Optimizing risk stratification in heart failure and the selection of candidates for heart transplantation
Autor(a) principal: | |
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Data de Publicação: | 2018 |
Outros Autores: | , , , , , , |
Tipo de documento: | Artigo |
Idioma: | eng |
Título da fonte: | Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) |
Texto Completo: | http://hdl.handle.net/10400.21/9130 |
Resumo: | Introduction and Aims: Selecting patients for heart transplantation is challenging. We aimed to identify the most important risk predictors in heart failure and an approach to optimize the selection of candidates for heart transplantation. Methods: Ambulatory patients followed in our center with symptomatic heart failure and left ventricular ejection fraction <= 40% prospectively underwent a comprehensive baseline assessment including clinical, laboratory, electrocardiographic, echocardiographic, and cardiopulmonary exercise testing parameters. All patients were followed for 60 months. The combined endpoint was cardiac death, urgent heart transplantation or need for mechanical circulatory support, up to 36 months. Results: In the 263 enrolled patients (75% male, age 54 +/- 12 years), 54 events occurred. The independent predictors of adverse outcome were ventilatory efficiency (VE/VCO2) slope (HR 1.14, 95% CI 1.11-1.18), creatinine level (HR 2.23, 95% CI 1.14-4.36), and left ventricular ejection fraction (HR 0.96, 95% CI 0.93-0.99). VE/VCO2 slope was the most accurate risk predictor at any follow-up time analyzed (up to 60 months). The threshold of 39.0 yielded high specificity (97%), discriminated a worse or better prognosis than that reported for post-heart transplantation, and outperformed peak oxygen consumption thresholds of 10.0 or 12.0 ml/kg/min. For low-risk patients (VE/VCO2 slope <39.0), sodium and creatinine levels and variations in end-tidal carbon dioxide partial pressure on exercise identified those with excellent prognosis. Conclusions: VE/VCO2 slope was the most accurate parameter for risk stratification in patients with heart failure and reduced ejection fraction. Those with VE/VCO2 slope >= 39.0 may benefit from heart transplantation. |
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Optimizing risk stratification in heart failure and the selection of candidates for heart transplantationAprimoramento da estratificação de risco na insuficiência cardíaca e da seleção de candidatos a transplantação cardíacaCardiopulmonary exercise testingHeart failureRisk stratificationEntilatory efficiency slopeProva de esforço cardiorespiratóriaInsuficiência cardíacaEstratificação de riscoDeclive da eficiência ventilatóriaIntroduction and Aims: Selecting patients for heart transplantation is challenging. We aimed to identify the most important risk predictors in heart failure and an approach to optimize the selection of candidates for heart transplantation. Methods: Ambulatory patients followed in our center with symptomatic heart failure and left ventricular ejection fraction <= 40% prospectively underwent a comprehensive baseline assessment including clinical, laboratory, electrocardiographic, echocardiographic, and cardiopulmonary exercise testing parameters. All patients were followed for 60 months. The combined endpoint was cardiac death, urgent heart transplantation or need for mechanical circulatory support, up to 36 months. Results: In the 263 enrolled patients (75% male, age 54 +/- 12 years), 54 events occurred. The independent predictors of adverse outcome were ventilatory efficiency (VE/VCO2) slope (HR 1.14, 95% CI 1.11-1.18), creatinine level (HR 2.23, 95% CI 1.14-4.36), and left ventricular ejection fraction (HR 0.96, 95% CI 0.93-0.99). VE/VCO2 slope was the most accurate risk predictor at any follow-up time analyzed (up to 60 months). The threshold of 39.0 yielded high specificity (97%), discriminated a worse or better prognosis than that reported for post-heart transplantation, and outperformed peak oxygen consumption thresholds of 10.0 or 12.0 ml/kg/min. For low-risk patients (VE/VCO2 slope <39.0), sodium and creatinine levels and variations in end-tidal carbon dioxide partial pressure on exercise identified those with excellent prognosis. Conclusions: VE/VCO2 slope was the most accurate parameter for risk stratification in patients with heart failure and reduced ejection fraction. Those with VE/VCO2 slope >= 39.0 may benefit from heart transplantation.Elsevier EspañaRCIPLPereira-da-Silva, TiagoSoares, Rui M.Papoila, Ana LuisaPinto, IolaFeliciano, JoanaMorais, Luís AlmeidaAbreu, AnaFerreira, Rui Cruz2018-12-05T10:38:12Z2018-022018-02-01T00:00:00Zinfo:eu-repo/semantics/publishedVersioninfo:eu-repo/semantics/articleapplication/pdfhttp://hdl.handle.net/10400.21/9130engSilva, Tiago Pereira da; [et al] – Optimizing risk stratification in heart failure and the selection of candidates for heart transplantation. Revista Portuguesa de Cardiologia. ISSN 0870-2551. Vol. 37, N.º 2 (2018), pp. 129-1370870-255110.1016/j.repc.2017.06.018metadata only accessinfo:eu-repo/semantics/openAccessreponame:Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos)instname:Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informaçãoinstacron:RCAAP2023-08-03T09:57:27Zoai:repositorio.ipl.pt:10400.21/9130Portal AgregadorONGhttps://www.rcaap.pt/oai/openaireopendoar:71602024-03-19T20:17:46.195192Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) - Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informaçãofalse |
dc.title.none.fl_str_mv |
Optimizing risk stratification in heart failure and the selection of candidates for heart transplantation Aprimoramento da estratificação de risco na insuficiência cardíaca e da seleção de candidatos a transplantação cardíaca |
title |
Optimizing risk stratification in heart failure and the selection of candidates for heart transplantation |
spellingShingle |
Optimizing risk stratification in heart failure and the selection of candidates for heart transplantation Pereira-da-Silva, Tiago Cardiopulmonary exercise testing Heart failure Risk stratification Entilatory efficiency slope Prova de esforço cardiorespiratória Insuficiência cardíaca Estratificação de risco Declive da eficiência ventilatória |
title_short |
Optimizing risk stratification in heart failure and the selection of candidates for heart transplantation |
title_full |
Optimizing risk stratification in heart failure and the selection of candidates for heart transplantation |
title_fullStr |
Optimizing risk stratification in heart failure and the selection of candidates for heart transplantation |
title_full_unstemmed |
Optimizing risk stratification in heart failure and the selection of candidates for heart transplantation |
title_sort |
Optimizing risk stratification in heart failure and the selection of candidates for heart transplantation |
author |
Pereira-da-Silva, Tiago |
author_facet |
Pereira-da-Silva, Tiago Soares, Rui M. Papoila, Ana Luisa Pinto, Iola Feliciano, Joana Morais, Luís Almeida Abreu, Ana Ferreira, Rui Cruz |
author_role |
author |
author2 |
Soares, Rui M. Papoila, Ana Luisa Pinto, Iola Feliciano, Joana Morais, Luís Almeida Abreu, Ana Ferreira, Rui Cruz |
author2_role |
author author author author author author author |
dc.contributor.none.fl_str_mv |
RCIPL |
dc.contributor.author.fl_str_mv |
Pereira-da-Silva, Tiago Soares, Rui M. Papoila, Ana Luisa Pinto, Iola Feliciano, Joana Morais, Luís Almeida Abreu, Ana Ferreira, Rui Cruz |
dc.subject.por.fl_str_mv |
Cardiopulmonary exercise testing Heart failure Risk stratification Entilatory efficiency slope Prova de esforço cardiorespiratória Insuficiência cardíaca Estratificação de risco Declive da eficiência ventilatória |
topic |
Cardiopulmonary exercise testing Heart failure Risk stratification Entilatory efficiency slope Prova de esforço cardiorespiratória Insuficiência cardíaca Estratificação de risco Declive da eficiência ventilatória |
description |
Introduction and Aims: Selecting patients for heart transplantation is challenging. We aimed to identify the most important risk predictors in heart failure and an approach to optimize the selection of candidates for heart transplantation. Methods: Ambulatory patients followed in our center with symptomatic heart failure and left ventricular ejection fraction <= 40% prospectively underwent a comprehensive baseline assessment including clinical, laboratory, electrocardiographic, echocardiographic, and cardiopulmonary exercise testing parameters. All patients were followed for 60 months. The combined endpoint was cardiac death, urgent heart transplantation or need for mechanical circulatory support, up to 36 months. Results: In the 263 enrolled patients (75% male, age 54 +/- 12 years), 54 events occurred. The independent predictors of adverse outcome were ventilatory efficiency (VE/VCO2) slope (HR 1.14, 95% CI 1.11-1.18), creatinine level (HR 2.23, 95% CI 1.14-4.36), and left ventricular ejection fraction (HR 0.96, 95% CI 0.93-0.99). VE/VCO2 slope was the most accurate risk predictor at any follow-up time analyzed (up to 60 months). The threshold of 39.0 yielded high specificity (97%), discriminated a worse or better prognosis than that reported for post-heart transplantation, and outperformed peak oxygen consumption thresholds of 10.0 or 12.0 ml/kg/min. For low-risk patients (VE/VCO2 slope <39.0), sodium and creatinine levels and variations in end-tidal carbon dioxide partial pressure on exercise identified those with excellent prognosis. Conclusions: VE/VCO2 slope was the most accurate parameter for risk stratification in patients with heart failure and reduced ejection fraction. Those with VE/VCO2 slope >= 39.0 may benefit from heart transplantation. |
publishDate |
2018 |
dc.date.none.fl_str_mv |
2018-12-05T10:38:12Z 2018-02 2018-02-01T00:00:00Z |
dc.type.status.fl_str_mv |
info:eu-repo/semantics/publishedVersion |
dc.type.driver.fl_str_mv |
info:eu-repo/semantics/article |
format |
article |
status_str |
publishedVersion |
dc.identifier.uri.fl_str_mv |
http://hdl.handle.net/10400.21/9130 |
url |
http://hdl.handle.net/10400.21/9130 |
dc.language.iso.fl_str_mv |
eng |
language |
eng |
dc.relation.none.fl_str_mv |
Silva, Tiago Pereira da; [et al] – Optimizing risk stratification in heart failure and the selection of candidates for heart transplantation. Revista Portuguesa de Cardiologia. ISSN 0870-2551. Vol. 37, N.º 2 (2018), pp. 129-137 0870-2551 10.1016/j.repc.2017.06.018 |
dc.rights.driver.fl_str_mv |
metadata only access info:eu-repo/semantics/openAccess |
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metadata only access |
eu_rights_str_mv |
openAccess |
dc.format.none.fl_str_mv |
application/pdf |
dc.publisher.none.fl_str_mv |
Elsevier España |
publisher.none.fl_str_mv |
Elsevier España |
dc.source.none.fl_str_mv |
reponame:Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) instname:Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informação instacron:RCAAP |
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Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informação |
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Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) |
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Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) |
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Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) - Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informação |
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