32 results on '"SCRUTINIO, DOMENICO"'
Search Results
2. Association of improvement in functional capacity after rehabilitation with long-term survival in heart failure.
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Scrutinio, Domenico, Guida, Pietro, Passantino, Andrea, Scalvini, Simonetta, Bussotti, Maurizio, Forni, Giovanni, Tibollo, Valentina, Vaninetti, Raffaella, and La Rovere, Maria Teresa
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HEART failure , *FUNCTIONAL status , *PROPORTIONAL hazards models , *HEART failure patients , *CARDIAC rehabilitation - Abstract
The prognostic value of change in six-minute walking distance (6MWD) after treatment to predict mortality in heart failure (HF) remains a controversial issue. We assessed the prognostic value of rehabilitation-induced improvement in 6MWD in predicting mortality in patients with HF. We studied 2257 patients admitted to six inpatient rehabilitation facilities after a hospitalization for HF (N. 912) or because of worsening functional capacity and/or deteriorating clinical status (N. 1345). A six-minute walking test was performed at admission and discharge. The primary outcome was 3-year all-cause mortality after discharge from cardiac rehabilitation. We used multivariable Cox proportional hazard modeling to assess the association of increase in 6MWD with 3-year mortality, adjusting for established predictors of mortality. 6MWD significantly increased by 61 m (p <.001) from admission to discharge and 969 patients (42.9%) achieved an increase in 6MWD >50 m. After full adjustment, an increase in 6MWD >50 m was associated with a 22% decreased risk for 3-year mortality (HR 0.78 [95% CI 0.68–0.91]; p =.002). When modeled as a continuous variable, improvement in 6MWD remained independently associated with decreased risk for 3-year mortality (HR per each 50 m increase: 0.92 [95% CI 0.88–0.96]). Rehabilitation–induced improvement in 6MWD was associated with a significantly reduced risk for 3-year mortality. Our data also suggest that an improvement in 6MWD of more than 50 m could represent a clinically meaningful endpoint of cardiac rehabilitation for patients with heart failure. • The prognostic role of improvement in 6-min walk distance in heart failure is a debated issue. • We studied 2250 heart failure patients admitted to inpatient cardiac rehabilitation. • Rehabilitation-induced improvement in 6-min walk distance predicted improved survival. • This finding can contribute to promote cardiac rehabilitation referral for heart failure. [ABSTRACT FROM AUTHOR]
- Published
- 2022
- Full Text
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3. The metabolic exercise test data combined with Cardiac And Kidney Indexes (MECKI) score and prognosis in heart failure. A validation study
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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
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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
4. Multiparametric prognostic scores in chronic heart failure with reduced ejection fraction: a long-term comparison
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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
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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.
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- 2018
5. Exercise tolerance can explain the obesity paradox in patients with systolic heart failure: data from the MECKI Score Research Group
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Piepoli, Massimo F., Corrà, Ugo, Veglia, Fabrizio, Bonomi, Alice, Salvioni, Elisabetta, Cattadori, Gaia, Metra, Marco, Lombardi, Carlo, Sinagra, Gianfranco, Limongelli, Giuseppe, Raimondo, Rosa, Federica, Re, Magri', Damiano, Belardinelli, Romualdo, Parati, Gianfranco, Minà, Chiara, Scardovi, Angela B., Guazzi, Marco, Cicoira, Mariantonietta, Scrutinio, Domenico, Di Lenarda, Andrea, Bussotti, Maurizio, Frigerio, Maria, Correale, Michele, Villani, Giovanni Quinto, Paolillo, Stefania, Passino, Claudio, Agostoni, Piergiuseppe, Piepoli, Massimo F., Corrã , Ugo, Veglia, Fabrizio, Bonomi, Alice, Salvioni, Elisabetta, Cattadori, Gaia, Metra, Marco, Lombardi, Carlo, Sinagra, Gianfranco, Limongelli, Giuseppe, Raimondo, Rosa, Re, Federica, Magrã¬, Damiano, Belardinelli, Romualdo, Parati, Gianfranco, Minã , Chiara, Scardovi, Angela B., Guazzi, Marco, Cicoira, Mariantonietta, Scrutinio, Domenico, Di Lenarda, Andrea, Bussotti, Maurizio, Frigerio, Maria, Correale, Michele, Villani, Giovanni Quinto, Paolillo, Stefania, Passino, Claudio, Agostoni, Piergiuseppe, Piepoli, M, Corrà, U, Veglia, F, Bonomi, A, Salvioni, E, Cattadori, G, Metra, M, Lombardi, C, Sinagra, G, Limongelli, G, Raimondo, R, Re, F, Magrì, D, Belardinelli, R, Parati, G, Minà, C, Scardovi, A, Guazzi, M, Cicoira, M, Scrutinio, D, Di Lenarda, A, Bussotti, M, Frigerio, M, Correale, M, Villani, G, Paolillo, S, Passino, C, Agostoni, P, Corrà, Ugo, Magrì, Damiano, Minà, Chiara, and DI LENARDA, Andrea
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Male ,Prognosi ,Matching analysi ,Heart failure ,Cohort Studies ,Oxygen Consumption ,Exercise tolerance ,Cause of Death ,Humans ,Cardiopulmonary exercise testing ,MECKI score ,Matching analysis ,Prognosis ,Obesity ,Aged ,Cardiology and Cardiovascular Medicine ,cardiopulmonary exercise testing ,exercise tolerance ,heart failure ,matching analysis ,prognosis ,ardiology and cardiovascular medicineC ,Middle Aged ,Protective Factors ,Cardiorespiratory Fitness ,Italy ,Multivariate Analysis ,Exercise Test ,Heart Transplantation ,Female ,Heart Failure, Systolic - Abstract
AIMS: Obesity has been found to be protective in heart failure (HF), a finding leading to the concept of an obesity paradox. We hypothesized that a preserved cardiorespiratory fitness in obese HF patients may affect the relationship between survival and body mass index (BMI) and explain the obesity paradox in HF. METHODS AND RESULTS: A total of 4623 systolic HF patients (LVEF 31.5 ± 9.5%, BMI 26.2 ± 3.6 kg/m(2) ) were recruited and prospectively followed in 24 Italian HF centres belonging to the MECKI Score Research Group. Besides full clinical examination, patients underwent maximal cardiopulmonary exercise test at study enrolment. Median follow-up was 1113 (553-1803) days. The study population was divided according to BMI (30 to ≤35 kg/m(2) ) and predicted peak oxygen consumption (peak VO2 , 80%). Study endpoints were all-cause and cardiovascular deaths including urgent cardiac transplant. All-cause and cardiovascular deaths occurred in 951 (28.6%, 57.4 per person-years) and 802 cases (17.4%, 48.4 per 1000 person-years), respectively. In the high BMI groups, several prognostic parameters presented better values [LVEF, peak VO2 , ventilation/carbon dioxide slope, renal function, and haemoglobin (P < 0.01)] compared with the lower BMI groups. Both BMI and peak VO2 were significant positive predictors of longer survival: both higher BMI and peak VO2 groups showed lower mortality (P < 0.001). At multivariable analysis and using a matching procedure (age, gender, LVEF, and peak VO2 ), the protective role of BMI disappeared. CONCLUSION: Exercise tolerance affects the relationship between BMI and survival. Cardiorespiratory fitness mitigates the obesity paradox observed in HF patients.
- Published
- 2016
6. Cardiovascular Death Risk in Recovered Mid-Range Ejection Fraction Heart Failure: Insights From Cardiopulmonary Exercise Test.
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MAGRÌ, DAMIANO, PIEPOLI, MASSIMO, CORRÀ, UGO, GALLO, GIOVANNA, MARUOTTI, ANTONELLO, VIGNATI, CARLO, SALVIONI, ELISABETTA, MAPELLI, MASSIMO, PAOLILLO, STEFANIA, PERRONE FILARDI, PASQUALE, GIROLA, DAVIDE, METRA, MARCO, SCARDOVI, ANGELA B., LAGIOIA, ROCCO, LIMONGELLI, GIUSEPPE, SENNI, MICHELE, SCRUTINIO, DOMENICO, EMDIN, MICHELE, PASSINO, CLAUDIO, and LOMBARDI, CARLO
- Abstract
Background: Heart failure with midrange ejection fraction (HFmrEF) represents a heterogeneous category where phenotype, as well as prognostic assessment, remains debated. The present study explores a specific HFmrEF subset, namely those who recovered from a reduced EF (rec-HFmrEF) and, particularly, it focuses on the possible additive prognostic role of cardiopulmonary exercise testing.Methods and Results: We analyzed data from 4535 patients with HFrEF and 1176 patients with rec-HFmrEF from the Metabolic Exercise combined with Cardiac and Kidney Indexes database. The end point was cardiovascular death at 5 years. The median follow-up was 1343 days (25th-75th range 627-2403 days). Cardiovascular death occurred in 552 HFrEF and 61 rec-HFmrEF patients. The multivariate analysis confirmed an independent role of the MECKI score's variables in HFrEF (C-index = 0.744) whereas, in the rec-HFmrEF group, only age and peak oxygen uptake (pVO2) remained associated to the end point (C-index = 0.745). A peak oxygen uptake of ≤55% of predicted and a ventilatory efficiency of ≥31 resulted as the most accurate cut-off values in the outcome prediction.Conclusions: Present data support the cardiopulmonary exercise test and, particularly, the peak oxygen uptake, as a useful tool in the rec-HFmrEF prognostic assessment. A peak VO2 of ≤55% predicted and ventilatory efficiency of ≥31 might help to identify a high-risk rec-HFmrEF subgroup. [ABSTRACT FROM AUTHOR]- Published
- 2020
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7. Renal function and peak exercise oxygen consumption in chronic heart failure with reduced left ventricular ejection fraction
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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
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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
8. Exercise oscillatory ventilation and prognosis in heart failure patients with reduced and mid-range ejection fraction.
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Rovai, Sara, Corrà, Ugo, Piepoli, Massimo, Vignati, Carlo, Salvioni, Elisabetta, Bonomi, Alice, Mattavelli, Irene, Arcari, Luca, Scardovi, Angela B., Perrone Filardi, Pasquale, Lagioia, Rocco, Paolillo, Stefania, Magrì, Damiano, Limongelli, Giuseppe, Metra, Marco, Senni, Michele, Scrutinio, Domenico, Raimondo, Rosa, Emdin, Michele, and Lombardi, Carlo
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HEART failure patients ,HEART failure ,EXERCISE tests ,HEART assist devices ,HEART transplantation ,EXERCISE - Abstract
Aims: Exercise oscillatory ventilation (EOV) is a pivotal cardiopulmonary exercise test parameter for the prognostic evaluation of patients with chronic heart failure (HF). It has been described in patients with HF with reduced ejection fraction (<40%, HFrEF) and with HF with preserved ejection fraction (>50%, HFpEF), but no data are available for patients with HF with mid-range ejection fraction (40-49%, HFmrEF). The aim of the study was to evaluate the prognostic role of EOV in HFmrEF patients.Methods and Results: We analysed 1239 patients with HFmrEF and 4482 patients with HFrEF, enrolled in the MECKI score database, with a 2-year follow-up. The study endpoint was the composite of cardiovascular death, urgent heart transplant, and ventricular assist device implantation. We identified EOV in 968 cases (16% and 17% of cases in HFmrEF and HFrEF, respectively). HFrEF EOV+ patients were significantly older, and their parameters suggested a more severe HF than HFrEF EOV- patients. A similar behaviour was found in HFmrEF EOV+ vs. EOV- patients. Kaplan-Meier analysis, irrespective of ejection fraction, showed that EOV is associated with a worse survival, and that patients with HFrEF and HFmrEF EOV+ had a significantly worse outcome than the EOV- of the same ejection fraction groups. EOV-associated survival differences in HFmrEF patients started after 18 months of follow-up.Conclusion: Exercise oscillatory ventilation has a similar prevalence and ominous prognostic value in both HFmrEF and HFrEF patients, indicating a group of patients in need of a more intensive follow-up and a more aggressive therapy. In HFmrEF, the survival curves between EOV+ and EOV- patients diverged only after 18 months. [ABSTRACT FROM AUTHOR]- Published
- 2019
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9. Acutely decompensated heart failure with chronic obstructive pulmonary disease: Clinical characteristics and long-term survival.
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Scrutinio, Domenico, Guida, Pietro, Passantino, Andrea, Ammirati, Enrico, Oliva, Fabrizio, Lagioia, Rocco, Raimondo, Rosa, Venezia, Mario, and Frigerio, Maria
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OBSTRUCTIVE lung diseases , *HEART assist devices , *HEART failure , *PROPORTIONAL hazards models - Abstract
Abstract Background Chronic obstructive pulmonary disease (COPD) is among the most common comorbidities in patients hospitalized with heart failure and is generally associated with poor outcomes. However, the results of previous studies with regard to increased mortality and risk trajectories were not univocal. We sought to assess the prognostic impact of COPD in patients admitted for acutely decompensated heart failure (ADHF) and investigate the association between use of β-blockers at discharge and mortality in patients with COPD. Methods We studied 1530 patients. The association of COPD with mortality was examined in adjusted Fine-Gray proportional hazard models where heart transplantation and ventricular assist device implantation were treated as competing risks. The primary outcome was 5-year all-cause mortality. Results After adjusting for establisked risk markers, the subdistribution hazard ratios (SHR) of 5-year mortality for COPD patients compared with non-COPD patients was 1.25 (95% confidence intervals [CIs] 1.06–1.47; p =.007). The relative risk of death for COPD patients increased steeply from 30 to 180 days, and remained noticeably high throughout the entire follow-up. Among patients with comorbid COPD, the use of β-blockers at discharge was associated with a significantly reduced risk of 1-year post-discharge mortality (SHR 0.66, 95%CIs 0.53–0.83; p ≤.001). Conclusions Our data indicate that ADHF patients with comorbid COPD have a worse long-term survival than those without comorbid COPD. Most of the excess mortality occurred in the first few months following hospitalization. Our data also suggest that the use of β-blockers at discharge is independently associated with improved survival in ADHF patients with COPD. Highlights • Chronic obstructive pulmonary disease (COPD) is a common comorbidity in acute heart failure. • Comorbid COPD entailed an increased risk of long-term mortality. • Most of the excess mortality occurred in the first few months following hospitalization. • β-blockers reduced the risk of death in patients with comorbid COPD. [ABSTRACT FROM AUTHOR]
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- 2019
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10. Heart failure prognosis over time: how the prognostic role of oxygen consumption and ventilatory efficiency during exercise has changed in the last 20 years.
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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, and Cicoira, Mariantonietta
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HEART assist devices ,HEART failure ,OXYGEN consumption ,HEART ,COMPARATIVE studies ,EXERCISE tests ,FORECASTING ,LONGITUDINAL method ,RESEARCH methodology ,MEDICAL cooperation ,PROGNOSIS ,RESEARCH ,RESPIRATION ,PULMONARY function tests ,EVALUATION research ,RETROSPECTIVE studies ,RECEIVER operating characteristic curves ,DISEASE progression - Abstract
Aims: Exercise-derived parameters, specifically peak exercise oxygen uptake (peak VO2 ) and minute ventilation/carbon dioxide relationship slope (VE/VCO2 slope), have a pivotal prognostic value in heart failure (HF). It is unknown how the prognostic threshold of peak VO2 and VE/VCO2 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 VO2 and VE/VCO2 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 VO2 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/VCO2 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 VO2 and VE/VCO2 slope cut-offs identifying a definite risk progressively decreased and increased over time, respectively. The prognostic threshold of peak VO2 and VE/VCO2 slope must be updated whenever HF prognosis improves. [ABSTRACT FROM AUTHOR]- Published
- 2019
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11. Female gender and mortality risk in decompensated heart failure.
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Scrutinio, Domenico, Guida, Pietro, Passantino, Andrea, Lagioia, Rocco, Raimondo, Rosa, Venezia, Mario, Ammirati, Enrico, Oliva, Fabrizio, Stucchi, Miriam, and Frigerio, Maria
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HEART disease related mortality , *GENDER differences (Psychology) , *HEART failure , *HEART transplantation , *HEART assist devices , *DISEASE incidence , *PROGNOSIS - Abstract
Background Still there is conflicting evidence about gender-related differences in prognosis among patients with heart failure. This prognostic uncertainty may have implications for risk stratification and planning management strategy. The aim of the present study was to explore the association between gender and one-year mortality in patients admitted with acute decompensated heart failure (ADHF). Methods We studied 1513 patients. The Cumulative Incidence Function (CIF) method was used to estimate the absolute rate of mortality, heart transplantation (HT)/ventricular assist device (VAD) implantation, and survival free of HT/VAD implantation at 1 year. An interaction analysis was performed to assess the association between covariates, gender, and mortality risk. Propensity score matching and Cox regression were used to compare mortality rates in the gender subgroups. Results The CIF estimates of 1-year mortality, HT/VAD implantation, and survival free of HT/VAD implantation at 1 year were 33.1%, 7.0%, and 59.9% for women and 30.2%, 10.2%, and 59.6% for men, respectively. Except for diabetes, there was no significant interaction between gender, covariates, and mortality risk. In the matched cohort, the hazard ratio of death for women was 1.19 (95% confidence intervals [CIs]: 0.90–1.59; p = .202). After adjusting for age and baseline risk, the hazard ratio of death for women was 1.18 (95% CIs: 0.95–1.43; p = .127). The use of gender-specific predictive models did not allow improving the accuracy of risk prediction. Conclusions Our data strongly suggest that women and men have comparable outcome in the year following a hospitalization for ADHF. [ABSTRACT FROM AUTHOR]
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- 2018
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12. Relationship among body mass index, NT-proBNP, and mortality in decompensated chronic heart failure.
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Scrutinio, Domenico, Passantino, Andrea, Guida, Pietro, Ammirati, Enrico, Oliva, Fabrizio, Sarzi Braga, Simona, La Rovere, Maria Teresa, Lagioia, Rocco, Frigerio, Maria, and Di Somma, Salvatore
- Abstract
Background Obesity has been suggested to confer a survival benefit in acute heart failure. The concentrations of NT-proBNP may be reduced in patients with high body mass index (BMI). Objectives To investigate the relationship among BMI, NT-proBNP, and mortality risk in decompensated chronic heart failure (DCHF). Methods This was a retrospective study. We studied 1001 patients with DCHF. Hazard ratios (HR) were calculated with Cox regression analysis. Results During the 1-year follow-up, 295 patients died. Compared with normal-weight patients, the unadjusted HR for death were 1.02 (95% CIs 0.79–1.33; p = 0.862) for patients with a BMI of 25.0–29.9 kg/m 2 and 0.83 (95% CIs 0.61–1.12; p = 0.213) for patients with a BMI ≥ 30 kg/m 2 . NT-proBNP remained independently associated with mortality across the BMI categories. There was no statistically significant interaction between BMI and NT-proBNP levels for risk prediction. Conclusions Obesity was not associated with mortality risk. NT-proBNP remained an independent prognostic factor across the BMI categories. [ABSTRACT FROM AUTHOR]
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- 2017
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13. Predictors of Long-Term Mortality in Older Patients Hospitalized for Acutely Decompensated Heart Failure: Clinical Relevance of Natriuretic Peptides.
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Passantino, Andrea, Guida, Piero, Lagioia, Rocco, Ammirati, Enrico, Oliva, Fabrizio, Frigerio, Maria, and Scrutinio, Domenico
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MORTALITY risk factors ,HOSPITAL care of older people ,RETROSPECTIVE studies ,HEART failure ,HOSPITALS ,MEDICAL cooperation ,PEPTIDE hormones ,REFERENCE values ,RESEARCH ,RISK assessment ,COMORBIDITY ,DESCRIPTIVE statistics ,VENTRICULAR ejection fraction ,PROGNOSIS - Abstract
Background Acute heart failure is a common cause of hospitalization among older patients. Optimized risk stratification might improve the outcome for this subgroup of patients. Natriuretic peptides have been used in the diagnosis of heart failure and in evaluating the prognosis of patients hospitalized for heart failure. However, their utility in the elderly is still controversial. Objective To evaluate long-term survival and prognostic factors for elderly patients hospitalized for acutely decompensated heart failure and evaluate the prognostic utility of NT-proBNP. Design Retrospective, multicenter cohort study. Setting Two Italian hospitals. Participants Two hundred seventy-nine patients, aged >75 years; hospitalized for decompensation of chronic, established heart failure. Methods Baseline clinical data were recorded at admission. The primary outcome was long-term mortality. Results In-hospital, 12-month and 5-year mortality were, respectively, 10%, 36%, and 77%. NT-proBNP, eGFR, hemoglobin, diabetes, systolic blood pressure, and moderate to severe tricuspid regurgitation were independently associated with long-term prognosis and were entered into a multivariate model, with a C-index of 0.765 for the determination of high-risk patients. The C-index for NT-proBNP to predict mortality at 2 and 12 months was 0.740 and 0.756, respectively. The optimal cutoff point for predicting mortality at 2 and 12 months was 8,444 pg/mL (hazard ratio 5.33) and 8,275 pg/mL (hazard ratio 6.03), respectively. Conclusion Elderly patients hospitalized for acutely decompensated heart failure had a poor long-term outcome, especially in the subgroup with reduced ejection fraction (EF). In addition to EF and comorbidities, NT-pro-BNP remained independently prognostic among elderly patients hospitalized with heart failure. [ABSTRACT FROM AUTHOR]
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- 2017
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14. Long-term prognostic implications of the ADHF/NT-proBNP risk score in patients admitted with advanced heart failure.
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Scrutinio, Domenico, Guida, Pietro, Ammirati, Enrico, Oliva, Fabrizio, and Frigerio, Maria
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HEART failure patients , *HEART failure , *PROGNOSIS - Published
- 2016
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15. Prognostic impact of comorbidities in hospitalized patients with acute exacerbation of chronic heart failure.
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Scrutinio, Domenico, Passantino, Andrea, Guida, Pietro, Ammirati, Enrico, Oliva, Fabrizio, Braga, Simona Sarzi, La Rovere, Maria Teresa, Lagioia, Rocco, and Frigerio, Maria
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HEART failure , *CHRONIC diseases , *HOSPITAL care , *DISEASE exacerbation , *SYMPTOMS , *MORTALITY , *PROGNOSIS - Abstract
Background To assess the impact of comorbidities on long-term all-cause mortality in patients hospitalized with exacerbated signs/symptoms of previously chronic stable HF (AE-CHF). Methods 1119 patients admitted for AE-CHF and with NT-proBNP levels > 900 pg/mL were enrolled. Univariable and multivariable Cox analyses were performed to assess the association of age, gender, hypertension, diabetes, obesity, atrial fibrillation, coronary heart disease (CHD), chronic obstructive pulmonary disease, previous cerebrovascular accidents, chronic liver disease (CLD), thyroid disease, renal impairment (RI), and anemia with 3-year all-cause mortality. Results During the follow-up, 441 patients died and 126 underwent heart transplantation (HT) or ventricular assist device (VAD) implantation. 45.8% of the fatal events and 52.4% of HT/VAD implantations occurred within 180 days after admission. Increasing age (p = .012), obesity (p = .037), atrial fibrillation (p = .030), CHD (p = .015), CLD (p = .001), RI (p < .001), and anemia (p < .001) were independently associated with 3-year all-cause mortality. Most of the prognostic impact of CHD, took place within the first 180 days after admission. Male gender was associated with mortality beyond 180 days. Compared with normal weight, obesity was associated with better overall survival. Obese patients, however, had significantly lower NT-proBNP concentrations and less frequently presented with hypotension, hyponatremia, and severe left ventricular systolic dysfunction, despite a similar prevalence of severe dyspnea at admission. Conclusions Several comorbidities are associated with long-term risk of death in hospitalized patients with worsening HF, although the nature of this association does appear to be complex. Our data may help to raise awareness about the clinical relevance of comorbid conditions. [ABSTRACT FROM AUTHOR]
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- 2016
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16. Incremental utility of prognostic variables at discharge for risk prediction in hospitalized patients with acutely decompensated chronic heart failure.
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Scrutinio, Domenico, Passantino, Andrea, Guida, Pietro, Ammirati, Enrico, Oliva, Fabrizio, Lagioia, Rocco, Braga, Simona Sarzi, Agostoni, Piergiuseppe, and Frigerio, Maria
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Objectives: To assess the incremental prognostic utility of discharge serum creatinine (SCr), systolic blood pressure (SBP), and NT-proBNP and sodium concentrations in hospitalized patients with acutely decompensated chronic heart failure. Background: Whether key prognostic variables at discharge provide incremental prognostic information beyond that provided by a model based on admission variables (referent) remains incompletely defined. Methods: The primary outcome was a composite of death, urgent heart transplantation, or ventricular assist device implantation at 1 year. The gain in predictive performance was assessed using C index, Bayesian Information Criterion, and Net Reclassification Improvement. Results: The best fit was obtained when discharge NT-proBNP was added to the referent model. No interaction between admission and discharge NT-proBNP was found. Discharge SCr, SBP, and sodium did not improve goodness-of-fit. Conclusions: Admission and discharge NT-proBNP provide complementary and independent prognostic information; as such, they should be taken into account concurrently. [ABSTRACT FROM AUTHOR]
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- 2016
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17. Clinical utility of N-terminal pro-B-type natriuretic peptide for risk stratification of patients with acute decompensated heart failure. Derivation and validation of the ADHF/NT-proBNP risk score.
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Scrutinio, Domenico, Ammirati, Enrico, Guida, Pietro, Passantino, Andrea, Raimondo, Rosa, Guida, Valentina, Braga, Simona Sarzi, Pedretti, Roberto FE, Lagioia, Rocco, Frigerio, Maria, Catanzaro, Raffaella, and Oliva, Fabrizio
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NATRIURETIC peptides , *BRAIN natriuretic factor , *HEART failure , *HEART failure patients , *HEART failure risk factors , *COHORT analysis , *GLOMERULAR filtration rate , *PROGNOSIS - Abstract
Abstract: Background: NT-proBNP has been associated with prognosis in acute decompensated heart failure (ADHF). Whether NT-proBNP provides additional prognostic information beyond that obtained from standard clinical variables is uncertain. We sought to assess whether N-terminal pro-B-type natriuretic peptide (NT-proBNP) determination improves risk reclassification of patients with ADHF and to develop and validate a point-based NT-proBNP risk score. Methods: This study included 824 patients with ADHF (453 in the derivation cohort, 371 in the validation cohort). We compared two multivariable models predicting 1-year all-cause mortality, including clinical variables and clinical variables plus NT-proBNP. We calculated the net reclassification improvement (NRI) and the integrated discrimination improvement (IDI). Then, we developed and externally validated the NT-proBNP risk score. Results: One-year mortalities for the derivation and validation cohorts were 28.3% and 23.4%, respectively. Multivariable predictors of mortality included chronic obstructive pulmonary disease, estimated glomerular filtration rate, sodium, hemoglobin, left ventricular ejection fraction, and moderate to severe tricuspid regurgitation. Adding NT-proBNP to the clinical variables only model significantly improved the NRI (0.129; p=0.0027) and the IDI (0.037; p=0.0005). In the derivation cohort, the NT-proBNP risk score had a C index of 0.839 (95% CI: 0.798–0.880) and the Hosmer–Lemeshow statistic was 1.23 (p=0.542), indicating good calibration. In the validation cohort, the risk score had a C index of 0.768 (95% CI: 0.711–0.817); the Hosmer–Lemeshow statistic was 2.76 (p=0.251), after recalibration. Conclusions: The NT-proBNP risk score provides clinicians with a contemporary, accurate, easy-to-use, and validated predictive tool. Further validation in other datasets is advisable. [Copyright &y& Elsevier]
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- 2013
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18. Clinical utility of different estimates of renal function for predicting mortality in chronic heart failure
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Scrutinio, Domenico, Passantino, Andrea, Catanzaro, Raffaella, and Guida, Pietro
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HEART disease related mortality , *HEART failure risk factors , *KIDNEY function tests , *CALIBRATION , *GLOMERULAR filtration rate , *HEALTH outcome assessment - Abstract
Abstract: Background: The clinical utility of different renal function (RF) measures for risk stratification in chronic heart failure (CHF) and the incremental discriminative value of renal dysfunction have not been investigated thoroughly. Methods: We studied 802 patients with systolic CHF. The primary outcome was all-cause mortality. The association of candidate variables and RF measures [serum creatinine (SCr), serum urea nitrogen (SUN), estimated creatinine clearance adjusted for body-surface area (eCrClBSA), and estimated glomerular filtration rate (eGFR)] with mortality was evaluated using Cox proportional-hazards analyses. Recommended metrics of goodness-of-fit and discrimination were calculated. Results: At follow-up (median: 1269days), there were 301 deaths. Age (p<0.001), ischemic etiology (p=0.009), NYHA class (p<0.001), anemia (p<0.001), and left ventricular ejection fraction (p<0.001) independently predicted mortality (reference risk model). On multivariable analysis incorporating one of the measures of RF at a time, each had an independent value for predicting mortality (p<0.001). The addition of each RF measures to the reference model significantly increased the likelihood-ratio χ2 and the models incorporating eCrClBSA or SUN demonstrated the highest probability of being the best. Although changes in C statistic and net reclassification were not significant, the Integrated Discrimination Index was significantly improved by the addition of eCrClBSA. Calibration was improved by all measures of RF expect SUN. The model incorporating eCrClBSA demonstrated both the best goodness-of-fit and discrimination. Conclusions: Our data suggest that renal dysfunction significantly improves risk stratification in a context of established risk factors. eCrClBSA appears to be the most performing measure of RF for this purpose. [Copyright &y& Elsevier]
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- 2012
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19. Detection and prognostic impact of renal dysfunction in patients with chronic heart failure and normal serum creatinine
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Scrutinio, Domenico, Passantino, Andrea, Lagioia, Rocco, Santoro, Daniela, and Cacciapaglia, Erasmo
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KIDNEY disease diagnosis , *HEART failure patients , *SERUM , *CREATINE , *GLOMERULAR filtration rate , *MULTIVARIATE analysis , *MORTALITY , *HEART disease prognosis - Abstract
Abstract: Background: Accurate identification of renal dysfunction (RD) is crucial to risk stratification in chronic heart failure (CHF). Patients with CHF are at special risk of having RD despite normal serum creatinine (SCr), owing to a decreased Cr generation. At low levels of SCr, the equations estimating renal function are less accurate. This study was aimed to assess and compare the prognostic value of formulas estimating renal function in CHF patients with normal SCr. Methods: We studied 462 patients with systolic CHF and normal SCr. Creatinine clearance was estimated by the Cockcroft–Gault (eCrCl) and glomerular filtration rate by the 4-variable MDRD equation (eGFR); eCrCl normalized for body-surface area (eCrClBSA) was calculated. The primary outcome was all-cause mortality at 2years. Results: Seventy five patients died. At multivariate Cox regression analysis, only eCrClBSA was significantly associated with mortality (p =0.006); eGFR (p =0.24), eCrCl (p =0.09) and BUN (p =0.14) were not statistically significant predictors. The patients in the lowest eCrClBSA quartile had an adjusted 2.1-fold (CI: 1.06–4.1) increased risk of mortality, compared with those in the referent quartile. Two-year survival was 70.4% in the lowest eCrClBSA quartile and 89.7% in the referent quartile. Other independent predictors of mortality were ischemic etiology (RR: 2.16 [CI: 1.3–3.5], p =0.0017), NYHA III/IV class (RR: 2.45 [CI: 1.51–3.97], p =0.0003), LVEF <0.25 (RR: 3.38 [CI: 1.69–6.75], p =0.014), and anemia (RR: 1.86 [CI: 1.16–2.99], p =0.009). Conclusions: A sizeable proportion of CHF patients have prognostically significant RD despite normal SCr. Such patients represent a high-risk subgroup and can more accurately be identified by the CG formula corrected for BSA than the MDRD. [Copyright &y& Elsevier]
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- 2011
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20. The cardiorenal anaemia syndrome in systolic heart failure: prevalence, clinical correlates, and long-term survival.
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Scrutinio, Domenico, Passantino, Andrea, Santoro, Daniela, and Catanzaro, Raffaella
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HEART failure , *ANEMIA , *CLINICAL trials , *DISEASE prevalence , *KIDNEY function tests , *HEART transplantation , *CONFIDENCE intervals , *PROGNOSIS - Abstract
Aims We sought to assess the prevalence and clinical correlates of cardiorenal anaemia (CRA) syndrome in systolic heart failure and the relationship between renal dysfunction and anaemia on hard clinical outcomes. Methods and results We studied 951 patients with chronic heart failure (CHF) and systolic dysfunction. The primary outcome was all-cause mortality and urgent heart transplantation (UHT). Cox's regression analyses were used to assess the relation of the variables to the primary outcome. Hazard ratios (HRs) with 95% confidence intervals (CI) were calculated. Conclusion Heart failure, renal dysfunction, and anaemia are a fatal combination. Despite a relatively low prevalence, the CRA syndrome contributes to considerable mortality due to CHF. [ABSTRACT FROM AUTHOR]
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- 2011
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21. Prognostic value of formulas estimating excretory renal function in the elderly with systolic heart failure.
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Scrutinio, Domenico, Passantino, Andrea, Santoro, Daniela, Cacciapaglia, Erasmo, and Farinola, Giuseppe
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HEART failure , *PROGNOSIS , *MORTALITY , *CARDIOLOGY , *ANEMIA , *BLOOD diseases - Abstract
Background: reduced renal excretory function (REF) is increasingly being appreciated as a potent prognostic factor in chronic heart failure (CHF). The Cockroft-Gault (CG) and the simplified Modification of Diet in Renal Disease (MDRD) equations have been recommended to estimate REF. However, limitations for both formulas have been reported in the elderly. Their prognostic performance in older CHF patients has not been investigated. Objectives: to assess the factors independently associated with all-cause mortality and compare the prognostic value of formulas estimating REF in CHF patients aged ⩾70 years. Design: a longitudinal study with a median follow-up of 859 days. The end-point was all-cause mortality. Setting: Division of Cardiology and Cardiac Rehabilitation. Subjects: two hundred and sixty-six patients aged ⩾70 years with systolic CHF. Methods: REF was estimated using the CG (eCrClCG) and the MDRD (eGFRMDRD) formulas. Cox proportional hazards model was used to assess the factors independently associated with mortality and compare the prognostic value of estimating formulas. Receiver-operating characteristic (ROC) curve analysis was also performed. Results: Kaplan-Meier estimates of the rates of death at 1 and 2 years were 85% and 73%, respectively At multivariate analysis, eCrClCG <50 mL/min (P = 0.005), anaemia (P = 0.012), non-prescription of beta-blockers (P = 0.006) and left ventricular ejection fraction (P 0.03) were the only independent predictors of mortality. On ROC analysis, the eCrClCG was significantly more accurate than the eGFRMDRD. Conclusions: among CHF patients aged ⩾70 years, reduced REF is the most powerful independent predictor of survival. The excess in risk conferred by reduced REF is better appraised by means of the CG than the MDRD equation. [ABSTRACT FROM AUTHOR]
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- 2009
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22. Dose-dependent efficacy of β-blocker in patients with chronic heart failure and atrial fibrillation.
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Campodonico, Jeness, Piepoli, Massimo, Clemenza, Francesco, Bonomi, Alice, Paolillo, Stefania, Salvioni, Elisabetta, Corrà, Ugo, Binno, Simone, Veglia, Fabrizio, Lagioia, Rocco, Sinagra, Gianfranco, Cattadori, Gaia, Scardovi, Angela B., Metra, Marco, Senni, Michele, Scrutinio, Domenico, Raimondo, Rosa, Emdin, Michele, Magrì, Damiano, and Parati, Gianfranco
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HEART failure , *ATRIAL fibrillation , *KAPLAN-Meier estimator , *CENSORING (Statistics) , *HEART transplantation - Abstract
Abstract Background The usefulness of β-blockers in heart failure (HF) patients with permanent atrial fibrillation (AF) has been questioned. Methods and results We analyzed data from HF patients (958 patients (801 males, 84%, age 67 ± 11 years)) with AF enrolled in the MECKI score database. We evaluated prognosis (composite of cardiovascular death, urgent heart transplant, or left ventricular assist device) of patients receiving β-blockers (n = 777, 81%) vs. those not treated with β-blockers (n = 181, 19%). We also analyzed the role β1-selectivity and the role of daily β-blocker dose. To account for different HF severity, Kaplan-Meier survival curves were normalized for relevant confounding factors and for treatment strategies. Dose was available in 629 patients. Median follow-up was 1312 (577–2304) days in the entire population, 1203 (614–2420) and 1325 (569–2300) days in patients not receiving and receiving β-blockers. 224 (23%, 54/1000 events/year), 163 (21%, 79/1000 events/year), and 61 (34%, 49/1000 events/year) events were recorded, respectively. At 10-year patients treated with β-blockers had a better outcome (HR 0.447, p < 0.01) with no effects as regards β1selective drugs (53%) vs. β1-β2 blockers (47%). Survival improved in parallel with β-blocker dose increase (HR 0.296, 0.496, 0.490 for the high, medium, and low dose vs. no β-blockers, p < 0.0001). Conclusion HF patients with AF taking a β-blocker have a better outcome (with a survival improvement in parallel with daily dose but no differences as regards β1 selectivity) but this does not mean that β-blockers improve outcomes in these patients as we cannot control for all the potential confounders associated with β-blocker use. Highlights • Usefulness of β-blockers in patients with atrial fibrillation and heart failure • No impact of β1 selectivity on prognosis in heart failure patients with AF • Importance of daily β-blocker dose on long-term outcomes of patients with AF and HF [ABSTRACT FROM AUTHOR]
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- 2018
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23. Revisiting a Prognosticating Algorithm from Cardiopulmonary Exercise Testing in Chronic Heart Failure (from the MECKI Score Population)
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Ugo Corrà, Massimo Francesco Piepoli, Andrea Giordano, Francesco Doni, Alessandra Magini, Alice Bonomi, Elisabetta Salvioni, Rocco Lagioia, Giuseppe Limongelli, Stefania Paolillo, Damiano Magrì, Pasquale Perrone Filardi, Gianfranco Sinagra, Angela B. Scardovi, Marco Metra, Michele Senni, Domenico Scrutinio, Rosa Raimondo, Michele Emdin, Gaia Cattadori, Gianfranco Parati, Federica Re, Mariantonietta Cicoira, Chiara Minà, Michele Correale, Maria Frigerio, Enrico Perna, Maurizio Bussotti, Elisa Battaia, Marco Guazzi, Francesco Bandera, Roberto Badagliacca, Andrea Di Lenarda, Aldo Maggioni, Claudio Passino, Susanna Sciomer, Giuseppe Pacileo, Massimo Mapelli, Carlo Vignati, Francesco Clemenza, Carlo Lombardi, Piergiuseppe Agostoni, Corrà, Ugo, Piepoli, Massimo Francesco, Giordano, Andrea, Doni, Francesco, Magini, Alessandra, Bonomi, Alice, Salvioni, Elisabetta, Lagioia, Rocco, Limongelli, Giuseppe, Paolillo, Stefania, Magrì, Damiano, Filardi, Pasquale Perrone, Sinagra, Gianfranco, Scardovi, Angela B, Metra, Marco, Senni, Michele, Scrutinio, Domenico, Raimondo, Rosa, Emdin, Michele, Cattadori, Gaia, Parati, Gianfranco, Re, Federica, Cicoira, Mariantonietta, Minà, Chiara, Correale, Michele, Frigerio, Maria, Perna, Enrico, Bussotti, Maurizio, Battaia, Elisa, Guazzi, Marco, Bandera, Francesco, Badagliacca, Roberto, Lenarda, Andrea Di, Maggioni, Aldo, Passino, Claudio, Sciomer, Susanna, Pacileo, Giuseppe, Mapelli, Massimo, Vignati, Carlo, Clemenza, Francesco, Lombardi, Carlo, and Agostoni, Piergiuseppe
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Heart Failure ,Oxygen Consumption ,Adrenergic beta-Antagonists ,Exercise Test ,Humans ,Stroke Volume ,HFrEF ,Prognosis ,Cardiology and Cardiovascular Medicine ,Algorithms ,Ventricular Function, Left - Abstract
Cardiopulmonary exercise testing is a prognostic tool in heart failure with reduced left ventricular ejection fraction (HFrEF). Prognosticating algorithms have been proposed, but none has been validated. In 2017, a predictive algorithm, based on peak oxygen consumption (VO2), ventilatory response to exercise (ventilation [VE] carbon dioxide production [VCO2], the VE/VCO2 slope), exertional oscillatory ventilation (EOV), and peak respiratory exchange ratio, was recommended, according treatment with β blockers: patients with HFrEF registered in the metabolic exercise test data combined with cardiac and kidney indexes (MECKIs) database were used to validated this algorithm. According to the inclusion/exclusion criteria, 4,683 MECKI patients with HFrEF were enrolled. At 3years follow-up, the end point was cardiovascular death and urgent heart transplantation (cardiovascular events [CV]). CV events occurred in 25% in patients without β blockers, whereas those with β-blockers had 11% (p 10
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- 2022
24. Dose-dependent efficacy of β-blocker in patients with chronic heart failure and atrial fibrillation
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Michele Correale, Domenico Scrutinio, Stefania Paolillo, Gaia Cattadori, Marco Metra, Gianfranco Sinagra, Jeness Campodonico, Giuseppe Pacileo, Simone Binno, Massimo Mapelli, Angela Beatrice Scardovi, Marco Guazzi, Carlo Vignati, Susanna Sciomer, Massimo F Piepoli, Michele Emdin, Claudio Passino, Elisa Battaia, Pasquale Perrone Filardi, Andrea Di Lenarda, Piergiuseppe Agostoni, Carlo Lombardi, Fabrizio Veglia, Aldo P. Maggioni, Damiano Magrì, Giuseppe Limongelli, Chiara Minà, Federica Re, Elisabetta Salvioni, Maurizio Bussotti, Ugo Corrà, Francesco Clemenza, Michele Senni, Roberto Badagliacca, Rosa Raimondo, Rocco Lagioia, Alice Bonomi, Mariantonietta Cicoira, Maria Frigerio, Enrico Perna, Gianfranco Parati, Campodonico, Jene, Piepoli, Massimo, Clemenza, Francesco, Bonomi, Alice, Paolillo, Stefania, Salvioni, Elisabetta, Corrà, Ugo, Binno, Simone, Veglia, Fabrizio, Lagioia, Rocco, Sinagra, Gianfranco, Cattadori, Gaia, Scardovi, Angela B., Metra, Marco, Senni, Michele, Scrutinio, Domenico, Raimondo, Rosa, Emdin, Michele, Magrì, Damiano, Parati, Gianfranco, Re, Federica, Cicoira, Mariantonietta, Minà, Chiara, Limongelli, Giuseppe, Correale, Michele, Frigerio, Maria, Bussotti, Maurizio, Perna, Enrico, Battaia, Elisa, Guazzi, Marco, Badagliacca, Roberto, Di Lenarda, Andrea, Maggioni, Aldo, Passino, Claudio, Sciomer, Susanna, Pacileo, Giuseppe, Mapelli, Massimo, Vignati, Carlo, Lombardi, Carlo, Filardi, Pasquale Perrone, Agostoni, Piergiuseppe, Campodonico, J., Piepoli, M., Clemenza, F., Bonomi, A., Paolillo, S., Salvioni, E., Corra, U., Binno, S., Veglia, F., Lagioia, R., Sinagra, G., Cattadori, G., Scardovi, A. B., Metra, M., Senni, M., Scrutinio, D., Raimondo, R., Emdin, M., Magri, D., Parati, G., Re, F., Cicoira, M., Mina, C., Limongelli, G., Correale, M., Frigerio, M., Bussotti, M., Perna, E., Battaia, E., Guazzi, M., Badagliacca, R., Di Lenarda, A., Maggioni, A., Passino, C., Sciomer, S., Pacileo, G., Mapelli, M., Vignati, C., Lombardi, C., Filardi, P. P., Agostoni, P., Campodonico, J, Piepoli, M, Clemenza, F, Bonomi, A, Paolillo, S, Salvioni, E, Corrà, U, Binno, S, Veglia, F, Lagioia, R, Sinagra, G, Cattadori, G, Scardovi, A, Metra, M, Senni, M, Scrutinio, D, Raimondo, R, Emdin, M, Magrì, D, Parati, G, Re, F, Cicoira, M, Minà, C, Limongelli, G, Correale, M, Frigerio, M, Bussotti, M, Perna, E, Battaia, E, Guazzi, M, Badagliacca, R, Di Lenarda, A, Maggioni, A, Passino, C, Sciomer, S, Pacileo, G, Mapelli, M, Vignati, C, Lombardi, C, Filardi, P, and Agostoni, P
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Male ,medicine.medical_specialty ,Prognosi ,medicine.medical_treatment ,Cardiopulmonary exercise test ,Prognosis ,β-Blockers, Atrial fibrillation ,Cardiology and Cardiovascular Medicine ,Adrenergic beta-Antagonists ,Dose dependence ,heart failure, atrial fibrillation, prognosis, beta-blocker, cardiopulmonary exercise test ,030204 cardiovascular system & hematology ,Follow-Up Studie ,03 medical and health sciences ,0302 clinical medicine ,Retrospective Studie ,Internal medicine ,Atrial Fibrillation ,medicine ,Humans ,In patient ,030212 general & internal medicine ,Survival analysis ,Aged ,Retrospective Studies ,Heart Failure ,Entire population ,Dose-Response Relationship, Drug ,business.industry ,Confounding ,Adrenergic beta-Antagonist ,Atrial fibrillation ,Middle Aged ,medicine.disease ,Death ,Treatment Outcome ,Ventricular assist device ,Heart failure ,beta-blocker ,Cardiology ,β-Blockers ,Female ,business ,Human ,Follow-Up Studies - Abstract
The usefulness of β-blockers in heart failure (HF) patients with permanent atrial fibrillation (AF) has been questioned. Background: The usefulness of β-blockers in heart failure (HF) patients with permanent atrial fibrillation (AF) has been questioned. Methods and results: We analyzed data from HF patients (958 patients (801 males, 84%, age 67 ± 11 years)) with AF enrolled in the MECKI score database. We evaluated prognosis (composite of cardiovascular death, urgent heart transplant, or left ventricular assist device) of patients receiving β-blockers (n = 777, 81%) vs. those not treated with β-blockers (n = 181, 19%). We also analyzed the role β1-selectivity and the role of daily β-blocker dose. To account for different HF severity, Kaplan-Meier survival curves were normalized for relevant confounding factors and for treatment strategies. Dose was available in 629 patients. Median follow-up was 1312 (577–2304) days in the entire population, 1203 (614–2420) and 1325 (569–2300) days in patients not receiving and receiving β-blockers. 224 (23%, 54/1000 events/year), 163 (21%, 79/1000 events/year), and 61 (34%, 49/1000 events/year) events were recorded, respectively. At 10-year patients treated with β-blockers had a better outcome (HR 0.447, p < 0.01) with no effects as regards β1selective drugs (53%) vs. β1-β2 blockers (47%). Survival improved in parallel with β-blocker dose increase (HR 0.296, 0.496, 0.490 for the high, medium, and low dose vs. no β-blockers, p < 0.0001). Conclusion: HF patients with AF taking a β-blocker have a better outcome (with a survival improvement in parallel with daily dose but no differences as regards β1 selectivity) but this does not mean that β-blockers improve outcomes in these patients as we cannot control for all the potential confounders associated with β-blocker use.
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- 2018
25. Prognostic role of atrial fibrillation in patients affected by chronic heart failure. Data from the MECKI score research group.
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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, Iorio, Annamaria, Emdin, Michele, Raimondo, Rosa, Re, Federica, Cicoira, Mariantonietta, Belardinelli, Romualdo, and Guazzi, Marco
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ATRIAL fibrillation , *HEART failure , *DISEASE complications , *HEART transplantation , *CELL death , *DATA analysis , *PROGNOSIS - 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. [ABSTRACT FROM AUTHOR]
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- 2015
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26. Metabolic exercise test data combined with cardiac and kidney indexes, the MECKI score: A multiparametric approach to heart failure prognosis.
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Agostoni, Piergiuseppe, Corrà, Ugo, Cattadori, Gaia, Veglia, Fabrizio, La Gioia, Rocco, Scardovi, Angela B., Emdin, Michele, Metra, Marco, Sinagra, Gianfranco, Limongelli, Giuseppe, Raimondo, Rossella, Re, Federica, Guazzi, Marco, Belardinelli, Romualdo, Parati, Gianfranco, Magrì, Damiano, Fiorentini, Cesare, Mezzani, Alessandro, Salvioni, Elisabetta, and Scrutinio, Domenico
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- *
HEART failure , *CARDIOPULMONARY system , *DISEASES , *STRESS echocardiography , *HEART failure treatment , *DECISION making in clinical medicine , *COHORT analysis , *HEART transplantation , *PROGNOSIS - Abstract
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/VCO2 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. [Copyright &y& Elsevier]
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- 2013
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27. Short-Term Change in Distance Walked in 6 Min Is an Indicator of Outcome in Patients With Chronic Heart Failure in Clinical Practice
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Passantino, Andrea, Lagioia, Rocco, Mastropasqua, Filippo, and Scrutinio, Domenico
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PROGNOSIS , *EXERCISE tests , *MEDICAL function tests , *HEART failure treatment , *HEALTH outcome assessment , *CLINICAL trials - Abstract
Objectives: The purpose of this study was to investigate the prognostic value of change in distance walked in 6 min in chronic heart failure (CHF). Background: The strongest indication for the 6-min walking test (6MWT) is for measuring the response to therapeutic interventions in patients with CHF. Whether the increase in distance walked after a therapeutic intervention translates into improved clinical outcome is largely unknwon. Methods: We studied 476 CHF patients with left ventricular systolic dysfunction who were referred to our institution for adjustment of heart failure therapy because of persisting or worsening symptoms. Adjustment of therapy involved four classes of drugs: angiotensin-converting enzyme inhibitors or angiotensin II receptor blockers, beta-blockers, loop diuretics, and aldosterone antagonists. A standardized 6MWT was performed at baseline and at discharge. Results: After 15.2 ± 8 days, the distance walked increased from 326 ± 107 m to 408 ± 109 m (+25%; p = 0.001). During a mean follow-up of 23.9 months, 94 patients died and 12 patients underwent cardiac transplantation. Among a set of variables, New York Heart Association functional class (p = 0.02), serum creatinine concentration (p = 0.01), left ventricular ejection fraction (p = 0.002), distance walked at baseline (p = 0.0002), and change in distance walked (p = 0.002) were significant independent predictors of survival. When the patients were divided into two subgroups according to the median value of the distance walked at baseline, the increase in walking distance was significantly associated with survival only in the subgroup of patients who walked <340 m at baseline. Conclusions: Our data indicate that repeating a 6MWT after drug intervention provides independent prognostic information in CHF patients with more compromised exercise capacity. [Copyright &y& Elsevier]
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- 2006
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28. Heart failure prognosis over time: how the prognostic role of oxygen consumption and ventilatory efficiency during exercise has changed in the last 20 years
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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.
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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.
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- 2019
29. Heart failure and anemia: Effects on prognostic variables
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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
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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
30. 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
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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
31. Prognostic role of atrial fibrillation in patients affected by chronic heart failure. Data from the MECKI score research group
- Author
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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
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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
32. Deceptive meaning of oxygen uptake measured at the anaerobic threshold in patients with systolic heart failure and atrial fibrillation
- Author
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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
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