Optimizing risk stratification in heart failure and the selection of candidates for heart transplantation
| Autor(a) principal: | |
|---|---|
| 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/10362/148199 |
Resumo: | Copyright © 2018 Sociedade Portuguesa de Cardiologia. Publicado por Elsevier España, S.L.U. All rights reserved. |
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Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) |
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Optimizing risk stratification in heart failure and the selection of candidates for heart transplantationCardiopulmonary exercise testingConsumo de oxigénio de picoDeclive da eficiência ventilatóriaEstratificação de riscoHeart failureHeart transplantationInsuficiência cardíacaPeak oxygen consumptionProva de esforço cardiorrespiratóriaRisk stratificationTransplantação cardíacaVentilatory efficiency slopeCopyright © 2018 Sociedade Portuguesa de Cardiologia. Publicado por Elsevier España, S.L.U. All rights reserved.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/VCO2slope 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/VCO2slope <39.0), sodium and creatinine levels and variations in end-tidal carbon dioxide partial pressure on exercise identified those with excellent prognosis. CONCLUSIONS: VE/VCO2slope was the most accurate parameter for risk stratification in patients with heart failure and reduced ejection fraction. Those with VE/VCO2slope ≥39.0 may benefit from heart transplantation.NOVA Medical School|Faculdade de Ciências Médicas (NMS|FCM)RUNPereira-da-Silva, TiagoM Soares, RuiPapoila, Ana LuísaPinto, IolaFeliciano, JoanaAlmeida-Morais, LuísAbreu, AnaCruz Ferreira, Rui2023-01-26T22:09:50Z2018-022018-02-01T00:00:00Zinfo:eu-repo/semantics/publishedVersioninfo:eu-repo/semantics/article9application/pdfhttp://hdl.handle.net/10362/148199eng0870-2551PURE: 3734201https://doi.org/10.1016/j.repc.2017.06.018info: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:RCAAP2024-03-11T05:29:36Zoai:run.unl.pt:10362/148199Portal AgregadorONGhttps://www.rcaap.pt/oai/openaireopendoar:71602024-03-20T03:53:16.472169Repositório 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 |
| 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 Consumo de oxigénio de pico Declive da eficiência ventilatória Estratificação de risco Heart failure Heart transplantation Insuficiência cardíaca Peak oxygen consumption Prova de esforço cardiorrespiratória Risk stratification Transplantação cardíaca Ventilatory efficiency slope |
| 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 M Soares, Rui Papoila, Ana Luísa Pinto, Iola Feliciano, Joana Almeida-Morais, Luís Abreu, Ana Cruz Ferreira, Rui |
| author_role |
author |
| author2 |
M Soares, Rui Papoila, Ana Luísa Pinto, Iola Feliciano, Joana Almeida-Morais, Luís Abreu, Ana Cruz Ferreira, Rui |
| author2_role |
author author author author author author author |
| dc.contributor.none.fl_str_mv |
NOVA Medical School|Faculdade de Ciências Médicas (NMS|FCM) RUN |
| dc.contributor.author.fl_str_mv |
Pereira-da-Silva, Tiago M Soares, Rui Papoila, Ana Luísa Pinto, Iola Feliciano, Joana Almeida-Morais, Luís Abreu, Ana Cruz Ferreira, Rui |
| dc.subject.por.fl_str_mv |
Cardiopulmonary exercise testing Consumo de oxigénio de pico Declive da eficiência ventilatória Estratificação de risco Heart failure Heart transplantation Insuficiência cardíaca Peak oxygen consumption Prova de esforço cardiorrespiratória Risk stratification Transplantação cardíaca Ventilatory efficiency slope |
| topic |
Cardiopulmonary exercise testing Consumo de oxigénio de pico Declive da eficiência ventilatória Estratificação de risco Heart failure Heart transplantation Insuficiência cardíaca Peak oxygen consumption Prova de esforço cardiorrespiratória Risk stratification Transplantação cardíaca Ventilatory efficiency slope |
| description |
Copyright © 2018 Sociedade Portuguesa de Cardiologia. Publicado por Elsevier España, S.L.U. All rights reserved. |
| publishDate |
2018 |
| dc.date.none.fl_str_mv |
2018-02 2018-02-01T00:00:00Z 2023-01-26T22:09:50Z |
| dc.type.status.fl_str_mv |
info:eu-repo/semantics/publishedVersion |
| dc.type.driver.fl_str_mv |
info:eu-repo/semantics/article |
| format |
article |
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publishedVersion |
| dc.identifier.uri.fl_str_mv |
http://hdl.handle.net/10362/148199 |
| url |
http://hdl.handle.net/10362/148199 |
| dc.language.iso.fl_str_mv |
eng |
| language |
eng |
| dc.relation.none.fl_str_mv |
0870-2551 PURE: 3734201 https://doi.org/10.1016/j.repc.2017.06.018 |
| dc.rights.driver.fl_str_mv |
info:eu-repo/semantics/openAccess |
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openAccess |
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9 application/pdf |
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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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RCAAP |
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RCAAP |
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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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