☆ 4.6 Article

Prognostic Value of Indeterminable Anaerobic Threshold in Heart Failure

CIRCULATION-HEART FAILURE (2013)

期刊

CIRCULATION-HEART FAILURE

卷 6, 期 5, 页码 977-987

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LIPPINCOTT WILLIAMS & WILKINS

DOI: 10.1161/CIRCHEARTFAILURE.113.000471

关键词

exercise; follow-up studies; heart failure; oxygen; prognosis

类别

Cardiac & Cardiovascular Systems

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Background In patients with heart failure (HF), during maximal cardiopulmonary exercise test, anaerobic threshold (AT) is not always identified. We evaluated whether this finding has a prognostic meaning. Methods and Results We recruited and prospectively followed up, in 14 dedicated HF units, 3058 patients with systolic (left ventricular ejection fraction <40%) HF in stable clinical conditions, New York Heart Association class I to III, who underwent clinical, laboratory, echocardiographic, and cardiopulmonary exercise test investigations at study enrollment. We excluded 921 patients who did not perform a maximal exercise, based on lack of achievement of anaerobic metabolism (peak respiratory quotient 1.05). Primary study end point was a composite of cardiovascular death and urgent cardiac transplant, and secondary end point was all-cause death. Median follow-up was 3.01 (1.39-4.98) years. AT was identified in 1935 out of 2137 patients (90.54%). At multivariable logistic analysis, failure in detecting AT resulted significantly in reduced peak oxygen uptake and higher metabolic exercise and cardiac and kidney index score value, a powerful prognostic composite HF index (P<0.001). At multivariable analysis, the following variables were significantly associated with primary study end point: peak oxygen uptake (% pred; P<0.001; hazard ratio [HR]=0.977; confidence interval [CI]=0.97-0.98), ventilatory efficiency slope (P=0.01; HR=1.02; CI=1.01-1.03), hemoglobin (P<0.05; HR=0.931; CI=0.87-1.00), left ventricular ejection fraction (P<0.001; HR=0.948; CI=0.94-0.96), renal function (modification of diet in renal disease; P<0.001; HR=0.990; CI=0.98-0.99), sodium (P<0.05; HR=0.967; CI=0.94-0.99), and AT nonidentification (P<0.05; HR=1.41; CI=1.06-1.89). Nonidentification of AT remained associated to prognosis also when compared with metabolic exercise and cardiac and kidney index score (P<0.01; HR=1.459; CI=1.09-1.10). Similar results were obtained for the secondary study end point. Conclusions The inability to identify AT most often occurs in patients with severe HF, and it has an independent prognostic role in HF.

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Prognostic Value of Plasma Catestatin Concentration in Patients with Heart Failure with Reduced Ejection Fraction in Two-Year Follow-Up

Lukasz Wolowiec, Joanna Banach, Jacek Budzynski, Anna Wolowiec, Mariusz Kozakiewicz, Maciej Bielinski, Albert Jasniak, Agata Olejarczyk, Grzegorz Grzesk

Summary: The study aimed to assess the prognostic value of plasma catestatin concentration in patients with heart failure with reduced ejection fraction (HFrEF) in predicting unplanned hospitalization and all-cause death at a 2-year follow-up. The study included 122 hospitalized Caucasian patients in NYHA classes II to IV. Patients who died during the follow-up period had higher levels of CST, NT-proBNP, troponin T, creatinine, and glucose, and lower TAPSE, hemoglobin concentration, hematocrit, and platelet count compared to survivors. Plasma catestatin concentration was positively associated with NYHA class and blood NT-proBNP concentration. Higher plasma catestatin concentration increased the risk of all-cause death by more than five times. Plasma CST concentration is a valuable prognostic parameter in predicting death from all causes and unplanned hospitalization in patients with HFrEF.

JOURNAL OF CLINICAL MEDICINE (2023)