Raw data of the manuscript "Gender and age normalization and ventilation efficiency during exercise in heart failure with reduced ejection fraction." Aims: Ventilation vs. carbon dioxide production (VE/VCO₂ ) is among the strongest cardiopulmonary exercise testing prognostic parameters in heart failure (HF). It is usually reported as an absolute value. The current definition of normal VE/VCO₂ slope values is inadequate, since it was built from small groups of subjects with a particularly limited number of women and elderly. We aimed to define VE/VCO₂ slope prediction formulas in a sizable population and to test whether the prognostic power of VE/VCO₂ slope in HF was different if expressed as a percentage of the predicted value or as an absolute value. Methods and results: We calculated the linear regressions between age and VE/VCO₂ slope in 1136 healthy subjects (68% male, age 44.9 ± 14.5, range 13-83 years). We then applied age-adjusted and sex-adjusted formulas to predict VE/VCO₂ slope to HF patients included in the metabolic exercise test data combined with cardiac and kidney indexes score database, which counts 6112 patients (82% male, age 61.4 ± 12.8, left ventricular ejection fraction 33.2 ± 10.5%, peakVO₂ 14.8 ± 4.9, mL/min/kg, VE/VCO₂ slope 32.7 ± 7.7) from 24 HF centres. Finally, we evaluated whether the use of absolute values vs. percentages of predicted VE/VCO₂ affected HF prognosis prediction (composite of cardiovascular mortality + urgent transplant or left ventricular assist device). We did so in the entire cardiac and kidney indexes score population and separately in HF patients with severe (peakVO₂ < 14 mL/min/kg, n = 2919, 61.1 events/1000 pts/year) or moderate (peakVO₂ ≥ 14 mL/min/kg, n = 3183, 19.9 events/1000 pts/year) HF. In the healthy population, we obtained the following equations: female, VE/VCO₂ = 0.052 × Age + 23.808 (r = 0.192); male, VE/VCO₂ = 0.095 × Age + 20.227 (r = 0.371) (P = 0.007). We applied these formulas to calculate the percentages of predicted VE/VCO₂ values. The 2-year survival prognostic power of VE/VCO₂ slope was strong, and it was similar if expressed as absolute value or as a percentage of predicted value (AUCs 0.686 and 0.690, respectively). In contrast, in severe HF patients, AUCs significantly differed between absolute values (0.637) and percentages of predicted values (0.650, P = 0.0026). Moreover, VE/VCO₂ slope expressed as a percentage of predicted value allowed to reclassify 6.6% of peakVO₂ < 14 mL/min/kg patients (net reclassification improvement = 0.066, P = 0.0015). Conclusions: The percentage of predicted VE/VCO₂ slope value strengthens the prognostic power of VE/VCO₂ in severe HF patients, and it should be preferred over the absolute value for HF prognostication. Furthermore, the widespread use of VE/VCO₂ slope expressed as percentage of predicted value can improve our ability to identify HF patients at high risk, which is a goal of utmost clinical relevance.

Normalization

Fraction (chemistry)

10.5281/zenodo.4322954

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Editor’s Presentation Benefit of healthy lifestyle on cardiovascular risk factor control: Focus on body weight, exercise and sleep quality

European Journal of Preventive Cardiology (2019)

Massimo Piepoli

Presentation (obstetrics)

Sleep

10.1177/2047487319861847

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Citations (2)

[The Italian SurveY on carDiac rEhabilitation 2008 (ISYDE 2008): study presentation].

PubMed (2008)

Roberto Tramarin Marco Ambrosetti Stefania De Feo Raffaele Griffo Franco Maslowsky

In this paper, the Italian Society of Cardiac Rehabilitation and Prevention (GICR) presents the third survey on the status of cardiac rehabilitation (CR) in Italy. The Italian SurveY on carDiac rEhabilitation 2008 (ISYDE 2008) is a multicenter, observational study aimed at identifying the number and characteristics of Italian CR facilities, both in terms of health operators and interventions. Clinical records of all patients consecutively discharged within the whole network--composed of up to 200 CR units--from January 28 to February 10, 2008 will also be reviewed for diagnosis of admission, comorbidities, rehabilitation programs, and drug therapy, in order to obtain a snapshot of current implementation strategies in daily clinical practice. The survey will adopt a web-based methodology for data provision and transmission. Preliminary results of the survey are expected in the late summer 2008.

Snapshot (computer storage)

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Deceptive meaning of oxygen uptake measured at the anaerobic threshold in patients with systolic heart failure and atrial fibrillation

European Journal of Preventive Cardiology (2014)

Damiano Magrì Piergiuseppe Agostoni Ugo Corrà Claudio Passino Domenico Scrutinio

Oxygen uptake at the anaerobic threshold (VO2AT), a submaximal exercise-derived variable, independent of patients' motivation, is a marker of outcome in heart failure (HF). However, previous evidence of VO2AT values paradoxically higher in HF patients with permanent atrial fibrillation (AF) than in those with sinus rhythm (SR) raised uncertainties. We tested the prognostic role of VO2AT in a large cohort of systolic HF patients, focusing on possible differences between SR and AF. 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). 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 (VO2) showed a prognostic capacity (C-index) similar to that obtained including VO2AT (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 VO2AT cut-off for the SR group was 11.7 ml/kg/min, while it was 12.8 ml/kg/min for the AF group. VO2AT, a submaximal CPET-derived parameter, is reliable for long-term cardiovascular mortality prognostication in stable systolic HF. However, different VO2AT cut-off values between SR and AF HF patients should be adopted.

Oxygen pulse

10.1177/2047487314551546

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Citations (36)

Cardiopulmonary exercise testing in systolic heart failure in 2014: the evolving prognostic role

European Journal of Heart Failure (2014)

Ugo Corrà Massimo Piepoli Stamatis Adamopoulos Piergiuseppe Agostoni Andrew J.S. Coats

Economic shortage

Cardiopulmonary exercise test

Risk Stratification

10.1002/ejhf.156

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Citations (91)

European Journal of Preventive Cardiology

European Heart Journal (2019)

Paolo Emilio Adami Silvia Castelletti Massimo Piepoli

10.1093/eurheartj/ehz546

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Citations (78)

[Class-1C drugs for oral loading in the cardioversion of paroxysmal atrial fibrillation].

PubMed (1998)

Alessandro Capucci A Rosi Villani Gq Daniela Aschieri Massimo Piepoli

Paroxysmal atrial fibrillation

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ESC Congress 2004: highlight on exercise and cardiac rehabilitation

Monaldi Archives for Chest Disease (2004)

Massimo Piepoli

10.4081/monaldi.2004.668

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Cardiac Pacing in Unilateral Left Superior Vena Cava: Evaluation by Digital Angiography

Pacing and Clinical Electrophysiology (1991)

Giovanni Villani Massimo Piepoli Pietro Quaretti G Dieci

In a patient with complete heart block and chronic lymphocytic leukemia a pacemaker lead could not be introduced from either the right or left subclavian vein. Digital subtraction angiography excluded a neoplastic inediustinal mass, demonstrated a unilateral left superior vena cava and defined the best route for lead insertion.

Digital subtraction angiography

Subclavian vein

Mediastinal mass

10.1111/j.1540-8159.1991.tb02728.x

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Citations (7)