V<sub>o2peak</sub>, Ve/V<sub>CO2</sub>, and Cardiac Remodeling Correlate with Long-Term Cardiovascular Outcome in Heart Failure Patients
Accurate prognostic stratification in patients with chronic heart failure and reduced ejection fraction (HFrEF) remains a significant clinical challenge. Many different parameters, including left ventricular (LV) and right ventricular (RV) function and cardiopulmonary exercise testing (CPET) paramet...
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2025-05-01
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| author | Antonio Pagliaro Luna Cavigli Roberta Molle Elisabetta Iardino Francesca Anselmi Francesca Righini Luca Martini Valerio Zacà Giulia Elena Mandoli Maria Concetta Pastore Marta Focardi Matteo Cameli Sonia Bernazzali Massimo Maccherini Marco Chiostri Flavio D’Ascenzi Serafina Valente |
| author_facet | Antonio Pagliaro Luna Cavigli Roberta Molle Elisabetta Iardino Francesca Anselmi Francesca Righini Luca Martini Valerio Zacà Giulia Elena Mandoli Maria Concetta Pastore Marta Focardi Matteo Cameli Sonia Bernazzali Massimo Maccherini Marco Chiostri Flavio D’Ascenzi Serafina Valente |
| author_sort | Antonio Pagliaro |
| collection | DOAJ |
| description | Accurate prognostic stratification in patients with chronic heart failure and reduced ejection fraction (HFrEF) remains a significant clinical challenge. Many different parameters, including left ventricular (LV) and right ventricular (RV) function and cardiopulmonary exercise testing (CPET) parameters, are available in the literature. LV ejection fraction (LVEF) is the most used parameter in clinical practice. This study aimed to analyze CPET and echocardiographic data in patients under evaluation for heart transplantation (HTx) to identify the parameter that best correlates with cardiac events. Methods and Results. Echocardiography and CPET were performed in patients with HFrEF under evaluation for HTx. The population comprised 170 patients (mean age: 55 ± 9 years; 88% male; non-ischemic etiology: 63%). LVEF was 30.4 ± 7.6%, peak oxygen uptake (Vo<sub>2peak</sub>) was 17.08 ± 4.6 mL/Kg/min; minute ventilation (VE)/carbon dioxide production (Vco<sub>2</sub>) slope was 34.8 ± 8.7. During a follow-up of 4 ± 1 years, 37 hospitalizations, 4 deaths, 14 HTx, and 5 LV assist device implantation occurred. Patients who experienced major events had a lower Vo<sub>2peak</sub> (<i>p</i> < 0.005), higher VE/Vco<sub>2</sub> slope (<i>p</i> < 0.005), greater LV end-systolic diameter (<i>p</i> < 0.005), and RV end-diastolic diameter (<i>p</i> < 0.005) than patients without events. Conversely, LVEF did not differ between these two groups. VE/Vco<sub>2</sub> slope and RV dimensions significantly correlated with hard cardiac events (<i>p</i> = 0.019 and <i>p</i> = 0.008, respectively). Conclusions. In patients with HFrEF, parameters quantifying the system reserve (i.e., Vo<sub>2peak</sub> and VE/Vco<sub>2</sub> slope) and those demonstrating advanced biventricular remodeling may help stratify the risk of cardiac events. Conversely, LVEF showed a limited prognostic value in this setting. |
| format | Article |
| id | doaj-art-ef47235e0846421686f177f673e97bf7 |
| institution | DOAJ |
| issn | 2308-3425 |
| language | English |
| publishDate | 2025-05-01 |
| publisher | MDPI AG |
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| series | Journal of Cardiovascular Development and Disease |
| spelling | doaj-art-ef47235e0846421686f177f673e97bf72025-08-20T03:14:35ZengMDPI AGJournal of Cardiovascular Development and Disease2308-34252025-05-0112517410.3390/jcdd12050174V<sub>o2peak</sub>, Ve/V<sub>CO2</sub>, and Cardiac Remodeling Correlate with Long-Term Cardiovascular Outcome in Heart Failure PatientsAntonio Pagliaro0Luna Cavigli1Roberta Molle2Elisabetta Iardino3Francesca Anselmi4Francesca Righini5Luca Martini6Valerio Zacà7Giulia Elena Mandoli8Maria Concetta Pastore9Marta Focardi10Matteo Cameli11Sonia Bernazzali12Massimo Maccherini13Marco Chiostri14Flavio D’Ascenzi15Serafina Valente16Division of Cardiology, Department of Medical Biotechnologies, University of Siena, 53100 Siena, ItalyDivision of Cardiology, Department of Medical Biotechnologies, University of Siena, 53100 Siena, ItalyDivision of Cardiology, Department of Medical Biotechnologies, University of Siena, 53100 Siena, ItalyDivision of Cardiology, Department of Medical Biotechnologies, University of Siena, 53100 Siena, ItalyDivision of Cardiology, Department of Medical Biotechnologies, University of Siena, 53100 Siena, ItalyDivision of Cardiology, Department of Medical Biotechnologies, University of Siena, 53100 Siena, ItalyDivision of Cardiology, Department of Medical Biotechnologies, University of Siena, 53100 Siena, ItalyDivision of Cardiology, Department of Medical Biotechnologies, University of Siena, 53100 Siena, ItalyDivision of Cardiology, Department of Medical Biotechnologies, University of Siena, 53100 Siena, ItalyDivision of Cardiology, Department of Medical Biotechnologies, University of Siena, 53100 Siena, ItalyDivision of Cardiology, Department of Medical Biotechnologies, University of Siena, 53100 Siena, ItalyDivision of Cardiology, Department of Medical Biotechnologies, University of Siena, 53100 Siena, ItalyDepartment of Cardiac Surgery, University of Siena, 53100 Siena, ItalyDepartment of Cardiac Surgery, University of Siena, 53100 Siena, ItalySOD Fisiopatologia Respiratoria, Dipartimento delle Specialistiche Mediche, Az. USL Toscana Centro, 50137 Firenze, ItalyDivision of Cardiology, Department of Medical Biotechnologies, University of Siena, 53100 Siena, ItalyDivision of Cardiology, Department of Medical Biotechnologies, University of Siena, 53100 Siena, ItalyAccurate prognostic stratification in patients with chronic heart failure and reduced ejection fraction (HFrEF) remains a significant clinical challenge. Many different parameters, including left ventricular (LV) and right ventricular (RV) function and cardiopulmonary exercise testing (CPET) parameters, are available in the literature. LV ejection fraction (LVEF) is the most used parameter in clinical practice. This study aimed to analyze CPET and echocardiographic data in patients under evaluation for heart transplantation (HTx) to identify the parameter that best correlates with cardiac events. Methods and Results. Echocardiography and CPET were performed in patients with HFrEF under evaluation for HTx. The population comprised 170 patients (mean age: 55 ± 9 years; 88% male; non-ischemic etiology: 63%). LVEF was 30.4 ± 7.6%, peak oxygen uptake (Vo<sub>2peak</sub>) was 17.08 ± 4.6 mL/Kg/min; minute ventilation (VE)/carbon dioxide production (Vco<sub>2</sub>) slope was 34.8 ± 8.7. During a follow-up of 4 ± 1 years, 37 hospitalizations, 4 deaths, 14 HTx, and 5 LV assist device implantation occurred. Patients who experienced major events had a lower Vo<sub>2peak</sub> (<i>p</i> < 0.005), higher VE/Vco<sub>2</sub> slope (<i>p</i> < 0.005), greater LV end-systolic diameter (<i>p</i> < 0.005), and RV end-diastolic diameter (<i>p</i> < 0.005) than patients without events. Conversely, LVEF did not differ between these two groups. VE/Vco<sub>2</sub> slope and RV dimensions significantly correlated with hard cardiac events (<i>p</i> = 0.019 and <i>p</i> = 0.008, respectively). Conclusions. In patients with HFrEF, parameters quantifying the system reserve (i.e., Vo<sub>2peak</sub> and VE/Vco<sub>2</sub> slope) and those demonstrating advanced biventricular remodeling may help stratify the risk of cardiac events. Conversely, LVEF showed a limited prognostic value in this setting.https://www.mdpi.com/2308-3425/12/5/174heart failureleft ventricular ejection fractioncardiopulmonary exercise testingheart transplantationprognostic stratificationcardiac remodeling |
| spellingShingle | Antonio Pagliaro Luna Cavigli Roberta Molle Elisabetta Iardino Francesca Anselmi Francesca Righini Luca Martini Valerio Zacà Giulia Elena Mandoli Maria Concetta Pastore Marta Focardi Matteo Cameli Sonia Bernazzali Massimo Maccherini Marco Chiostri Flavio D’Ascenzi Serafina Valente V<sub>o2peak</sub>, Ve/V<sub>CO2</sub>, and Cardiac Remodeling Correlate with Long-Term Cardiovascular Outcome in Heart Failure Patients Journal of Cardiovascular Development and Disease heart failure left ventricular ejection fraction cardiopulmonary exercise testing heart transplantation prognostic stratification cardiac remodeling |
| title | V<sub>o2peak</sub>, Ve/V<sub>CO2</sub>, and Cardiac Remodeling Correlate with Long-Term Cardiovascular Outcome in Heart Failure Patients |
| title_full | V<sub>o2peak</sub>, Ve/V<sub>CO2</sub>, and Cardiac Remodeling Correlate with Long-Term Cardiovascular Outcome in Heart Failure Patients |
| title_fullStr | V<sub>o2peak</sub>, Ve/V<sub>CO2</sub>, and Cardiac Remodeling Correlate with Long-Term Cardiovascular Outcome in Heart Failure Patients |
| title_full_unstemmed | V<sub>o2peak</sub>, Ve/V<sub>CO2</sub>, and Cardiac Remodeling Correlate with Long-Term Cardiovascular Outcome in Heart Failure Patients |
| title_short | V<sub>o2peak</sub>, Ve/V<sub>CO2</sub>, and Cardiac Remodeling Correlate with Long-Term Cardiovascular Outcome in Heart Failure Patients |
| title_sort | v sub o2peak sub ve v sub co2 sub and cardiac remodeling correlate with long term cardiovascular outcome in heart failure patients |
| topic | heart failure left ventricular ejection fraction cardiopulmonary exercise testing heart transplantation prognostic stratification cardiac remodeling |
| url | https://www.mdpi.com/2308-3425/12/5/174 |
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