi, G. M., Cavallaro, T., Santoro, Lucio, Manganelli, Fiore, Gemignani, F., Vitetta, F., Quattrone, A., Mazzeo, A., Russo, M., and Vita, G.

Subjects
Male, 030506 rehabilitation, medicine.medical_treatment, Validity, Walking, Disease, Outcome measure, 0302 clinical medicine, Quality of life, Charcot-Marie-Tooth Disease, Outcome Assessment, Health Care, Charcot−Marie−Tooth, outcome measures, quality of life, rehabilitation, Prospective Studies, Prospective cohort study, Reliability (statistics), Rehabilitation, Charcot-Marie-Tooth, Outcome measures, Neurology (clinical), Neurology, Middle Aged, Test (assessment), Settore MED/26 - NEUROLOGIA, Italy, Female, 0305 other medical science, Adult, congenital, hereditary, and neonatal diseases and abnormalities, medicine.medical_specialty, Adolescent, Monitoring, MEDLINE, Walk Test, Outcome Assessment (Health Care), Young Adult, 03 medical and health sciences, Physical medicine and rehabilitation, medicine, Humans, Physiologic, Monitoring, Physiologic, Aged, business.industry, Charcot−Marie−Tooth, Reproducibility of Results, Quality of Life, Charcotâ Marieâ Tooth, nervous system diseases, Physical therapy, business, 030217 neurology & neurosurgery, Settore MED/34 - MEDICINA FISICA E RIABILITATIVA
Abstract

Background and purpose Charcot−Marie−Tooth (CMT) disease is the most common inherited neuropathy, but therapeutic options have been limited to symptom management. Past pharmacological trials have failed, possibly due to insensitive outcome measures (OMs). The aim of the current study was to evaluate the validity and reliability of the 6-min walk test (6MWT) and StepWatch™ Activity Monitoring (SAM) with other previously validated OMs in CMT disease. Methods A prospective multicenter study was performed, consecutively enrolling 168 CMT patients (104 with CMT1A, 27 with CMT1B, 37 with X-linked CMT) from Italian centers specializing in CMT care. Results Statistical analysis showed that the 6MWT was highly related with all previously used OMs. Some, but not all, SAM parameters were related to commonly used OMs but may provide more information about quality of life. Conclusions The current study demonstrated the validity and reliability of the 6MWT and SAM as OMs for CMT. Moreover, SAM provides data that correlate better with quality of life measures, making it useful in future rehabilitation trials.

Published
2016

5. Metabolic exercise data combined with cardiac and kidney indexes: MECKI score. Predictive role in cardiopulmonary exercise testing with low respiratory exchange ratio in heart failure

Author

Corrà, U, Agostoni, P, Piepoli, Mf, Giordano, A, Mezzani, A, Giannuzzi, P, Cattadori, G, Fiorentini, C, Salvioni, E, Giovannardi, M, Veglia, F, Apostolo, A, Palermo, P, Contini, M, Vignati, C, Farina, S, Bovis, F, Cicoira, M, Vassanelli, C, La Gioia, R, Scrutinio, D, Passantino, A, Santoro, D, Campanale, S, Caputo, D, Scardovi, Ab, Ricci, R, Emdin, Michele, Metra, M, Dei Cas, L, Sinagra, G, Berton, E, Limongelli, G, Iorio, Am, Roselli, T, Buono, A, Calabrò, R, Raimondo, R, Vaninetti, R, Bertipaglia, D, Re, F, Guazzi, M, Belardinelli, R, Pietrucci, F, Parati, G, Magrì, D, Di Lenarda, A, Paolillo, S, Perrone Filardi, P, Passino, Claudio, Pastormerlo, Luigi Emilio, Malfatto, G, Caravita, S., Corrà, Ugo, Agostoni, Piergiuseppe, Piepoli, Massimo F., Giordano, Andrea, Mezzani, Alessandro, Giannuzzi, Pantaleo, Cattadori, Gaia, Fiorentini, Cesare, Salvioni, Elisabetta, Giovannardi, Marta, Veglia, Fabrizio, Apostolo, Anna, Palermo, Pietro, Contini, Mauro, Vignati, Carlo, Farina, Stefania, Bovis, Francesca, Cicoira, Mariantonietta, Vassanelli, Corrado, La Gioia, Rocco, Scrutinio, Domenico, Passantino, Andrea, Santoro, Daniela, Campanale, Saba, Caputo, Domenica, Scardovi, Angela B., Ricci, Roberto, Emdin, Michele, Metra, Marco, Dei Cas, Livio, Sinagra, Gianfranco, Berton, Emanuela, Limongelli, Giuseppe, Iorio, Anna Maria, Roselli, Teo, Buono, Andrea, Calabro', Raffaele, Raimondo, Rosa, Vaninetti, Raffaella, Bertipaglia, Donatella, Re, Federica, Guazzi, Marco, Belardinelli, Milano Romualdo, Pietrucci, Francesca, Parati, Gianfranco, Magrì, Damiano, Di Lenarda, Andrea, Paolillo, Stefania, Perrone Filardi, Pasquale, Passino, Claudio, Pastormerlo, Luigi E., Malfatto, Gabriella, Corrà, U, Agostoni, P, Piepoli, M, Giordano, A, Mezzani, A, Giannuzzi, P, Cattadori, G, Fiorentini, C, Salvioni, E, Giovannardi, M, Veglia, F, Apostolo, A, Palermo, P, Contini, M, Vignati, C, Farina, S, Bovis, F, Cicoira, M, Vassanelli, C, La Gioia, R, Scrutinio, D, Passantino, A, Santoro, D, Campanale, S, Caputo, D, Scardovi, A, Ricci, R, Emdin, M, Metra, M, Dei Cas, L, Sinagra, G, Berton, E, Limongelli, G, Iorio, A, Roselli, T, Buono, A, Calabrò, R, Raimondo, R, Vaninetti, R, Bertipaglia, D, Re, F, Guazzi, M, Belardinelli, M, Pietrucci, F, Parati, G, Magrì, D, Di Lenarda, A, Paolillo, S, Perrone Filardi, P, Passino, C, Pastormerlo, L, Malfatto, G, Calabrò, Raffaele, and DI LENARDA, Andrea

Subjects
Male, medicine.medical_specialty, Cardiopulmonary exercise, Heart failure, Oxygen consumption, Prognosis, Respiratory quotient, Prognosi, Renal function, Respiratory physiology, Kidney Function Tests, Severity of Illness Index, Predictive Value of Tests, Internal medicine, Severity of illness, medicine, Humans, Respiratory exchange ratio, Aged, Kidney, business.industry, Medicine (all), Middle Aged, medicine.disease, medicine.anatomical_structure, Predictive value of tests, Exercise Test, Respiratory Mechanics, Cardiology, Female, Energy Metabolism, Cardiology and Cardiovascular Medicine, business, cardiopulmonary exercise, heart failure, oxygen consumption, prognosis, respiratory quotient, aged, energy metabolism, exercise test, female, humans, kidney function tests, male, middle aged, predictive value of tests, respiratory mechanics, severity of illness index, cardiology and cardiovascular medicine
Abstract

n/a

Published
2015

6. Prognostic value of indeterminable anaerobic threshold in heart failure

Author

Agostoni, P., Corrà, U., Cattadori, G., Veglia, F., Battaia, E., Gioia, R. L., Scardovi, A. B., Emdin, M., Metra, M., Sinagra, G., Limongelli, G., Raimondo, R., Re, F., Guazzi, M., Belardinelli, R., Parati, G., Magrì, D., Fiorentini, C., Cicoira, Mariantonietta, Salvioni, E., Giovannardi, M., Mezzani, A., Scrutinio, D., Lenarda, A. D., Mantegazza, V., Ricci, R., Apostolo, A., Iorio, A., Paolillo, S., Palermo, P., Contini, M., Vassanelli, Corrado, Passino, C., Piepoli, M. F., M. E. C., Agostoni, P, Corrà, U, Cattadori, G, Veglia, F, Battaia, E, La Gioia, R, Scardovi, A, Emdin, M, Metra, M, Sinagra, G, Limongelli, G, Raimondo, R, Re, F, Guazzi, M, Belardinelli, R, Parati, G, Magrì, D, Fiorentini, C, Cicoira, M, Salvioni, E, Giovannardi, M, Mezzani, A, Scrutinio, D, Di Lenarda, A, Mantegazza, V, Ricci, R, Apostolo, A, Iorio, A, Paolillo, S, Palermo, P, Contini, M, Vassanelli, C, Passino, C, Piepoli, M, Scardovi, Ab, Sinagra, Gianfranco, Piepoli, Mf, Gargiulo, P, Agostoni, P., Corra, U., Cattadori, G., Veglia, F., Battaia, E., Gioia, R. L., Scardovi, A. B., Emdin, M., Metra, M., Sinagra, G., Limongelli, G., Raimondo, R., Re, F., Guazzi, M., Belardinelli, R., Parati, G., Magri, D., Fiorentini, C., Cicoira, M., Salvioni, E., Giovannardi, M., Mezzani, A., Scrutinio, D., Lenarda, A. D., Mantegazza, V., Ricci, R., Apostolo, A., Iorio, A., Paolillo, S., Palermo, P., Contini, M., Vassanelli, C., Passino, C., and Piepoli, M. F.

Subjects
Male, Time Factors, Left, heart failure, Predictive Value of Test, Kaplan-Meier Estimate, Kidney, Severity of Illness Index, Ventricular Function, Left, Risk Factors, Cardiopulmonary exercise test, Exercise, follow-up studies, heart failure, oxygen, prognosis, Ventricular Function, Prospective Studies, Multivariate Analysi, exercise, Follow up studies, follow-up studies, oxygen, prognosis, Aged, Chi-Square Distribution, Energy Metabolism, Female, Heart Failure, Heart Transplantation, Humans, Italy, Logistic Models, Middle Aged, Multivariate Analysis, Predictive Value of Tests, Prognosis, Proportional Hazards Models, Stroke Volume, Anaerobic Threshold, Exercise Test, Cardiology, Cardiology and Cardiovascular Medicine, Anaerobic exercise, Prognostic value, Human, medicine.medical_specialty, Logistic Model, Time Factor, Prognosi, follow-up studie, anaerobic threshold, Internal medicine, medicine, Intensive care medicine, Follow-up studie, business.industry, Risk Factor, MED/11 - MALATTIE DELL'APPARATO CARDIOVASCOLARE, medicine.disease, Prospective Studie, Heart failure, Proportional Hazards Model, business, Value (mathematics)
Abstract

Background— In patients with heart failure (HF), during maximal cardiopulmonary exercise test, anaerobic threshold (AT) is not always identified. We evaluated whether this finding has a prognostic meaning. Methods and Results— We recruited and prospectively followed up, in 14 dedicated HF units, 3058 patients with systolic (left ventricular ejection fraction P P P =0.01; HR=1.02; CI=1.01–1.03), hemoglobin ( P P P P P P Conclusions— The inability to identify AT most often occurs in patients with severe HF, and it has an independent prognostic role in HF.

Published
2013

7. Modification of plasma glycosaminoglycans in long distance runners

Author

Contini, M, Pacini, S, Ibba-Manneschi, L, Boddi, V, Ruggiero, M, Liguri, G, Gulisano, M, Catini, C, and Mourao, P

Subjects
Adult, Male, medicine.medical_specialty, Keratan sulfate, Physical Therapy, Sports Therapy and Rehabilitation, Running, Glycosaminoglycan, chemistry.chemical_compound, Internal medicine, medicine, Humans, Chondroitin, Orthopedics and Sports Medicine, Thromboembolic disease, Life Style, Glycosaminoglycans, Long distance runners, Total plasma, Anthropometry, Chondroitin Sulfates, General Medicine, Anatomy, Keratan sulphate, Endocrinology, chemistry, Keratan Sulfate, Exercise Test, Original Article, Heparitin Sulfate, Anaerobic exercise
Abstract

Background:It is well documented that exercise reduces the risk of thromboembolic disease, possibly by increasing the plasma concentration of anticoagulant-antithrombotic compounds.Objectives:As plasma glycosaminoglycans (GAGs) play a role in the anticoagulant-antithrombotic potential of plasma, to examine the concentration and profile of these compounds in well trained, long distance runners and sedentary subjects.Methods:Plasma GAGs were measured in 10 male, long distance runners and 10 sedentary counterparts before and after ergometric tests. GAGs were extracted, purified, and identified by electrophoretic and enzymatic methods, and measured as hexosamine.Results:Plasma GAGs found in sedentary subjects were slow migrating heparan sulphates I and II, keratan sulphate I, and chondroitin 4–6-sulphate. Those found in trained athletes were slow migrating heparan sulphate I, chondroitin 4–6-sulphate (or keratan sulphate I), and fast migrating heparan sulphate. Total plasma concentrations of GAGs were higher in athletes than in sedentary subjects at rest. In sedentary subjects, plasma GAGs did not change after cycle ergometric exercise at 80% of their anaerobic threshold. However, the appearance of a novel band of heparan sulphate migrating faster than fast migrating heparan sulphate was observed in athletes after exercise.Conclusions:Exercise changes the amount and profile of plasma GAGs; these changes may play a role in protecting subjects who practise aerobic sports against developing cardiovascular disease.

Published
2004

8. The metabolic exercise test data combined with Cardiac And Kidney Indexes (MECKI) score and prognosis in heart failure. A validation study

Author

Corrà, Ugo, Agostoni, Piergiuseppe, Giordano, Andrea, Cattadori, Gaia, Battaia, Elisa, La Gioia, Rocco, Scardovi, Angela B., Emdin, Michele, Metra, Marco, Sinagra, Gianfranco, Limongelli, Giuseppe, Raimondo, Rosa, Federica, Re, Guazzi, Marco, Belardinelli, Romualdo, Parati, Gianfranco, Magri', Damiano, Fiorentini, Cesare, Cicoira, Mariantonietta, Salvioni, Elisabetta, Giovannardi, Marta, Veglia, Fabrizio, Mezzani, Alessandro, Scrutinio, Domenico, Di Lenarda, Andrea, Ricci, Roberto, Apostolo, Anna, Iorio, Anna Maria, Paolillo, Stefania, Palermo, Pietro, Contini, Mauro, Vassanelli, Corrado, Passino, Claudio, Giannuzzi, Pantaleo, Piepoli, Massimo F., MECKI ScoreResearch Group, Other Members of the MECKI Score research Group, Antonioli, L., Segurini, C., Bertella, E., Farina, S., Bovis, F., Pietrucci, F., Malfatto, G., Roselli, T., Buono, A., Calabrò, R., De Maria, R., Santoro, D., Campanale, S., Caputo, D., Bertipaglia, D., Berton, E., Corrà, Ugo, Agostoni, Piergiuseppe, Giordano, Andrea, Cattadori, Gaia, Battaia, Elisa, La Gioia, Rocco, Scardovi, Angela B., Emdin, Michele, Metra, Marco, Sinagra, Gianfranco, Limongelli, Giuseppe, Raimondo, Rosa, Re, Federica, Guazzi, Marco, Belardinelli, Romualdo, Parati, Gianfranco, Magrì, Damiano, Fiorentini, Cesare, Cicoira, Mariantonietta, Salvioni, Elisabetta, Giovannardi, Marta, Veglia, Fabrizio, Mezzani, Alessandro, Scrutinio, Domenico, DI LENARDA, Andrea, Ricci, Roberto, Apostolo, Anna, Iorio, Anna Maria, Paolillo, Stefania, Palermo, Pietro, Contini, Mauro, Vassanelli, Corrado, Passino, Claudio, Giannuzzi, Pantaleo, Piepoli, Massimo F., Corra, U., Agostoni, P., Giordano, A., Cattadori, G., Battaia, E., La Gioia, R., Scardovi, A. B., Emdin, M., Metra, M., Sinagra, G., Limongelli, G., Raimondo, R., Re, F., Guazzi, M., Belardinelli, R., Parati, G., Magri, D., Fiorentini, C., Cicoira, M., Salvioni, E., Giovannardi, M., Veglia, F., Mezzani, A., Scrutinio, D., Di Lenarda, A., Ricci, R., Apostolo, A., Iorio, A. M., Paolillo, S., Palermo, P., Contini, M., Vassanelli, C., Passino, C., Giannuzzi, P., Piepoli, M. F., Corrà, U, Agostoni, P, Giordano, A, Cattadori, G, Battaia, E, La Gioia, R, Scardovi, A, Emdin, M, Metra, M, Sinagra, G, Limongelli, G, Raimondo, R, Re, F, Guazzi, M, Belardinelli, R, Parati, G, Magrì, D, Fiorentini, C, Cicoira, M, Salvioni, E, Giovannardi, M, Veglia, F, Mezzani, A, Scrutinio, D, Di Lenarda, A, Ricci, R, Apostolo, A, Iorio, A, Paolillo, S, Palermo, P, Contini, M, Vassanelli, C, Passino, C, Giannuzzi, P, and Piepoli, M

Subjects
Male, medicine.medical_treatment, Predictive Value of Test, 030204 cardiovascular system & hematology, Kidney Function Tests, Severity of Illness Index, 0302 clinical medicine, score, 030212 general & internal medicine, Heart transplantation, education.field_of_study, Ejection fraction, Heart Function Test, Stroke volume, Middle Aged, Prognosis, Predictive value of tests, Heart Function Tests, Cardiology, Female, Cardiology and Cardiovascular Medicine, Human, medicine.medical_specialty, Prognosi, Population, Renal function, Heart failure, Prognosis, score, Lower risk, Follow-Up Studie, 03 medical and health sciences, Oxygen Consumption, Predictive Value of Tests, Internal medicine, medicine, Humans, medicine (all), education, Aged, Kidney Function Test, business.industry, heart failure, prognosis, score, aged, exercise test, female, follow-up studies, heart function tests, heart transplantation, humans, kidney function tests, male, middle aged, oxygen consumption, predictive value of tests, prognosis, severity of illness index, stroke volume, cardiology and cardiovascular medicine, Stroke Volume, medicine.disease, Exercise Test, Follow-Up Studies, Heart Failure, Heart Transplantation, business
Abstract

Background The Metabolic Exercise test data combined with Cardiac and Kidney Indexes (MECKI) score is a prognostic model to identify heart failure (HF) patients at risk for cardiovascular mortality (CVM) and urgent heart transplantation (uHT) based on 6 routine clinical parameters: hemoglobin, sodium, kidney function by the Modification of Diet in Renal Disease (MDRD) equation, left ventricle ejection fraction (LVEF), percentage of predicted peak oxygen consumption (VO2) and VE/VCO2 slope. Objectives MECKI score must be generalizable to be considered useful: therefore, its performance was validated in a new sequence of HF patients. Methods Both the development (MECKI-D) and the validation (MECKI-V) cohorts were composed of consecutive HF patients with LVEF < 40% able to perform a symptom-limited cardiopulmonary exercise testing. The CVM or uHT rates were analyzed at one, two and three years in both cohorts: all patients with a censoring time shorter than the scheduled follow-up were excluded, while those with events occurring after 1, 2 and 3 years were considered as censored. Results MECKI-D and MECKI-V consisted of 2009 and 992 patients, respectively. MECKI-V patients had a higher LVEF, higher peak VO2 and lower VE/VCO2 slope, higher prescription of beta-blockers and device therapy: after the 3-year follow-up, CVM or uHT occurred in 206 (18%) MECKI-D and 44 (13%) MECKI-V patients (p < 0.000), respectively. MECKI-V AUC values at one, two and three years were 0.81 ± 0.04, 0.76 ± 0.04, and 0.80 ± 0.03, respectively, not significantly different from MECKI-D. Conclusions MECKI score preserves its predictive ability in a HF population at a lower risk.

Published
2016

9. Multiparametric prognostic scores in chronic heart failure with reduced ejection fraction: a long-term comparison

Author

Agostoni, Piergiuseppe, Paolillo, Stefania, Mapelli, Massimo, Gentile, Piero, Salvioni, Elisabetta, Veglia, Fabrizio, Bonomi, Alice, Corrà , Ugo, Lagioia, Rocco, Limongelli, Giuseppe, Sinagra, Gianfranco, Cattadori, Gaia, Scardovi, Angela B., Metra, Marco, Carubelli, Valentina, Scrutinio, Domenico, Raimondo, Rosa, Emdin, Michele, Piepoli, Massimo, Magrì, Damiano, Parati, Gianfranco, Caravita, Sergio, Re, Federica, Cicoira, Mariantonietta, Minà , Chiara, Correale, Michele, Frigerio, Maria, Bussotti, Maurizio, Oliva, Fabrizio, Battaia, Elisa, Belardinelli, Romualdo, Mezzani, Alessandro, Pastormerlo, Luigi, Guazzi, Marco, Badagliacca, Roberto, Di Lenarda, Andrea, Passino, Claudio, Sciomer, Susanna, Zambon, Elena, Pacileo, Giuseppe, Ricci, Roberto, Apostolo, Anna, Palermo, Pietro, Contini, Mauro, Clemenza, Francesco, Marchese, Giovanni, Gargiulo, Paola, Binno, Simone, Lombardi, Carlo, Passantino, Andrea, Filardi, Pasquale Perrone, Agostoni, P, Paolillo, S, Mapelli, M, Gentile, P, Salvioni, E, Veglia, F, Bonomi, A, Corrà, U, Lagioia, R, Limongelli, G, Sinagra, G, Cattadori, G, Scardovi, A, Metra, M, Carubelli, V, Scrutinio, D, Raimondo, R, Emdin, M, Piepoli, M, Magrì, D, Parati, G, Caravita, S, Re, F, Cicoira, M, Minà, C, Correale, M, Frigerio, M, Bussotti, M, Oliva, F, Battaia, E, Belardinelli, R, Mezzani, A, Pastormerlo, L, Guazzi, M, Badagliacca, R, Di Lenarda, A, Passino, C, Sciomer, S, Zambon, E, Pacileo, G, Ricci, R, Apostolo, A, Palermo, P, Contini, M, Clemenza, F, Marchese, G, Gargiulo, P, Binno, S, Lombardi, C, Passantino, A, Filardi, P, Scardovi, Ab, CARAVITA DI TORITTO, Beniamino, Perrone Filardi, P., Agostoni, P., Paolillo, S., Mapelli, M., Gentile, P., Salvioni, E., Veglia, F., Bonomi, A., Corra, U., Lagioia, R., Limongelli, G., Sinagra, G., Cattadori, G., Scardovi, A. B., Metra, M., Carubelli, V., Scrutinio, D., Guarino, Raimondo, Emdin, M., Piepoli, M., Magri, D., Parati, G., Caravita, S., Re, F., Cicoira, M., Mina, C., Correale, M., Frigerio, M., Bussotti, M., Oliva, F., Battaia, E., Belardinelli, R., Mezzani, A., Pastormerlo, L., Guazzi, M., Badagliacca, R., Di Lenarda, A., Passino, C., Sciomer, S., Zambon, E., Pacileo, G., Ricci, R., Apostolo, A., Palermo, P., Contini, M., Clemenza, F., Marchese, G., Gargiulo, P., Binno, S., Lombardi, C., Passantino, A., Filardi, P. P., Agostoni, Piergiuseppe, Paolillo, Stefania, Mapelli, Massimo, Gentile, Piero, Salvioni, Elisabetta, Veglia, Fabrizio, Bonomi, Alice, Corrã , Ugo, Lagioia, Rocco, Limongelli, Giuseppe, Sinagra, Gianfranco, Cattadori, Gaia, Scardovi, Angela B., Metra, Marco, Carubelli, Valentina, Scrutinio, Domenico, Raimondo, Rosa, Emdin, Michele, Piepoli, Massimo, Magrã¬, Damiano, Parati, Gianfranco, Caravita, Sergio, Re, Federica, Cicoira, Mariantonietta, Minã , Chiara, Correale, Michele, Frigerio, Maria, Bussotti, Maurizio, Oliva, Fabrizio, Battaia, Elisa, Belardinelli, Romualdo, Mezzani, Alessandro, Pastormerlo, Luigi, Guazzi, Marco, Badagliacca, Roberto, Di Lenarda, Andrea, Passino, Claudio, Sciomer, Susanna, Zambon, Elena, Pacileo, Giuseppe, Ricci, Roberto, Apostolo, Anna, Palermo, Pietro, Contini, Mauro, Clemenza, Francesco, Marchese, Giovanni, Gargiulo, Paola, Binno, Simone, Lombardi, Carlo, Passantino, Andrea, and Filardi, Pasquale Perrone

Subjects
Male, Time Factors, Heart-Assist Device, Time Factor, Prognosi, Reproducibility of Result, Settore MED/11 - Malattie dell'Apparato Cardiovascolare, Heart failure, Risk Assessment, Follow-Up Studie, Oxygen Consumption, HFSS, Cause of Death, MECKI score, Prognosis, Risk score, SHFM, Exercise Test, Female, Follow-Up Studies, Heart Failure, Heart Transplantation, Heart-Assist Devices, Humans, Italy, Middle Aged, Morbidity, Prospective Studies, Reproducibility of Results, Stroke Volume, Survival Rate, Disease Management, heart failure, prognosis, heart failure, prognosis, risk score, cardiology and cardiovascular medicine, Prospective Studie, Human
Abstract

Aims: Risk stratification in heart failure (HF) is crucial for clinical and therapeutic management. A multiparametric approach is the best method to stratify prognosis. In 2012, the Metabolic Exercise test data combined with Cardiac and Kidney Indexes (MECKI) score was proposed to assess the risk of cardiovascular mortality and urgent heart transplantation. The aim of the present study was to compare the prognostic accuracy of MECKI score to that of HF Survival Score (HFSS) and Seattle HF Model (SHFM) in a large, multicentre cohort of HF patients with reduced ejection fraction. Methods and results: We collected data on 6112 HF patients and compared the prognostic accuracy of MECKI score, HFSS, and SHFM at 2- and 4-year follow-up for the combined endpoint of cardiovascular death, urgent cardiac transplantation, or ventricular assist device implantation. Patients were followed up for a median of 3.67 years, and 931 cardiovascular deaths, 160 urgent heart transplantations, and 12 ventricular assist device implantations were recorded. At 2-year follow-up, the prognostic accuracy of MECKI score was significantly superior [area under the curve (AUC) 0.781] to that of SHFM (AUC 0.739) and HFSS (AUC 0.723), and this relationship was also confirmed at 4 years (AUC 0.764, 0.725, and 0.720, respectively). Conclusion: In this cohort, the prognostic accuracy of the MECKI score was superior to that of HFSS and SHFM at 2- and 4-year follow-up in HF patients in stable clinical condition. The MECKI score may be useful to improve resource allocation and patient outcome, but prospective evaluation is needed.

Published
2018

10. Comprehensive effects of left ventricular assist device speed changes on alveolar gas exchange, sleep ventilatory pattern, and exercise performance

Author

Jonida Bejko, Jeness Campodonico, Vincenzo Tarzia, Niccolò Bonini, Anna Apostolo, Stefania Paolillo, Francesca Maria Righini, Luca Salvi, Gianfranco Parati, Francesco Alamanni, Tomaso Bottio, Carolina Lombardi, Massimo Mapelli, Piergiuseppe Agostoni, Paola Gugliandolo, Elisabetta Salvioni, Carlo Vignati, Massimo Massetti, Mauro Contini, Gino Gerosa, Apostolo, A., Paolillo, S., Contini, M., Vignati, C., Tarzia, V., Campodonico, J., Mapelli, M., Massetti, M., Bejko, J., Righini, F., Bottio, T., Bonini, N., Salvioni, E., Gugliandolo, P., Parati, G., Lombardi, C., Gerosa, G., Salvi, L., Alamanni, F., Agostoni, P., Apostolo, A, Paolillo, S, Contini, M, Vignati, C, Tarzia, V, Campodonico, J, Mapelli, M, Massetti, M, Bejko, J, Righini, F, Bottio, T, Bonini, N, Salvioni, E, Gugliandolo, P, Parati, G, Lombardi, C, Gerosa, G, Salvi, L, Alamanni, F, and Agostoni, P

Subjects
Pulmonary and Respiratory Medicine, Spirometry, Male, medicine.medical_specialty, Cardiac output, LVAD, cardiac output, CPET, exercise, lung diffusion, muscle oxygenation, Surgery, Cardiology and Cardiovascular Medicine, Transplantation, Cardiac index, 030204 cardiovascular system & hematology, Nitric Oxide, 03 medical and health sciences, 0302 clinical medicine, Oxygen Consumption, Internal medicine, medicine, Humans, Muscle, Skeletal, Aged, Heart Failure, Carbon Monoxide, medicine.diagnostic_test, business.industry, Pulmonary Gas Exchange, Apnea, Gas exchange, Oxygenation, Equipment Design, Middle Aged, medicine.disease, 030228 respiratory system, Apnea–hypopnea index, Cardiology, Pulmonary Diffusing Capacity, Female, Heart-Assist Devices, medicine.symptom, business, Sleep, Hypopnea, Human
Abstract

BACKGROUND Increasing left ventricular assist device (LVAD) pump speed according to the patient's activity is a fascinating hypothesis. This study analyzed the short-term effects of LVAD speed increase on cardiopulmonary exercise test (CPET) performance, muscle oxygenation (near-infrared spectroscopy), diffusion capacity of the lung for carbon monoxide (D lco ) and nitric oxide (D lno ), and sleep quality. METHODS We analyzed CPET, D lco and D lno , and sleep in 33 patients supported with the Jarvik 2000 (Jarvik Heart Inc., New York, NY). After a maximal CPET (n = 28), patients underwent 2 maximal CPETs with LVAD speed randomly set at 3 or increased from 3 to 5 during effort (n = 15). Then, at LVAD speed randomly set at 2 or 4, we performed (1) constant workload CPETs assessing O2 kinetics, cardiac output (CO), and muscle oxygenation (n = 15); (2) resting D lco and D lno (n = 18); and (3) nocturnal cardiorespiratory monitoring ( n = 29). RESULTS The progressive pump speed increase raised peak volume of oxygen consumption (12.5 ± 2.5 ml/min/kg vs 11.7 ± 2.8 ml/min/kg at speed 3; p = 0.001). During constant workload, from speed 2 to 4, CO increased (at rest: 3.18 ± 0.76 liters/min vs 3.69 ± 0.75 liters/min, p = 0.015; during exercise: 5.91 ± 1.31 liters/min vs 6.69 ± 0.99 liters/min, p = 0.014), and system efficiency (τ = 65.8 ± 15.1 seconds vs 49.9 ± 14.8 seconds, p = 0.002) and muscle oxygenation improved. At speed 4, D lco decreased, and obstructive apneas increased despite a significant apnea/hypopnea index and a reduction of central apneas. CONCLUSIONS Short-term LVAD speed increase improves exercise performance, CO, O2 kinetics, and muscle oxygenation. However, it deteriorates lung diffusion and increases obstructive apneas, likely due to an increase of intrathoracic fluids . Self-adjusting LVAD speed is a fascinating but possibly unsafe option, probably requiring a monitoring of intrathoracic fluids.

Published
2018

11. Severe heart failure prognosis evaluation for transplant selection in the era of beta-blockers: Role of peak oxygen consumption

Author

Marco Metra, Angela Beatrice Scardovi, Marco Guazzi, Giuseppe Pacileo, Rocco La Gioia, Romualdo Belardinelli, Annamaria Iorio, Alessandro Mezzani, Cesare Fiorentini, Claudio Passino, Anna Apostolo, Massimo F Piepoli, Elisabetta Salvioni, Gaia Cattadori, Ugo Corrà, Gianfranco Sinagra, Pantaleo Giannuzzi, Pietro Palermo, Mauro Contini, Andrea Di Lenarda, Domenico Scrutinio, Stefania Paolillo, Gianfranco Parati, Piergiuseppe Agostoni, Giuseppe Limongelli, Federica Re, Elisa Battaia, Fabrizio Veglia, Michele Emdin, Rosa Raimondo, Mariantonietta Cicoira, Damiano Magrì, Cattadori, G, Agostoni, P, Corrà, U, DI LENARDA, Andrea, Sinagra, Gianfranco, Veglia, F, Salvioni, E, La Gioia, R, Scardovi, Ab, Emdin, M, Metra, M, Limongelli, G, Raimondo, R, Re, F, Guazzi, M, Belardinelli, R, Parati, G, Magrì, D, Fiorentini, C, Mezzani, A, Scrutinio, D, Pacileo, G, Apostolo, A, Iorio, A, Paolillo, S, Palermo, P, Contini, M, Giannuzzi, P, Battaia, E, Cicoira, M, Passino, C, Piepoli, Mf, MECKI score research, Group, Cattadori, G., Agostoni, P., Corra, U., Di Lenarda, A., Sinagra, G., Veglia, F., Salvioni, E., La Gioia, R., Scardovi, A. B., Emdin, M., Metra, M., Limongelli, G., Raimondo, R., Re, F., Guazzi, M., Belardinelli, R., Parati, G., Magri, D., Fiorentini, C., Mezzani, A., Scrutinio, D., Pacileo, G., Apostolo, A., Iorio, A., Paolillo, S., Palermo, P., Contini, M., Giannuzzi, P., Battaia, E., Cicoira, M., Passino, C., Piepoli, M. F., Di Lenarda, A, Sinagra, G, Scardovi, A, and Piepoli, M

Subjects
Male, medicine.medical_treatment, chronic, heart, failure, Severity of Illness Index, Beta-blockers, Aortic valve replacement, Heart transplantation, Ejection fraction, exercise, Middle Aged, Prognosis, failure, chronic, Survival Rate, Exercise, Heart failure, Oxygen consumption, Adrenergic beta-Antagonists, Aged, Female, Follow-Up Studies, Heart Failure, Heart Transplantation, Humans, Oxygen Consumption, Patient Selection, cardiovascular system, Cardiology, Cardiology and Cardiovascular Medicine, Human, medicine.medical_specialty, Prognosi, heart, Follow-Up Studie, Internal medicine, Severity of illness, medicine, Beta-blocker, Intensive care medicine, Beta (finance), Survival rate, business.industry, Exercise, Oxygen consumption, Beta-blockers, Heart failure, Prognosis, Adrenergic beta-Antagonist, beta-blockers, heart failure, oxygen consumption, prognosis, MED/11 - MALATTIE DELL'APPARATO CARDIOVASCOLARE, medicine.disease, Stenosis, business
Abstract

fraction. Rev Esp Cardiol 2013;66:261–8. [9] Herrmann HC, Pibarot P, Hueter I, et al. Predictors of mortality and outcomes of therapy in low-flow severe aortic stenosis: a Placement of Aortic Transcatheter Valves (PARTNER) Trial analysis. Circulation 2013;127:2316–26. [10] Ozkan A, Hachamovitch R, Kapadia SR, Tuzcu EM,Marwick TH. Impact of aortic valve replacement on outcome of symptomatic patients with severe aortic stenosis with low gradient and preserved left ventricular ejection fraction. Circulation 2013;128(6):622–31.

Published
2013

12. Sex Profile and Risk Assessment With Cardiopulmonary Exercise Testing in Heart Failure: Propensity Score Matching for Sex Selection Bias

Author

Domenico Scrutinio, Stefania Paolillo, Marco Metra, Cesare Fiorentini, Mariantonietta Cicoira, Michele Emdin, Corrado Vassanelli, Massimo F Piepoli, Angela Beatrice Scardovi, Alessandro Mezzani, Anna Maria Iorio, Marco Guazzi, Elisa Battaia, Rosa Raimondo, Andrea Di Lenarda, Pietro Palermo, Rocco La Gioia, Giuseppe Limongelli, Gianfranco Sinagra, Damiano Magrì, Federica Re, Piergiuseppe Agostoni, Andrea Giordano, Pantaleo Giannuzzi, Claudio Passino, Anna Apostolo, Elisabetta Salvioni, Gianfranco Parati, Fabrizio Veglia, Gaia Cattadori, Marta Giovannardi, Roberto Ricci, Mauro Contini, Ugo Corrà, Romualdo Belardinelli, Corrà, Ugo, Agostoni, Piergiuseppe, Giordano, Andrea, Cattadori, Gaia, Battaia, Elisa, La Gioia, Rocco, Scardovi, Angela B., Emdin, Michele, Metra, Marco, Sinagra, Gianfranco, Limongelli, Giuseppe, Raimondo, Rosa, Re, Federica, Guazzi, Marco, Belardinelli, Romualdo, Parati, Gianfranco, Magrì, Damiano, Fiorentini, Cesare, Cicoira, Mariantonietta, Salvioni, Elisabetta, Giovannardi, Marta, Veglia, Fabrizio, Mezzani, Alessandro, Scrutinio, Domenico, DI LENARDA, Andrea, Ricci, Roberto, Apostolo, Anna, Iorio, Anna Maria, Paolillo, Stefania, Palermo, Pietro, Contini, Mauro, Vassanelli, Corrado, Passino, Claudio, Giannuzzi, Pantaleo, Piepoli, Massimo F., Corrà, U, Agostoni, P, Giordano, A, Cattadori, G, Battaia, E, La Gioia, R, Scardovi, A, Emdin, M, Metra, M, Sinagra, G, Limongelli, G, Raimondo, R, Re, F, Guazzi, M, Belardinelli, R, Parati, G, Magrì, D, Fiorentini, C, Cicoira, M, Salvioni, E, Giovannardi, M, Veglia, F, Mezzani, A, Scrutinio, D, Di Lenarda, A, Ricci, R, Apostolo, A, Iorio, A, Paolillo, S, Palermo, P, Contini, M, Vassanelli, C, Passino, C, Giannuzzi, P, Piepoli, M, Corra, U., Agostoni, P., Giordano, A., Cattadori, G., Battaia, E., La Gioia, R., Scardovi, A. B., Emdin, M., Metra, M., Sinagra, G., Limongelli, G., Raimondo, R., Re, F., Guazzi, M., Belardinelli, R., Parati, G., Magri, D., Fiorentini, C., Cicoira, M., Salvioni, E., Giovannardi, M., Veglia, F., Mezzani, A., Scrutinio, D., Di Lenarda, A., Ricci, R., Apostolo, A., Iorio, A. M., Paolillo, S., Palermo, P., Contini, M., Vassanelli, C., Passino, C., Giannuzzi, P., and Piepoli, M. F.

Subjects
Male, medicine.medical_specialty, Multivariate analysis, Databases, Factual, media_common.quotation_subject, Heart Failure, Cardiopulmonary exercise testing, Selection Bia, 030204 cardiovascular system & hematology, Risk Assessment, Ventricular Function, Left, Body Mass Index, Follow-Up Studie, 03 medical and health sciences, 0302 clinical medicine, Oxygen Consumption, Risk Factors, Internal medicine, medicine, Humans, 030212 general & internal medicine, cardiology and cardiovascular medicine, cardiopulmonary exercise test, sex selection, Propensity Score, Selection Bias, media_common, Aged, Selection bias, Heart Failure, Univariate analysis, business.industry, Risk Factor, Middle Aged, medicine.disease, Cardiopulmonary exercise testing, Italy, Heart failure, Propensity score matching, Cardiology, Physical therapy, Exercise Test, Population study, Female, business, Risk assessment, Cardiology and Cardiovascular Medicine, Body mass index, Follow-Up Studies, Human
Abstract

Background In heart failure (HF), women show better survival despite a comparatively low peak oxygen consumption ( V ˙ o 2 ): this raises doubt about the accuracy of risk assessment by cardiopulmonary exercise testing (CPET) in women. Accordingly, we aimed to check (1) whether the predictive role of well-known CPET risk indexes, ie, peak V ˙ o 2 and ventilatory response ( V ˙ e/ V ˙ co 2 slope), is sex independent and (2) if sex-related characteristics that impact outcome in HF should be considered as associations that may confound the effect of sex on survival. Methods The study population consisted of 2985 patients with HF, 498 (17%) of whom were women, from the multicentre Metabolic Exercise Test Data Combined with Cardiac and Kidney Indexes (MECKI): the end point was cardiovascular death within a 3-year period. Results During the follow-up, 305 (12%) men and 39 (8%) women ( P = 0.005) died, and female sex was linked to better survival on univariate analysis ( P = 0.008) and independent of peak V ˙ o 2 and V ˙ e/ V ˙ co 2 slope on multivariate analysis. According to propensity score matching for female sex to exclude a sex selection bias and sample discrepancy, 498 men were selected: the standardized percentage bias ranged from 20.8 ( P P = 0.667). After clinical profile harmonizing, female sex was predictive of HF at univariate analysis. Conclusions The low peak V ˙ o 2 and female association with better outcome in HF might be counterfeit: the female prognostic advantage is lost when sex-specific differences are correctly taken into account with propensity score matching, suggesting that for an effective and efficient HF model, adjustment must be made for sex-related characteristics.

Published
2016

13. Choosing among β-blockers in heart failure patients according to β-receptors’ location and functions in the cardiopulmonary system

Author

Damiano Magrì, Mauro Contini, Stefania Paolillo, Susanna Sciomer, Piergiuseppe Agostoni, Pasquale Perrone Filardi, Gianfranco Sinagra, Roberto Badagliacca, Ugo Corrà, Sinagra, G., Corra, U., Contini, M., Magri, D., Paolillo, S., Perrone Filardi, P., Sciomer, S., Badagliacca, R., and Agostoni, P.

Subjects
Male, 0301 basic medicine, Nebivolol, 0302 clinical medicine, Quality of life, β-blocker, CID: 2585, 189562 [Nebivolol, CID], Lung, Metoprolol, CID: 441308, Carvedilol, CID: 2585, Sotalol, CID: 66245, Middle Aged, Prognosis, CID: 441308, CID: 2405, Bisoprolol, CID: 2405, Cardiopulmonary interaction, Heart failure, Nebivolol, CID: 189562, Sotalol, CID: 66245, β-receptor, Treatment Outcome, 030220 oncology & carcinogenesis, beta-blocker, Female, Algorithms, Signal Transduction, Metoprolol, medicine.medical_specialty, Prognosi, heart failure, beta-receptor, lung, prognosis, cardiopulmonary interaction, Adrenergic beta-Antagonists, Clinical Decision-Making, Context (language use), Respiratory physiology, Decision Support Techniques, 2585 [Carvedilol, CID], 03 medical and health sciences, CID: 189562, Receptors, Adrenergic, beta, medicine, Humans, Bisoprolol, In patient, Intensive care medicine, Aged, Cardiovascular mortality, Pharmacology, business.industry, Myocardium, 441308 [Metoprolol, CID], medicine.disease, β receptor, Clinical trial, 2405 [Bisoprolol, CID], 030104 developmental biology, Chronic Disease, 66245 [Sotalol, CID], Carvedilol, business
Abstract

Several large clinical trials showed a favorable effect of β-blocker treatment in patients with chronic heart failure (HF) as regards overall mortality, cardiovascular mortality, and hospitalizations. Indeed, the use of β-blockers is strongly recommended by current international guidelines, and it remains a cornerstone in the pharmacological treatment of HF. Although different types of β-blockers are currently approved for HF therapy, possible criteria to choose the best β-blocking agent according to HF patients’ characteristics and to β-receptors’ location and functions in the cardiopulmonary system are still lacking. In such a context, a growing body of literature shows remarkable differences between β-blocker types (β1-selective blockers versus β1-β2 blockers) with respect to alveolar-capillary gas diffusion and chemoreceptor response in HF patients, both factors able to impact on quality of life and, most likely, on prognosis. This review suggests an original algorithm for choosing among the currently available β-blocking agents based on the knowledge of cardiopulmonary pathophysiology. Particularly, starting from lung physiology and from some experimental models, it focuses on the mechanisms underlying lung mechanics, chemoreceptors, and alveolar-capillary unit impairment in HF. This paper also remarks the significant benefit deriving from the correct use of the different β-blockers in HF patients through a brief overview of the most important clinical trials.

Published
2020

14. Mineralocorticoid receptor antagonists for heart failure: a real-life observational study

Author

Bruno, Noemi, Sinagra, Gianfranco, Paolillo, Stefania, Bonomi, Alice, Corrà, Ugo, Piepoli, Massimo, Veglia, Fabrizio, Salvioni, Elisabetta, Lagioia, Rocco, Metra, Marco, Limongelli, Giuseppe, Cattadori, Gaia, Scardovi, Angela B, Carubelli, Valentina, Scrutino, Domenico, Badagliacca, Roberto, Guazzi, Marco, Raimondo, Rosa, Gentile, Piero, Magrì, Damiano, Correale, Michele, Parati, Gianfranco, Re, Federica, Cicoira, Mariantonietta, Frigerio, Maria, Bussotti, Maurizio, Vignati, Carlo, Oliva, Fabrizio, Mezzani, Alessandro, Vergaro, Giuseppe, Di Lenarda, Andrea, Passino, Claudio, Sciomer, Susanna, Pacileo, Giuseppe, Ricci, Roberto, Contini, Mauro, Apostolo, Anna, Palermo, Pietro, Mapelli, Massimo, Carriere, Cosimo, Clemenza, Francesco, Binno, Simone, Belardinelli, Romualdo, Lombardi, Carlo, Perrone Filardi, Pasquale, Emdin, Michele, Agostoni, Piergiuseppe, Bruno, N, Sinagra, G, Paolillo, S, Bonomi, A, Corrà, U, Piepoli, M, Veglia, F, Salvioni, E, Lagioia, R, Metra, M, Limongelli, G, Cattadori, G, Scardovi, A, Carubelli, V, Scrutino, D, Badagliacca, R, Guazzi, M, Raimondo, R, Gentile, P, Magrì, D, Correale, M, Parati, G, Re, F, Cicoira, M, Frigerio, M, Bussotti, M, Vignati, C, Oliva, F, Mezzani, A, Vergaro, G, Di Lenarda, A, Passino, C, Sciomer, S, Pacileo, G, Ricci, R, Contini, M, Apostolo, A, Palermo, P, Mapelli, M, Carriere, C, Clemenza, F, Binno, S, Belardinelli, R, Lombardi, C, Perrone Filardi, P, Emdin, M, Agostoni, P, Scardovi, Ab, Agostoni, P., Bruno, Noemi, Sinagra, Gianfranco, Paolillo, Stefania, Bonomi, Alice, Corrà, Ugo, Piepoli, Massimo, Veglia, Fabrizio, Salvioni, Elisabetta, Lagioia, Rocco, Metra, Marco, Limongelli, Giuseppe, Cattadori, Gaia, Scardovi, Angela B, Carubelli, Valentina, Scrutino, Domenico, Badagliacca, Roberto, Guazzi, Marco, Raimondo, Rosa, Gentile, Piero, Magrì, Damiano, Correale, Michele, Parati, Gianfranco, Re, Federica, Cicoira, Mariantonietta, Frigerio, Maria, Bussotti, Maurizio, Vignati, Carlo, Oliva, Fabrizio, Mezzani, Alessandro, Vergaro, Giuseppe, Di Lenarda, Andrea, Passino, Claudio, Sciomer, Susanna, Pacileo, Giuseppe, Ricci, Roberto, Contini, Mauro, Apostolo, Anna, Palermo, Pietro, Mapelli, Massimo, Carriere, Cosimo, Clemenza, Francesco, Binno, Simone, Belardinelli, Romualdo, Lombardi, Carlo, Perrone Filardi, Pasquale, Emdin, Michele, and Agostoni, Piergiuseppe

Subjects
Male, Heart failure, Hyperkalaemia, Mineralocorticoid receptor antagonists, Worsening renal function, Mineralocorticoid receptor antagonist, Stroke Volume, Middle Aged, Ventricular Function, Left, Cardiology and Cardiovascular Medicine, Treatment Outcome, Original Research Articles, cardiovascular system, Humans, Female, mineralocorticoid receptor antagonists, heart failure, worsening renal function, hyperkalaemia, cardiovascular diseases, Original Research Article, Prospective Studies, Propensity Score, Follow-Up Studies, Forecasting
Abstract

Aims Mineralocorticoid receptor antagonists (MRAs) have been demonstrated to improve outcomes in reduced ejection fraction heart failure (HFrEF) patients. However, MRAs added to conventional treatment may lead to worsening of renal function and hyperkalaemia. We investigated, in a population‐based analysis, the long‐term effects of MRA treatment in HFrEF patients. Methods and results We analysed data of 6046 patients included in the Metabolic Exercise Cardiac Kidney Index score dataset. Analysis was performed in patients treated (n = 3163) and not treated (n = 2883) with MRA. The study endpoint was a composite of cardiovascular death, urgent heart transplantation, or left ventricular assist device implantation. Ten years' survival was analysed through Kaplan–Meier, compared by log‐rank test and propensity score matching. At 10 years' follow‐up, the MRA‐untreated group had a significantly lower number of events than the MRA‐treated group (P

Published
2018

15. Heart failure and sleep related breathing disorders: Data from PROMISES (Progetto Multicentrico Italiano Sonno e Scompenso Cardiaco) study

Author

MariaTeresa La Rovere, Piergiuseppe Agostoni, Pasquale Perrone-Filardi, Carolina Lombardi, Sergio Caravita, Andrea Faini, Promises Investigators, Paola Mattaliano, Gianfranco Parati, Francesco Fanfulla, Mauro Contini, Lombardi, Carolina, Faini, Andrea, La Rovere, Mariateresa, Fanfulla, Francesco, Mattaliano, Paola, Caravita, Sergio, Contini, Mauro, Agostoni, Piergiuseppe, Perrone-Filardi, Pasquale, Parati, Gianfranco, Lombardi, C, Faini, A, La Rovere, M, Fanfulla, F, Mattaliano, P, Caravita, S, Contini, M, Agostoni, P, Perrone-Filardi, P, and Parati, G

Subjects
Male, medicine.medical_specialty, Databases, Factual, Central apnea, Polysomnography, Heart failure, Sleep apnea, Sleep related breathing disorders, Settore MED/11 - Malattie dell'Apparato Cardiovascolare, 030204 cardiovascular system & hematology, 03 medical and health sciences, Electrocardiography, 0302 clinical medicine, Sleep Apnea Syndromes, Internal medicine, Medicine, Humans, Decompensation, Longitudinal Studies, Aged, Ejection fraction, medicine.diagnostic_test, business.industry, Sleep related breathing disorder, Anthropometry, Middle Aged, medicine.disease, Obstructive sleep apnea, 030228 respiratory system, Italy, Cohort, Cardiology, Female, business, Cardiology and Cardiovascular Medicine
Abstract

In heart failure (HF) sleep problems and sleep-related breathing disorders are frequently reported and are associated with poor prognosis. However, only few large clinical studies have investigated this issue in heart failure through breathing pattern analysis by polysomnography. Background: In heart failure (HF) sleep problems and sleep-related breathing disorders are frequently reported and are associated with poor prognosis. However, only few large clinical studies have investigated this issue in heart failure through breathing pattern analysis by polysomnography. Methods and results: 370 HF patients, with either moderate-severe reduced ejection fraction or with clinical decompensation, consecutively referred to 10 participating cardiology centers, have been enrolled in the PROMISES Study, an Italian project aimed at generating a large, multidisciplinary database of anthropometric, clinical, echocardiographic and sleep data, the last derived from overnight unattended cardio-respiratory polysomnography in HF patients. Obstructive sleep apnea was the most frequent form of sleep related breathing disorders observed in our cohort (35.4% with an AHI cutoff of 15). The possible determinants of sleep related breathing disorders were analyzed through stepwise logistic regression analysis and two multivariate models showing that a markedly reduced left ventricular ejection fraction was the most important factor associated with central sleep apneas (OR = 7.7 for AHI cutoff = 15 and LVEF ≤ 35%) together with male gender and increasing age. Conventional risk factors for obstructive sleep apnea did not identify HF patients affected by this condition. Conversely, a greater neck circumference was associated with an increased risk for central apneas. Conclusions: Our paper offers a deeper insight into the features of SRBD and its determinants in HF patients, leading in turn to a better clinical management of these comorbid patients.

Published
2018

16. Prognostic role of beta-blocker selectivity and dosage regimens in heart failure patients. Insights from the MECKI score database

Author

Paolillo, Stefania, Mapelli, Massimo, Bonomi, Alice, Corrà, Ugo, Piepoli, Massimo, Veglia, Fabrizio, Salvioni, Elisabetta, Gentile, Piero, Lagioia, Rocco, Metra, Marco, Limongelli, Giuseppe, Sinagra, Gianfranco, Cattadori, Gaia, Scardovi, Angela B, Carubelli, Valentina, Scrutino, Domenico, Badagliacca, Roberto, Raimondo, Rosa, Emdin, Michele, Magri', Damiano, Correale, Michele, Parati, Gianfranco, Caravita, Sergio, Spadafora, Emanuele, Federica, Re, Cicoira, Mariantonietta, Frigerio, Maria, Bussotti, Maurizio, Minà, Chiara, Oliva, Fabrizio, Battaia, Elisa, Belardinelli, Romualdo, Mezzani, Alessandro, Pastormerlo, Luigi, Di Lenarda, Andrea, Passino, Claudio, Sciomer, Susanna, Iorio, Annamaria, Zambon, Elena, Guazzi, Marco, Pacileo, Giuseppe, Ricci, Roberto, Contini, Mauro, Apostolo, Anna, Palermo, Pietro, Clemenza, Francesco, Marchese, Giovanni, Binno, Simone, Lombardi, Carlo, Passantino, Andrea, Perrone Filardi, Pasquale, Agostoni, Piergiuseppe, Paolillo, Stefania, Mapelli, Massimo, Bonomi, Alice, Corrã , Ugo, Piepoli, Massimo, Veglia, Fabrizio, Salvioni, Elisabetta, Gentile, Piero, Lagioia, Rocco, Metra, Marco, Limongelli, Giuseppe, Sinagra, Gianfranco, Cattadori, Gaia, Scardovi, Angela B., Carubelli, Valentina, Scrutino, Domenico, Badagliacca, Roberto, Raimondo, Rosa, Emdin, Michele, Magrã¬, Damiano, Correale, Michele, Parati, Gianfranco, Caravita, Sergio, Spadafora, Emanuele, Re, Federica, Cicoira, Mariantonietta, Frigerio, Maria, Bussotti, Maurizio, Minã , Chiara, Oliva, Fabrizio, Battaia, Elisa, Belardinelli, Romualdo, Mezzani, Alessandro, Pastormerlo, Luigi, Di Lenarda, Andrea, Passino, Claudio, Sciomer, Susanna, Iorio, Annamaria, Zambon, Elena, Guazzi, Marco, Pacileo, Giuseppe, Ricci, Roberto, Contini, Mauro, Apostolo, Anna, Palermo, Pietro, Clemenza, Francesco, Marchese, Giovanni, Binno, Simone, Lombardi, Carlo, Passantino, Andrea, Perrone Filardi, Pasquale, Agostoni, Piergiuseppe, Corrà, Ugo, Scardovi, Angela B, Magrì, Damiano, Minà, Chiara, PERRONE FILARDI, Pasquale, Paolillo, S, Mapelli, M, Bonomi, A, Corrã , U, Piepoli, M, Veglia, F, Salvioni, E, Gentile, P, Lagioia, R, Metra, M, Limongelli, G, Sinagra, G, Cattadori, G, Scardovi, A, Carubelli, V, Scrutino, D, Badagliacca, R, Raimondo, R, Emdin, M, Magrã¬, D, Correale, M, Parati, G, Caravita, S, Spadafora, E, Re, F, Cicoira, M, Frigerio, M, Bussotti, M, Minã , C, Oliva, F, Battaia, E, Belardinelli, R, Mezzani, A, Pastormerlo, L, Di Lenarda, A, Passino, C, Sciomer, S, Iorio, A, Zambon, E, Guazzi, M, Pacileo, G, Ricci, R, Contini, M, Apostolo, A, Palermo, P, Clemenza, F, Marchese, G, Binno, S, Lombardi, C, Passantino, A, Perrone Filardi, P, and Agostoni, P

Subjects
Male, equivalent dose, heart failure, prognosis, β-blocker selectivity, β-blockers, Time Factors, Prognosi, Adrenergic beta-Antagonists, Carbazoles, Settore MED/11 - Malattie dell'Apparato Cardiovascolare, Heart failure, β-Blocker, β-Blocker, Ventricular Function, Left, β-Blocker selectivity, Propanolamines, Heart Rate, Humans, Prospective Studies, Equivalent dose, Prognosis, β-Blocker selectivity, β-Blockers, Cardiology and Cardiovascular Medicine, β-Blockers, Dose-Response Relationship, Drug, Stroke Volume, Middle Aged, Treatment Outcome, Echocardiography, Carvedilol, Female, Follow-Up Studies
Abstract

Aims: The use of β-blockers represents a milestone in the treatment of heart failure with reduced ejection fraction (HFrEF). Few studies have compared β-blockers in HFrEF, and there is little data on the effects of different doses. The present study aimed to investigate in a large database of HFrEF patients (MECKI score database) the association of β-blocker treatment with a composite outcome of cardiovascular death, urgent heart transplantation or left ventricular assist device implantation, addressing the role of β-selectivity and dosage regimens. Methods and results: In 5242 HFrEF patients, we investigated the role of: (i) β-blocker treatment vs. non-β-blocker treatment, (ii) β1-/β2-receptor-blockers vs. β1-selective blockers, and (iii) daily β-blocker dose. Patients were followed for 3.58 years, and 1101 events (18.3%) were observed; 4435 patients (86.8%) were on β-blockers, while 807 (13.2%) were not. At 5 years, β-blocker-patients showed a better outcome than non-β-blocker-subjects [hazard ratio (HR) 0.48, P < 0.0001], while also considering potential confounders. A comparable prognosis was observed at 5 years in the β1-/β2-receptor-blocker (n = 2219) vs. β1-selective group (n = 2216) (HR 0.95, P = ns). A better prognosis was observed in high-dose (>2 5 mg carvedilol equivalent daily dose, n = 1005) patients than in both medium dose (12.5–25 mg, n = 1431) and low dose (

Published
2017

17. Heart failure and anemia: Effects on prognostic variables

Author

Giovanni Marchese, Simone Binno, Fabrizio Oliva, Pantaleo Giannuzzi, Stefania Farina, Alessandro Mezzani, Michele Emdin, Elisa Battaia, Michele Correale, Chiara Minà, Roberto Badagliacca, Claudio Passino, Piergiuseppe Agostoni, Gianfranco Sinagra, Giuseppe Pacileo, Alice Bonomi, Elisabetta Salvioni, Mauro Contini, Marco Metra, Alessandro Ferraironi, Davide Girola, Anna Maria Iorio, Rocco La Gioia, Susanna Sciomer, Mariantonietta Cicoira, Ugo Corrà, Sergio Caravita, Angela Beatrice Scardovi, Domenico Scrutinio, Marco Guazzi, Stefania Paolillo, Maria Frigerio, Damiano Magrì, Pasquale Perrone Filardi, Fabrizio Veglia, Gaia Cattadori, Francesco Clemenza, Rosa Raimondo, Massimo Mapelli, Romualdo Belardinelli, Pietro Palermo, Andrea Di Lenarda, Anna Apostolo, Massimo F Piepoli, Maurizio Bussotti, Giuseppe Limongelli, Federica Re, Gianfranco Parati, Carlo Lombardi, Paola Gargiulo, Cattadori, G, Agostoni, P, Corrà, U, Sinagra, G, Veglia, F, Salvioni, E, Bonomi, A, La Gioia, R, Scardovi, Ab, Ferraironi, A, Emdin, M, Metra, M, Di Lenarda, A, Limongelli, G, Raimondo, R, Re, F, Guazzi, M, Belardinelli, R, Parati, G, Caravita, S, Magrì, D, Lombardi, C, Frigerio, M, Oliva, F, Girola, D, Mezzani, A, Farina, S, Mapelli, M, Scrutinio, D, Pacileo, G, Apostolo, A, Iorio, A, Paolillo, S, Filardi, Pp, Gargiulo, P, Bussotti, M, Marchese, G, Correale, M, Badagliacca, R, Sciomer, S, Palermo, P, Contini, M, Giannuzzi, P, Battaia, E, Cicoira, M, Clemenza, F, Minà, C, Binno, S, Passino, C, Piepoli, M, Cattadori, Gaia, Agostoni, Piergiuseppe, Corrã , Ugo, Sinagra, Gianfranco, Veglia, Fabrizio, Salvioni, Elisabetta, Bonomi, Alice, La Gioia, Rocco, Scardovi, Angela B., Ferraironi, Alessandro, Emdin, Michele, Metra, Marco, Di Lenarda, Andrea, Limongelli, Giuseppe, Raimondo, Rosa, Re, Federica, Guazzi, Marco, Belardinelli, Romualdo, Parati, Gianfranco, Caravita, Sergio, Magrã¬, Damiano, Lombardi, Carlo, Frigerio, Maria, Oliva, Fabrizio, Girola, Davide, Mezzani, Alessandro, Farina, Stefania, Mapelli, Massimo, Scrutinio, Domenico, Pacileo, Giuseppe, Apostolo, Anna, Iorio, Annamaria, Paolillo, Stefania, Filardi, Pasquale Perrone, Gargiulo, Paola, Bussotti, Maurizio, Marchese, Giovanni, Correale, Michele, Badagliacca, Roberto, Sciomer, Susanna, Palermo, Pietro, Contini, Mauro, Giannuzzi, Pantaleo, Battaia, Elisa, Cicoira, Mariantonietta, Clemenza, Francesco, Minã , Chiara, Binno, Simone, Passino, Claudio, Piepoli, Massimo F., Corrà, Ugo, DI LENARDA, Andrea, Magrì, Damiano, Minà, Chiara, Scardovi, A, and Filardi, P

Subjects
Male, Prognostic variable, medicine.medical_specialty, Anemia, Prognosi, Renal function, Heart failure, Settore MED/11 - Malattie dell'Apparato Cardiovascolare, Comorbidity, 030204 cardiovascular system & hematology, Cohort Studies, Prognosis, Hemoglobins, 03 medical and health sciences, Oxygen Consumption, 0302 clinical medicine, Internal medicine, medicine, Internal Medicine, Humans, Prospective Studies, 030212 general & internal medicine, Aged, Proportional Hazards Models, Entire population, Ejection fraction, business.industry, Sodium, Hazard ratio, Stroke Volume, Carbon Dioxide, Middle Aged, medicine.disease, Italy, Multivariate Analysis, Exercise Test, Cardiology, Female, Hemoglobin, Pulmonary Ventilation, business
Abstract

Background: Anemia is frequent in heart failure (HF), and it is associated with higher mortality. The predictive power of established HF prognostic parameters in anemic HF patients is unknown. Methods: Clinical, laboratory, echocardiographic and cardiopulmonary-exercise-test (CPET) data were analyzed in 3913 HF patients grouped according to hemoglobin (Hb) values. 248 (6%), 857 (22%), 2160 (55%) and 648 (17%) patients had very low (b11 g/dL), low (11–12 for females, 11–13 for males), normal (12–15 for females, 13–15 for males) and high (N15) Hb, respectively. Results: Median follow-up was 1363 days (606–1883). CPETs were always performed safely. Hb was related to prognosis (Hazard ratio (HR) = 0.864). No prognostic difference was observed between normal and high Hb groups. Peak oxygen consumption (VO2), ventilatory efficiency (VE/VCO2 slope), plasma sodium concentration, ejection fraction (LVEF), kidney function and Hb were independently related to prognosis in the entire popula- tion. Considering Hb groups separately, peakVO2 (very low Hb HR = 0.549, low Hb HR = 0.613, normal Hb HR = 0.618, high Hb HR = 0.542) and LVEF (very low Hb HR = 0.49, low Hb HR = 0.692, normal Hb HR = 0.697, high Hb HR = 0.694) maintained their prognostic roles. High VE/VCO2 slope was associated with poor prognosis only in patients with low and normal Hb. Conclusions: Anemic HF patients have a worse prognosis, but CPET can be safely performed. PeakVO2 and LVEF, but not VE/VCO2 slope, maintain their prognostic power also in HF patients with Hb b 11 g/dL, suggesting CPET use and a multiparametric approach in HF patients with low Hb. However, the prognostic effect of an anemia-oriented follow-up is unknown.

Published
2017

18. Acute Increase of Cardiac Output Reduces Central Sleep Apneas in Heart Failure Patients

Author

Mauro Contini, Gino Gerosa, Elisabetta Salvioni, Tomaso Bottio, Alberico Del Torto, Marco Morosin, Vincenzo Tarzia, Carolina Lombardi, Piergiuseppe Agostoni, Silvia Scuri, Gianfranco Parati, Anna Apostolo, Emanuele Spadafora, Giorgio De Vecchi Lajolo, Carlo Vignati, Agostoni, P, Contini, M, Vignati, C, Del Torto, A, De Vecchi Lajolo, G, Salvioni, E, Spadafora, E, Lombardi, C, Gerosa, G, Bottio, T, Morosin, M, Tarzia, V, Scuri, S, Parati, G, and Apostolo, A

Subjects
Male, medicine.medical_specialty, Cardiac output, Central sleep apnea, Sleep Apnea, Heart-Assist Device, Stimulation, Pathogenesis, Internal medicine, Hyperventilation, medicine, Humans, Cardiac Output, Central, Aged, Heart Failure, business.industry, Middle Aged, medicine.disease, Sleep in non-human animals, Sleep Apnea, Central, Heart failure, Anesthesia, Cardiology, Female, Heart-Assist Devices, Cardiology and Cardiovascular Medicine, medicine.symptom, business, Human
Abstract

Central sleep apnea (CSA) is reported in advanced heart failure (HF) [(1)][1]. At least 3 factors have been suggested to play a pivotal role in CSA pathogenesis, specifically hyperventilation, which is the likely consequence of an enhanced stimulation of intrapulmonary receptors; low cardiac output

Published
2015

19. Deceptive meaning of oxygen uptake measured at the anaerobic threshold in patients with systolic heart failure and atrial fibrillation

Author

Damiano, Magrì, Piergiuseppe, Agostoni, Ugo, Corrà, Claudio, Passino, Domenico, Scrutinio, Pasquale, Perrone-Filardi, Michele, Correale, Gaia, Cattadori, Marco, Metra, Davide, Girola, Massimo F, Piepoli, AnnaMaria, Iorio, Michele, Emdin, Rosa, Raimondo, Federica, Re, Mariantonietta, Cicoira, Romualdo, Belardinelli, Marco, Guazzi, Giuseppe, Limongelli, Francesco, Clemenza, Gianfranco, Parati, Maria, Frigerio, Matteo, Casenghi, Angela B, Scardovi, Alessandro, Ferraironi, Andrea, Di Lenarda, Maurizio, Bussotti, Anna, Apostolo, Stefania, Paolillo, Rocco, La Gioia, Paola, Gargiulo, Pietro, Palermo, Chiara, Minà, Stefania, Farina, Elisa, Battaia, Antonello, Maruotti, Giuseppe, Pacileo, Mauro, Contini, Fabrizio, Oliva, Roberto, Ricci, Gianfranco, Sinagra, Corrado, Vassanelli, Magrì, D, Agostoni, P, Corrà, U, Passino, C, Scrutinio, D, Perrone Filardi, P, Correale, M, Cattadori, G, Metra, M, Girola, D, Piepoli, M, Iorio, A, Emdin, M, Raimondo, R, Re, F, Cicoira, M, Belardinelli, R, Guazzi, M, Limongelli, G, Clemenza, F, Parati, G, Frigerio, M, Casenghi, M, Scardovi, A, Ferraironi, A, Di Lenarda, A, Bussotti, M, Apostolo, A, Paolillo, S, La Gioia, R, Gargiulo, P, Palermo, P, Minà, C, Farina, S, Battaia, E, Maruotti, A, Pacileo, G, Contini, M, Oliva, F, Ricci, R, Sinagra, G, Magrì, Damiano, Agostoni, Piergiuseppe, Corrà, Ugo, Passino, Claudio, Scrutinio, Domenico, Perrone Filardi, Pasquale, Correale, Michele, Cattadori, Gaia, Metra, Marco, Girola, Davide, Piepoli, Massimo F., Iorio, Annamaria, Emdin, Michele, Raimondo, Rosa, Re, Federica, Cicoira, Mariantonietta, Belardinelli, Romualdo, Guazzi, Marco, Limongelli, Giuseppe, Clemenza, Francesco, Parati, Gianfranco, Frigerio, Maria, Casenghi, Matteo, Scardovi, Angela B., Ferraironi, Alessandro, DI LENARDA, Andrea, Bussotti, Maurizio, Apostolo, Anna, Paolillo, Stefania, La Gioia, Rocco, Gargiulo, Paola, Palermo, Pietro, Minà, Chiara, Farina, Stefania, Battaia, Elisa, Maruotti, Antonello, Pacileo, Giuseppe, Contini, Mauro, Oliva, Fabrizio, Ricci, Roberto, Sinagra, Gianfranco, PERRONE FILARDI, Pasquale, Piepoli, Massimo F, Scardovi, Angela B, Di Lenarda, Andrea, Magri', D, Corra', U, PERRONE FILARDI, P, Correal, M, Piepoli, Mf, Iorio, Am, Raimonod, R, Cicoria, M, Scardovi, Ab, DI LENARDA, A, LA GIOIA, R, Mina', C, and Sinagra, G.

Subjects
Male, Time Factors, Digoxin, Anaerobic Threshold, Epidemiology, medicine.medical_treatment, Heart failure, anaerobic threshold, atrial fibrillation, exercise, prognosis, Predictive Value of Test, Kaplan-Meier Estimate, Risk Factors, Atrial Fibrillation, Sinus rhythm, Prospective Studies, Multivariate Analysi, Heart transplantation, Ejection fraction, Cardiology and Cardiovascular Medicine, Atrial fibrillation, Middle Aged, Prognosis, Italy, Area Under Curve, Cardiology, Female, Anaerobic exercise, prognosi, medicine.drug, Human, medicine.medical_specialty, Time Factor, Prognosi, Reproducibility of Result, Oxygen Consumption, Predictive Value of Tests, Internal medicine, Aged, Heart Failure, Systolic, Heart Transplantation, Humans, Multivariate Analysis, Proportional Hazards Models, ROC Curve, Reproducibility of Results, Exercise Test, medicine, business.industry, Risk Factor, medicine.disease, Transplantation, Prospective Studie, Proportional Hazards Model, business, Systolic
Abstract

Background: Oxygen uptake at the anaerobic threshold (VO 2 AT), a submaximal exercise-derived variable, independent of patients' motivation, is a marker of outcome in heart failure (HF). However, previous evidence of VO 2 AT values paradoxically higher in HF patients with permanent atrial fibrillation (AF) than in those with sinus rhythm (SR) raised uncertainties. Design: We tested the prognostic role of VO 2 AT in a large cohort of systolic HF patients, focusing on possible differences between SR and AF. Methods: Altogether 2976 HF patients (2578 with SR and 398 with AF) were prospectively followed. Besides a clinical examination, each patient underwent a maximal cardiopulmonary exercise test (CPET). Results: The follow-up was analysed for up to 1500 days. Cardiovascular death or urgent cardiac transplantation occurred in 303 patients (250 (9.6%) patients with SR and 53 (13.3%) patients with AF, p=0.023). In the entire population, multivariate analysis including peak oxygen uptake (VO 2 ) showed a prognostic capacity (C-index) similar to that obtained including VO 2 AT (0.76 vs 0.72). Also, left ventricular ejection fraction, ventilation vs carbon dioxide production slope, β-blocker and digoxin therapy proved to be significant prognostic indexes. The receiver-operating characteristic (ROC) curves analysis showed that the best predictive VO 2 AT cut-off for the SR group was 11.7 ml/kg/min, while it was 12.8 ml/kg/min for the AF group. Conclusions: VO 2 AT, a submaximal CPET-derived parameter, is reliable for long-term cardiovascular mortality prognostication in stable systolic HF. However, different VO 2 AT cut-off values between SR and AF HF patients should be adopted.

Published
2015

20. Renal function and peak exercise oxygen consumption in chronic heart failure with reduced left ventricular ejection fraction

Author

Scrutinio, Domenico, Agostoni, Piergiuseppe, Gesualdo, Loreto, Corra, Ugo, Mezzani, Alessandro, Piepoli, Massimo, Di Lenarda, Andrea, Iorio, Annamaria, Passino, Claudio, Magri, Damiano, Masarone, Daniele, Battaia, Elisa, Girola, Davide, Re, Federica, Cattadori, Gaia, Parati, Gianfranco, Sinagra, Gianfranco, Villani, Giovanni Quinto, LIMONGELLI, Giuseppe, Pacileo, Giuseppe, Guazzi, Marco, Metra, Marco, Frigerio, Maria, Cicoira, Mariantonietta, Miná, Chiara, Malfatto, Gabriella, Caravita, Sergio, Bussotti, Maurizio, Salvioni, Elisabetta, Veglia, Fabrizio, Correale, Michele, Scardovi, Angela B., Emdin, Michele, Giannuzzi, Pantaleo, Gargiulo, Paola, Giovannardi, Marta, Perrone Filardi, Pasquale, Raimondo, Rosa, Ricci, Roberto, Paolillo, Stefania, Farina, Stefania, Belardinelli, Romualdo, Passantino, Andrea, La Gioia, Rocco, Fiorentini, Cesare, Apostolo, Anna, Palermo, Pietro, Contini, Mauro, Bertella, Erika, Mantegazza, Valentina, Pietrucci, Francesca, Ferraironi, Aessandro, Casenghi, Matteo, Clemenza, Francesco, Roselli, Teo, Buono, Andrea, Santoro, Daniela, Campanale, Saba, Caputo, Domenica, Bertipaglia, Donatella, Vaninetti, Raffaella, Confalonieri, Marco, Zambon, Elena, Berton, Emanuela, Torregiani, Chiara, Cas, Livio Dei, Carubelli, Valentina, Binno, Simone, Marchese, Giovanni, Oliva, Fabrizio, Pastormerlo, Luigi, CALABRO', Raffaele, Scrutinio, Domenico, Agostoni, Piergiuseppe, Gesualdo, Loreto, Corra, Ugo, Mezzani, Alessandro, Piepoli, Massimo, Di Lenarda, Andrea, Iorio, Annamaria, Passino, Claudio, Magri, Damiano, Masarone, Daniele, Battaia, Elisa, Girola, Davide, Re, Federica, Cattadori, Gaia, Parati, Gianfranco, Sinagra, Gianfranco, Villani, Giovanni Quinto, Limongelli, Giuseppe, Pacileo, Giuseppe, Guazzi, Marco, Metra, Marco, Frigerio, Maria, Cicoira, Mariantonietta, Miná, Chiara, Malfatto, Gabriella, Caravita, Sergio, Bussotti, Maurizio, Salvioni, Elisabetta, Veglia, Fabrizio, Correale, Michele, Scardovi, Angela B., Emdin, Michele, Giannuzzi, Pantaleo, Gargiulo, Paola, Giovannardi, Marta, Perrone Filardi, Pasquale, Raimondo, Rosa, Ricci, Roberto, Paolillo, Stefania, Farina, Stefania, Belardinelli, Romualdo, Passantino, Andrea, La Gioia, Rocco, Fiorentini, Cesare, Apostolo, Anna, Palermo, Pietro, Contini, Mauro, Bertella, Erika, Mantegazza, Valentina, Pietrucci, Francesca, Ferraironi, Aessandro, Casenghi, Matteo, Clemenza, Francesco, Roselli, Teo, Buono, Andrea, Calabro', Raffaele, Santoro, Daniela, Campanale, Saba, Caputo, Domenica, Bertipaglia, Donatella, Vaninetti, Raffaella, Confalonieri, Marco, Zambon, Elena, Berton, Emanuela, Torregiani, Chiara, Cas, Livio Dei, Carubelli, Valentina, Binno, Simone, Marchese, Giovanni, Oliva, Fabrizio, Pastormerlo, Luigi, Corrà, Ugo, Lenarda, Andrea Di, Magrì, Damiano, Minà, Chiara, Scrutinio, D, Agostoni, P, Gesualdo, L, Corra, U, Mezzani, A, Piepoli, M, Di Lenarda, A, Iorio, A, Passino, C, Magri, D, Masarone, D, Battaia, E, Girola, D, Re, F, Cattadori, G, Parati, G, Sinagra, G, Villani, G, Limongelli, G, Pacileo, G, Guazzi, M, Metra, M, Frigerio, M, Cicoira, M, Miná, C, Malfatto, G, Caravita, S, Bussotti, M, Salvioni, E, Veglia, F, Correale, M, Scardovi, A, Emdin, M, Giannuzzi, P, Gargiulo, P, Giovannardi, M, Perrone Filardi, P, Raimondo, R, Ricci, R, Paolillo, S, Farina, S, Belardinelli, R, Passantino, A, La Gioia, R, Fiorentini, C, Apostolo, A, Palermo, P, Contini, M, Bertella, E, Mantegazza, V, Pietrucci, F, Ferraironi, A, Casenghi, M, Clemenza, F, Roselli, T, Buono, A, Calabrò, R, Santoro, D, Campanale, S, Caputo, D, Bertipaglia, D, Vaninetti, R, Confalonieri, M, Zambon, E, Berton, E, Torregiani, C, Cas, L, Carubelli, V, Binno, S, Marchese, G, Oliva, F, Pastormerlo, L, Scardovi, Angela B, and PERRONE FILARDI, Pasquale

Subjects
Adult, Male, medicine.medical_specialty, Kidney Disease, Aged, Chronic Disease, Female, Follow-Up Studies, Humans, Kidney Function Tests, Middle Aged, Exercise, Heart Failure, Kidney Diseases, Oxygen Consumption, Stroke Volume, Prognosi, medicine.medical_treatment, Renal function, Settore MED/11 - Malattie dell'Apparato Cardiovascolare, Heart failure, Follow-Up Studie, Peak exercise oxygen consumption, Prognosis, Cardiology and Cardiovascular Medicine, Internal medicine, medicine, Heart transplantation, Ejection fraction, Kidney Function Test, business.industry, Hazard ratio, Atrial fibrillation, General Medicine, Stroke volume, medicine.disease, heart failure, exercise capacity, renal function, exercise capacity, Cardiology, business, Kidney disease, Human
Abstract

Background: Chronic kidney disease is associated with sympathetic activation and muscle abnormalities, which may contribute to decreased exercise capacity. We investigated the correlation of renal function with peak exercise oxygen consumption (V˙O2) in heart failure (HF) patients. Methods and Results: We recruited 2,938 systolic HF patients who underwent clinical, laboratory, echocardiographic and cardiopulmonary exercise testing. The patients were stratified according to estimated glomerular filtration rate (eGFR). Mean follow-up was 3.7 years. The primary outcome was a composite of cardiovascular death and urgent heart transplantation at 3 years. On multivariable regression, eGFR was predictor of peakV˙O2 (P

Published
2015

21. Metabolic exercise test data combined with cardiac and kidney indexes, the MECKI score: a multiparametric approach to heart failure prognosis

Author

Andrea Passantino, Marco Metra, Anna Apostolo, Giuseppe Pacileo, Marco Confalonieri, Angela Beatrice Scardovi, Marco Guazzi, Gianfranco Sinagra, Piergiuseppe Agostoni, Luca Bettari, Romualdo Belardinelli, Andrea Di Lenarda, Michele Emdin, Annamaria Iorio, Fabrizio Veglia, Domenico Scrutinio, Rocco La Gioia, Pietro Palermo, Livio Dei Cas, Massimo F Piepoli, Stefania Paolillo, Damiano Magrì, Gianfranco Parati, R. P. Ricci, Giuseppe Limongelli, Federica Re, Elisabetta Salvioni, Rossella Raimondo, Raffaella Vaninetti, Alessandro Mezzani, Ugo Corrà, Luigi Emilio Pastormerlo, Mauro Contini, Claudio Passino, Gaia Cattadori, Cesare Fiorentini, Pantaleo Giannuzzi, Agostoni, P, Corrà, U, Cattadori, G, Veglia, F, La Gioia, R, Scardovi, Ab, Emdin, M, Metra, M, Sinagra, Gianfranco, Limongelli, G, Raimondo, R, Re, F, Guazzi, M, Belardinelli, R, Parati, G, Magrì, D, Fiorentini, C, Mezzani, A, Salvioni, E, Scrutinio, D, Ricci, R, Bettari, L, DI LENARDA, Andrea, Pastormerlo, Le, Pacileo, G, Vaninetti, R, Apostolo, A, Iorio, A, Paolillo, S, Palermo, P, Contini, M, Confalonieri, M, Giannuzzi, P, Passantino, A, Cas, Ld, Piepoli, Mf, Passino, C, on behalf of the MECKI score research, Group, Scardovi, A, Sinagra, G, Di Lenarda, A, Pastormerlo, L, Dei Cas, L, and Piepoli, M

Subjects
Male, medicine.medical_specialty, Prognosi, Population, Renal function, heart failure, Kidney Function Tests, Severity of Illness Index, Disease-Free Survival, Cohort Studies, Metabolic exercise test, Median follow-up, Internal medicine, medicine, Humans, Prospective Studies, education, Aged, Prognosis, survival score, Heart Failure, education.field_of_study, Ejection fraction, business.industry, Regression analysis, MED/11 - MALATTIE DELL'APPARATO CARDIOVASCOLARE, Stepwise regression, Middle Aged, medicine.disease, oxygen consumption, prognosis, Heart failure, Cohort, Heart Function Tests, Cardiology, Exercise Test, Female, Cardiology and Cardiovascular Medicine, business, Heart failure, Prognosis, Oxygen consumption, Follow-Up Studies
Abstract

Objectives We built and validated a new heart failure (HF) prognostic model which integrates cardiopulmonary exercise test (CPET) parameters with easy-to-obtain clinical, laboratory, and echocardiographic variables. Background HF prognostication is a challenging medical judgment, constrained by a magnitude of uncertainty. Methods Our risk model was derived from a cohort of 2716 systolic HF patients followed in 13 Italian centers. Median follow up was 1041days (range 4–5185). Cox proportional hazard regression analysis with stepwise selection of variables was used, followed by cross-validation procedure. The study end-point was a composite of cardiovascular death and urgent heart transplant. Results Six variables (hemoglobin, Na + , kidney function by means of MDRD, left ventricle ejection fraction [echocardiography], peak oxygen consumption [% pred] and VE/VCO 2 slope) out of the several evaluated resulted independently related to prognosis. A score was built from Metabolic Exercise Cardiac Kidney Indexes, the MECKI score, which identified the risk of study end-point with AUC values of 0.804 (0.754–0.852) at 1year, 0.789 (0.750–0.828) at 2years, 0.762 (0.726–0.799) at 3years and 0.760 (0.724–0.796) at 4years. Conclusions This is the first large-scale multicenter study where a prognostic score, the MECKI score, has been built for systolic HF patients considering CPET data combined with clinical, laboratory and echocardiographic measurements. In the present population, the MECKI score has been successfully validated, performing very high AUC.

Published
2012

22. Circulating plasma surfactant protein type B as biological marker of alveolar-capillary barrier damage in chronic heart failure

Author

Pietro Palermo, Anna Apostolo, Piergiuseppe Agostoni, Cristina Banfi, Maura Brioschi, Maurizio Bussotti, Gaia Cattadori, Mauro Contini, Elena Tremoli, Damiano Magrì, Jean-Paul Schmid, Susanna Sciomer, Cesare Fiorentini, Magri, D, Brioschi, M, Banfi, C, Schmid, J, Palermo, P, Contini, M, Apostolo, A, Bussotti, M, Tremoli, E, Sciomer, S, Cattadori, G, Fiorentini, C, and Agostoni, P

Subjects
Male, medicine.medical_specialty, Vascular permeability, Lung diffusion, Pulmonary function testing, Capillary Permeability, Diffusion, Oxygen Consumption, Pulmonary surfactant, Interquartile range, Predictive Value of Tests, Internal medicine, medicine, Humans, Cardiopulmonary exercise test, Aged, Heart Failure, Lung, Exercise Tolerance, Pulmonary Surfactant-Associated Protein B, business.industry, Surfactant protein B, Gas exchange, Carbon Dioxide, Middle Aged, medicine.disease, Chronic heart failure, Surgery, Respiratory Function Tests, Up-Regulation, Pulmonary Alveoli, medicine.anatomical_structure, Logistic Models, Heart failure, Case-Control Studies, Chronic Disease, Breathing, Cardiology, Exercise Test, Female, Alveolar-capillary barrier damage, Cardiology and Cardiovascular Medicine, business, Pulmonary Ventilation, Biomarkers
Abstract

Background— Surfactant protein type B (SPB) is needed for alveolar gas exchange. SPB is increased in the plasma of patients with heart failure (HF), with a concentration that is higher when HF severity is highest. The aim of this study was to evaluate the relationship between plasma SPB and both alveolar-capillary diffusion at rest and ventilation versus carbon dioxide production during exercise. Methods and Results— Eighty patients with chronic HF and 20 healthy controls were evaluated consecutively, but the required quality for procedures was only reached by 71 patients with HF and 19 healthy controls. Each subject underwent pulmonary function measurements, including lung diffusion for carbon monoxide and membrane diffusion capacity, and maximal cardiopulmonary exercise test. Plasma SPB was measured by immunoblotting. In patients with HF, SPB values were higher (4.5 [11.1] versus 1.6 [2.9], P =0.0006, median and 25th to 75th interquartile), whereas lung diffusion for carbon monoxide (19.7�4.5 versus 24.6�6.8 mL/mm Hg per min, P P P P P P P =0.004), and ventilation/carbon dioxide production slope (β, 0.25; SE, 0.026; P =0.034) were independently associated with SPB. Conclusion— Circulating plasma SPB levels are related to alveolar gas diffusion, overall exercise performance, and efficiency of ventilation showing a link between alveolar-capillary barrier damage, gas exchange abnormalities, and exercise performance in HF.

Published
2009

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