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1. 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

2. 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

3. 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

4. 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

5. 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

6. Exercise performance is a prognostic indicator in elderly patients with chronic heart failure: application of metabolic exercise cardiac kidney indexes score

Author

Valentina, Carubelli, Marco, Metra, Ugo, Corrà, Damiano, Magrì, Claudio, Passino, Carlo, Lombardi, Domenico, Scrutinio, Michele, Correale, Gaia, Cattadori, Massimo F, Piepoli, Elisabetta, Salvioni, Marta, Giovannardi, Rosa, Raimondo, Mariantonietta, Cicoira, Romualdo, Belardinelli, Marco, Guazzi, Giuseppe, Limongelli, Francesco, Clemenza, Gianfranco, Parati, Angela B, Scardovi, Andrea, Di Lenarda, Maurizio, Bussotti, Rocco, La Gioia, Piergiuseppe, Agostoni, Federica, Re, Carubelli, V., Metra, M., Corra, U., Magri, D., Passino, C., Lombardi, C., Scrutinio, D., Correale, M., Cattadori, G., Piepoli, M. F., Salvioni, E., Giovannardi, M., Raimondo, R., Cicoira, M., Belardinelli, R., Guazzi, M., Limongelli, G., Clemenza, F., Parati, G., Scardovi, A. B., Di Lenarda, A., Bussotti, M., La Gioia, R., Agostoni, P., Carubelli, V, Metra, M, Corrà, U, Magrì, D, Passino, C, Lombardi, C, Scrutinio, D, Correale, M, Cattadori, G, Piepoli, M, Salvioni, E, Giovannardi, M, Raimondo, R, Cicoira, M, Belardinelli, R, Guazzi, M, Limongelli, G, Clemenza, F, Parati, G, Scardovi, A, Di Lenarda, A, Bussotti, M, La Gioia, R, and Agostoni, P

Subjects
Databases, Factual, medicine.medical_treatment, Adrenergic beta-Antagonists, Adult, Age Factors, Aged, Chronic Disease, Female, Follow-Up Studies, Humans, Male, Middle Aged, Oxygen, Sodium, Exercise Therapy, Heart Failure, Systolic, Kidney, Organ Dysfunction Scores, Stroke Volume, heart failure, Organ Dysfunction Score, middle aged, Clinical endpoint, Medicine, Age Factor, humans, sodium, Heart transplantation, education.field_of_study, Framingham Risk Score, Ejection fraction, exercise therapy, adult, General Medicine, follow-up studies, aged, cardiology and cardiovascular medicine, female, Quartile, Cardiology, cardiopulmonary exercise test, Human, medicine.medical_specialty, age factors, kidney, databases factual, Population, exercise performance, elderly, MECKI score, adrenergic beta-antagonists, chronic disease, male, oxygen, heart failure, systolic, organ dysfunction scores, stroke volume, Follow-Up Studie, Databases, Internal medicine, education, Factual, business.industry, Kidney metabolism, Adrenergic beta-Antagonist, Cardiopulmonary exercise test, Elderly, Exercise performance, Heart failure, Cardiology and Cardiovascular Medicine, medicine.disease, Exercise Performance, Prognostic Indicator, Chronic Heart Failure, systolic, business
Abstract

Background:In patients with chronic heart failure (HF) the Metabolic Exercise Cardiac Kidney Indexes (MECKI) score, is a predictor of cardiovascular death and urgent heart transplantation. We investigated the relationship between age, exercise tolerance and the prognostic value of the MECKI score.Methods and Results:We analyzed data from 3,794 patients with chronic systolic HF. The primary endpoint was a composite of cardiovascular death and urgent heart transplantation. Older patients had higher prevalence of comorbidities and lower exercise performance compared with younger subjects (peak V̇O2, 925 vs. 1,351 L/min; P#x003C;0.0001; V̇E/V̇CO2slope, 33.2 vs. 28.3; P>0.0001). The rate of the primary endpoint was 19% in the highest age quartile and 14% in the lowest quartile. At multivariable analysis, the independent predictors of the primary endpoint were left ventricular ejection fraction (LVEF), eGFR, peak V̇O2, serum Na+and the use of β-blockers in patients aged ≥70 years, and LVEF, eGFR and peak V̇O2in younger subjects. The MECKI risk score increased across age subgroups, but on receiver operating characteristic curve analysis its prognostic power was similar in both patients aged ≥70 and #x003C;70 years.Conclusions:Older patients with HF are a high-risk population with lower exercise performance. The MECKI score increased according to age and maintained its prognostic value also in older patients.

Published
2015

7. Increased serum uric acid level predicts poor prognosis in mildly severe chronic heart failure with reduced ejection fraction. An analysis from the MECKI score research group

Author

Angela Beatrice Scardovi, Michele Correale, Carlo Lombardi, Roberto Badagliacca, Francesco Doni, Gianfranco Sinagra, Giuseppe Limongelli, Federica Re, Piergiuseppe Agostoni, Elisabetta Salvioni, Francesco Clemenza, Stefania Paolillo, Ugo Corrà, Rocco La Gioia, Massimo Francesco Piepoli, Michele Emdin, Rosa Raimondo, Alice Bonomi, Mariantonietta Cicoira, Piepoli, M. F., Salvioni, E., Corra, U., Doni, F., Bonomi, A., La Gioia, R., Limongelli, G., Paolillo, S., Sinagra, G., Scardovi, A. B., Raimondo, R., Emdin, M., Re, F., Cicoira, M., Correale, M., Badagliacca, R., Clemenza, F., Lombardi, C., and Agostoni, P.

Subjects
Uric acid, prognosis, medicine.medical_specialty, Poor prognosis, Renal function, Heart failure, 030204 cardiovascular system & hematology, Nyha class, 03 medical and health sciences, Ventricular Dysfunction, Left, heart failure, prognosis, uric acid, 0302 clinical medicine, Kidney function, male, left, Internal medicine, middle aged, Internal Medicine, medicine, 030212 general & internal medicine, Hyperuricemia, Hemoglobin, humans, Cardiopulmonary exercise test, Kidney, Ejection fraction, business.industry, Increased serum uric acid, ventricular dysfunction, medicine.disease, aged, medicine.anatomical_structure, stroke volume, Cardiology, business, cardiopulmonary exercise test, hemoglobin, kidney function, uric acid, prognosis, ventricular dysfunction, left
Abstract

Background: Hyperuricemia prognostic impact on clinical outcomes in chronic heart failure (HF) patients has been investigated with inconclusive results. Objectives: Aim of the study was to evaluate the prognostic impact of serum uric acid (SUA) on long-term clinical outcomes in HF. Methods: An analysis of MECKI (Metabolic Exercise Cardiac Kidney Index) database, with median follow-up of 3.4 years. Results: Relation between SUA and all-cause/ cardiovascular (CV) deaths have been analysed in 4,577 patients (3,688 males, age 62.7 ± 12.9 years), with reduced ejection fraction HF (35 ± 11%), peakVO2 1151 ± 440 ml/min; NYHA class I-II (72.6%), III-IV (27.4%). SUA was associated with increased total and CV mortality (HR 1.120 and HR 1.128, respectively p < 0.0001), also after adjustment for peakVO2, VE/VCO2 slope, diuretic use and MECKI score. SUA was significantly associated with CV mortality only in NYHA class I-II (HR 1.17, p < 0.0001) while there was no association in class III-IV (HR 1.03, p = NS). No prognostic added values of SUA with respect to the MECKI score was observed at the ROC analysis. Conclusions: SUA is confirmed to be associated with increased mortality, but in less severe HF only. However SUA did not show additional prognostic power to the MECKI score

Published
2020

8. 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

9. Prognostic role of atrial fibrillation in patients affected by chronic heart failure. Data from the MECKI score research group

Author

Marco Metra, Angela Beatrice Scardovi, Francesco Clemenza, Marco Guazzi, Giuseppe Limongelli, Federica Re, Claudio Passino, Piergiuseppe Agostoni, Rosa Raimondo, Massimo F Piepoli, Maria Frigerio, Romualdo Belardinelli, Domenico Scrutinio, Stefania Paolillo, Andrea Di Lenarda, Daniele Masarone, Rocco La Gioia, Davide Girola, Marta Giovannardi, Gianfranco Parati, Gaia Cattadori, Michele Correale, Pasquale Perrone-Filardi, Giuseppe Pacileo, Michele Emdin, Mariantonietta Cicoira, Gianfranco Sinagra, Paola Gargiulo, Carlo Lombardi, Annamaria Iorio, Elisabetta Salvioni, Ugo Corrà, Paolillo, S, Agostoni, P, Masarone, D, Corrà, U, Passino, C, Scrutinio, D, Correale, M, Cattadori, G, Metra, M, Girola, D, Piepoli, M, Salvioni, E, Giovannardi, M, Iorio, A, Emdin, M, Raimondo, R, Re, F, Cicoira, M, Belardinelli, R, Guazzi, M, Clemenza, F, Parati, G, Scardovi, A, Di Lenarda, A, La Gioia, R, Frigerio, M, Lombardi, C, Gargiulo, P, Sinagra, G, Pacileo, G, Perrone Filardi, P, Limongelli, G, Piepoli, Mf, Iorio, Annamaria, Scardovi, Ab, DI LENARDA, Andrea, Sinagra, Gianfranco, Limongelli, G., Paolillo, Stefania, Agostoni, Piergiuseppe, Masarone, Daniele, Corrà, Ugo, Passino, Claudio, Scrutinio, Domenico, Correale, Michele, Cattadori, Gaia, Metra, Marco, Girola, Davide, Piepoli, Massimo F, Salvioni, Elisabetta, Giovannardi, Marta, Emdin, Michele, Raimondo, Rosa, Re, Federica, Cicoira, Mariantonietta, Belardinelli, Romualdo, Guazzi, Marco, Clemenza, Francesco, Parati, Gianfranco, Scardovi, Angela B, Di Lenarda, Andrea, La Gioia, Rocco, Frigerio, Maria, Lombardi, Carlo, Gargiulo, Paola, Pacileo, Giuseppe, PERRONE FILARDI, Pasquale, Limongelli, Giuseppe, Piepoli, Massimo F., Scardovi, Angela B., and Perrone Filardi, Pasquale

Subjects
Male, medicine.medical_specialty, Digoxin, Prognosi, Left, Renal function, Heart failure, Matching analysi, Kaplan-Meier Estimate, Severity of Illness Index, Regression Analysi, Ventricular Function, Left, Atrial fibrillation, MECKI score, Matching analysis, Prognosis, Aged, Atrial Fibrillation, Biomarkers, Chronic Disease, Female, Heart Failure, Hospitalization, Humans, Middle Aged, Multivariate Analysis, Regression Analysis, Internal medicine, medicine, Clinical endpoint, Internal Medicine, Ventricular Function, Sinus rhythm, Multivariate Analysi, Ejection fraction, business.industry, Biomarker, medicine.disease, medicine.anatomical_structure, Ventricle, Cardiology, business, medicine.drug, Human
Abstract

Background Atrial fibrillation (AF) is common in heart failure (HF). It is unclear whether AF has an independent prognostic role in HF. The aim of the present study was to assess the prognostic role of AF in HF patients with reduced ejection fraction (EF). Methods HF patients were followed in 17 centers for 3.15 years (1.51–5.24). Study endpoints were the composite of cardiovascular (CV) death and heart transplant (HTX) and all-cause death. Data analysis was performed considering the entire population and a 1 to 1 match between sinus rhythm (SR) and AF patients. Match process was done for age ± 5, gender, left ventricle EF ± 5, peakVO 2 ± 3 (ml/min/kg) and recruiting center. Results A total of 3447 patients (SR = 2882, AF = 565) were included in the study. Considering the entire population, CV death and HTX occurred in 114 (20%) AF vs. 471 (16%) SR (p = 0.026) and all-cause death in 130 (23%) AF vs. 554 (19.2%) SR patients (p = 0.039). At univariable Cox analysis, AF was significantly related to prognosis. Applying a multivariable model based on all variables significant at univariable analysis (EF, peakVO 2 , ventilation/carbon dioxide relationship slope, sodium, kidney function, hemoglobin, beta-blockers and digoxin) AF was no longer associated with adverse outcomes. Matching procedure resulted in 338 couples. CV death and HTX occurred in 63 (18.6%) AF vs. 74 (21.9%) SR (p = 0.293) and all-cause death in 71 (21%) AF vs. 80 (23.6%) SR (p = 0.406), with no survival differences between groups. Conclusion In systolic HF AF is a marker of disease severity but not an independent prognostic indicator.

Published
2015

10. 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

11. 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

12. 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

13. PERMANENT ATRIAL FIBRILLATION AFFECTS EXERCISE CAPACITY IN CHRONIC HEART FAILURE PATIENTS

Author

Rocco La Gioia, Massimo F Piepoli, Alessandro Mezzani, Gianfranco Sinagra, Federica Re, Chiara Vittoria Colombo, Damiano Magrì, Marco Guazzi, Calogero C. Tedesco, Andrea Di Lenarda, Claudio Tondo, Pantaleo Giannuzzi, Alberto Giannoni, Erika Bertella, Michele Emdin, Emanuela Berton, Marco Vicenzi, Claudio Passino, Fabrizio Veglia, Ugo Corrà, Piergiuseppe Agostoni, Domenico Scrutinio, Romualdo Belardinelli, Agostoni, P, Emdin, M, Corrà, U, Veglia, F, Magrì, D, Tedesco, Cc, Berton, E, Passino, C, Bertella, E, Re, F, Mezzani, A, Belardinelli, R, Colombo, C, LA GIOIA, R, Vicenzi, M, Giannoni, A, Scrutinio, D, Giannuzzi, P, Tondo, C, DI LENARDA, A, Sinagra, Gianfranco, Piepoli, Mf, and Guazzi, M.

Subjects
Male, medicine.medical_specialty, Heart disease, anaerobic threshold, atrial fibrillation, cardiopulmonary exercise testing, heart failure, Physical exercise, Cohort Studies, Electrocardiography, Anaerobic threshold, Heart Rate, Internal medicine, Heart rate, Atrial Fibrillation, medicine, Humans, Sinus rhythm, Heart Failure, Cardiopulmonary exercise testing, Retrospective Studies, Exercise Tolerance, medicine.diagnostic_test, business.industry, Atrial fibrillation, Middle Aged, Prognosis, medicine.disease, Treatment Outcome, Heart failure, Chronic Disease, Disease Progression, Exercise Test, Cardiology, Female, Cardiology and Cardiovascular Medicine, business, Anaerobic exercise
Abstract

Aims The influence of permanent atrial fibrillation on exercise tolerance and cardio-respiratory function during exercise in heart failure (HF) is unknown. Methods and results We retrospectively compared the results of 942 cardiopulmonary exercise tests, performed consecutively at seven Italian laboratories, in HF patients with atrial fibrillation ( n = 180) and sinus rhythm ( n = 762). By multivariable logistic regression analysis, peak VO2 (OR 0.376, 95% CI 0.240–0.588, P < 0.0001), O2pulse (VO2/heart rate, HR) (OR 0.236, 95% CI 0.152–0.366, P < 0.0001), VCO2 (OR 3.97, 95% CI 2.163–7.287, P < 0.0001), and ventilation (OR 1.38, 95% CI 1.045–1.821, P = 0.0231) were independently associated with atrial fibrillation. Anaerobic threshold (AT) was identified in 132 of 180 (73%) atrial fibrillation and in 649 of 762 (85%) sinus rhythm patients ( P = 0.0002). By multivariable logistic regression analysis, only peak VO2 (OR 0.214, 95% CI 0.155–0.296, P < 0.0001) was independently associated with unidentified AT. At AT, atrial fibrillation HF patients had higher HR ( P < 0.0001) and higher VO2 ( P < 0.001) compared with sinus rhythm HF patients. Among AT variables, by multivariable logistic regression analysis, only HR was an independent predictor of atrial fibrillation. Conclusion In HF patients with permanent atrial fibrillation, exercise performance is reduced as reflected by reduced peak VO2. The finding of unidentified AT is associated with a poor performance. In atrial fibrillation patients, VO2 is higher at AT whereas lower at peak. This last observation raises uncertainties about the use of AT data to define performance and prognosis of HF patients with atrial fibrillation.

Published
2008

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