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Gentili F, Calcagni G, Cantarutti N, Manno EC, Cafiero G, Tranchita E, Salvati A, Palma P, Giordano U, Drago F, Turchetta A. Cardiopulmonary Exercise Testing in Children and Young Adolescents after a Multisystem Inflammatory Syndrome: Physical Deconditioning or Residual Pathology? J Clin Med 2023; 12:jcm12062375. [PMID: 36983374 PMCID: PMC10057515 DOI: 10.3390/jcm12062375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Revised: 03/02/2023] [Accepted: 03/15/2023] [Indexed: 03/30/2023] Open
Abstract
Multisystem inflammatory syndrome in children (MIS-C) is a serious health condition that imposes a long-term follow-up. The purpose of our pilot study is to evaluate the usefulness of the cardiopulmonary stress test (CPET) in the follow-up after MIS-C. All patients admitted for MIS-C in our hospital in the 12 months preceding the date of observation were considered for inclusion in the study. Pre-existing cardio-respiratory diseases and/or the lack of collaboration were the exclusion criteria. At enrolment, each subject passed a cardiological examination, rest ECG, echocardiogram, 24 h Holter-ECG, blood tests, and a CPET complete of spirometry. A total of 20 patients met the inclusion criteria (11.76 ± 3.29 years, 13 male). In contrast to the normality of all second-level investigations, CPET showed lower-than-expected peakVO2 and peak-oxygen-pulse values (50% of cases) and higher-than-expected VE/VCO2-slope values (95% of cases). A statistically significant inverse correlation was observed between P-reactive-protein values at admission and peakVO2/kg values (p = 0.034), uric acid values at admission, and peakVO2 (p = 0.011) or peak-oxygen-pulse expressed as a percentage of predicted (p = 0.021), NT-proBNP values at admission and peakVO2 expressed as a percentage of predicted (p = 0.046). After MIS-C (4-12 months) relevant anomalies can be observed at CPET, which can be a valuable tool in the follow-up after this condition.
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Affiliation(s)
- Federica Gentili
- Complex Unit of Cardiology S. Paolo, Palidoro, Santa Marinella and Arrhythmology, Clinical Area of Fetal, Neonatal and Cardiological Sciences, Bambino Gesù Children's Hospital, IRCCS, L.go S. Onofrio 4, 00165 Rome, Italy
| | - Giulio Calcagni
- Complex Unit of Cardiology S. Paolo, Palidoro, Santa Marinella and Arrhythmology, Clinical Area of Fetal, Neonatal and Cardiological Sciences, Bambino Gesù Children's Hospital, IRCCS, L.go S. Onofrio 4, 00165 Rome, Italy
| | - Nicoletta Cantarutti
- Complex Unit of Cardiology S. Paolo, Palidoro, Santa Marinella and Arrhythmology, Clinical Area of Fetal, Neonatal and Cardiological Sciences, Bambino Gesù Children's Hospital, IRCCS, L.go S. Onofrio 4, 00165 Rome, Italy
| | - Emma Concetta Manno
- Complex Unit of Clinical Immunology and Vaccinology, Clinical Area of University Hospital Pediatrics, Bambino Gesù Children's Hospital, IRCCS, L.go S. Onofrio 4, 00165 Rome, Italy
| | - Giulia Cafiero
- Complex Unit of Cardiology S. Paolo, Palidoro, Santa Marinella and Arrhythmology, Clinical Area of Fetal, Neonatal and Cardiological Sciences, Bambino Gesù Children's Hospital, IRCCS, L.go S. Onofrio 4, 00165 Rome, Italy
| | - Eliana Tranchita
- Complex Unit of Cardiology S. Paolo, Palidoro, Santa Marinella and Arrhythmology, Clinical Area of Fetal, Neonatal and Cardiological Sciences, Bambino Gesù Children's Hospital, IRCCS, L.go S. Onofrio 4, 00165 Rome, Italy
| | - Annamaria Salvati
- Complex Unit of Cardiology S. Paolo, Palidoro, Santa Marinella and Arrhythmology, Clinical Area of Fetal, Neonatal and Cardiological Sciences, Bambino Gesù Children's Hospital, IRCCS, L.go S. Onofrio 4, 00165 Rome, Italy
| | - Paolo Palma
- Complex Unit of Clinical Immunology and Vaccinology, Clinical Area of University Hospital Pediatrics, Bambino Gesù Children's Hospital, IRCCS, L.go S. Onofrio 4, 00165 Rome, Italy
| | - Ugo Giordano
- Complex Unit of Cardiology S. Paolo, Palidoro, Santa Marinella and Arrhythmology, Clinical Area of Fetal, Neonatal and Cardiological Sciences, Bambino Gesù Children's Hospital, IRCCS, L.go S. Onofrio 4, 00165 Rome, Italy
| | - Fabrizio Drago
- Complex Unit of Cardiology S. Paolo, Palidoro, Santa Marinella and Arrhythmology, Clinical Area of Fetal, Neonatal and Cardiological Sciences, Bambino Gesù Children's Hospital, IRCCS, L.go S. Onofrio 4, 00165 Rome, Italy
| | - Attilio Turchetta
- Complex Unit of Cardiology S. Paolo, Palidoro, Santa Marinella and Arrhythmology, Clinical Area of Fetal, Neonatal and Cardiological Sciences, Bambino Gesù Children's Hospital, IRCCS, L.go S. Onofrio 4, 00165 Rome, Italy
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Gallo G, Mastromarino V, Limongelli G, Calcagni G, Maruotti A, Ragni L, Valente F, Musumeci MB, Adorisio R, Rubino M, Autore C, Magrì D. Insights from Cardiopulmonary Exercise Testing in Pediatric Patients with Hypertrophic Cardiomyopathy. Biomolecules 2021; 11:biom11030376. [PMID: 33801562 PMCID: PMC7999553 DOI: 10.3390/biom11030376] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Revised: 02/22/2021] [Accepted: 02/24/2021] [Indexed: 11/25/2022] Open
Abstract
The usefulness of cardiopulmonary exercise test (CPET) in adult hypertrophic cardiomyopathy (HCM) patients is well-known, whereas its role in pediatric HCM patients has not yet been explored. The present study investigates possible insights from a CPET assessment in a cohort of pediatric HCM outpatients in terms of functional and prognostic assessment. Sixty consecutive pediatric HCM outpatients aged <18 years old were enrolled, each of them undergoing a full clinical assessment including a CPET; a group of 60 healthy subjects served as controls. A unique composite end-point of heart failure (HF) related and sudden cardiac death (SCD) or SCD-equivalent events was also explored. During a median follow-up of 53 months (25th–75th: 13–84 months), a total of 13 HF- and 7 SCD-related first events were collected. Compared to controls, HCM patients showed an impaired functional capacity with most of them showing peak oxygen uptake (pVO2) values of <80% of the predicted, clearly discrepant with functional New York Heart Association class assessment. The composite end-point occurred more frequently in patients with the worst CPETs’ profiles. At the univariate analysis, pVO2% was the variable with the strongest association with adverse events at follow-up (C-index = 0.72, p = 0.025) and a cut-off value equal to 60% was the most accurate in identifying those patients at the highest risk. In a pediatric HCM subset, the CPET assessment allows a true functional capacity estimation and it might be helpful in identifying early those patients at high risk of events.
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Affiliation(s)
- Giovanna Gallo
- Department of Clinical and Molecular Medicine, Sapienza University, 00189 Rome, Italy; (G.G.); (M.B.M.); (C.A.)
| | - Vittoria Mastromarino
- Paediatric Cardiology and ACHD Unit, S. Orsola, Malpighi Hospital, 40138 Bologna, Italy; (V.M.); (L.R.)
| | - Giuseppe Limongelli
- Cardiologia SUN, Monaldi Hospital, II University of Naples, 80100 Naples, Italy; (G.L.); (F.V.); (M.R.)
| | - Giulio Calcagni
- Department of Pediatric Cardiology and Cardiac Surgery, Bambino Gesù Children’s Hospital, IRCCS, 00050 Rome, Italy; (G.C.); (R.A.)
| | - Antonello Maruotti
- Department of Scienze Economiche, Politiche e delle Lingue Moderne, Libera Università SS Maria Assunta, 00193 Rome, Italy;
- Department of Mathematics, University of Bergen, 5052 Bergen, Norway
- School of Computing, University of Portsmouth, Portsmouth PO2 8QD, UK
| | - Luca Ragni
- Paediatric Cardiology and ACHD Unit, S. Orsola, Malpighi Hospital, 40138 Bologna, Italy; (V.M.); (L.R.)
| | - Fabio Valente
- Cardiologia SUN, Monaldi Hospital, II University of Naples, 80100 Naples, Italy; (G.L.); (F.V.); (M.R.)
| | - Maria Beatrice Musumeci
- Department of Clinical and Molecular Medicine, Sapienza University, 00189 Rome, Italy; (G.G.); (M.B.M.); (C.A.)
| | - Rachele Adorisio
- Department of Pediatric Cardiology and Cardiac Surgery, Bambino Gesù Children’s Hospital, IRCCS, 00050 Rome, Italy; (G.C.); (R.A.)
| | - Marta Rubino
- Cardiologia SUN, Monaldi Hospital, II University of Naples, 80100 Naples, Italy; (G.L.); (F.V.); (M.R.)
| | - Camillo Autore
- Department of Clinical and Molecular Medicine, Sapienza University, 00189 Rome, Italy; (G.G.); (M.B.M.); (C.A.)
| | - Damiano Magrì
- Department of Clinical and Molecular Medicine, Sapienza University, 00189 Rome, Italy; (G.G.); (M.B.M.); (C.A.)
- Correspondence: ; Tel.: +39-(0)6-3377-5563; Fax: +39-(0)6-3377-5061
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Magrì D, Gallo G, Parati G, Cicoira M, Senni M. Risk stratification in heart failure with mild reduced ejection fraction. Eur J Prev Cardiol 2020; 27:59-64. [PMID: 33238737 PMCID: PMC7691635 DOI: 10.1177/2047487320951104] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Accepted: 07/20/2020] [Indexed: 01/19/2023]
Abstract
Heart failure with mid-range ejection fraction represents a heterogeneous and relatively young heart failure category accounting for nearly 20-30% of the overall heart failure population. Due to its complex phenotype, a reliable clinical picture of heart failure with mid-range ejection fraction patients as well as a definite risk stratification are still relevant unsolved issues. In such a context, there is growing interest in a comprehensive functional assessment by means of a cardiopulmonary exercise test, yet considered a cornerstone in the clinical management of patients with heart failure and reduced ejection fraction. Indeed, the cardiopulmonary exercise test has also been found to be particularly useful in the heart failure with mid-range ejection fraction category, several cardiopulmonary exercise test-derived parameters being associated with a poor outcome. In particular, a recent contribution by the metabolic exercise combined with cardiac and kidney indexes research group showed an independent association between the peak oxygen uptake and pure cardiovascular mortality in a large cohort of recovered heart failure with mid-range ejection fraction patients. Contextually, the same study supplied an easy approach to identify a high-risk heart failure with mid-range ejection fraction subset by using a combination of peak oxygen uptake and ventilatory efficiency cut-off values, namely 55% of the maximum predicted and 31, respectively. Thus, looking at the above-mentioned promising results and waiting for specific trials, it is reasonable to consider cardiopulmonary exercise test assessment as part of the heart failure with mid-range ejection fraction work-up in order to identify those patients with an unfavourable functional profile who probably deserve a close clinical follow-up and, probably, more aggressive therapeutic strategies.
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Affiliation(s)
- Damiano Magrì
- Cardiology Unit, Department of Clinical and Molecular Medicine,
Sapienza University of Rome, Sant'Andrea Hospital, Italy
| | - Giovanna Gallo
- Cardiology Unit, Department of Clinical and Molecular Medicine,
Sapienza University of Rome, Sant'Andrea Hospital, Italy
| | - Gianfranco Parati
- Department of Cardiovascular Neural and Metabolic Sciences,
Istituto Auxologico Italiano, IRCCS, S.Luca Hospital, Italy
- Department of Cardiovascular Neural and Metabolic Sciences,
Istituto Auxologico Italiano, IRCCS, S.Luca Hospital, Italy
| | | | - Michele Senni
- Cardiology Division, Cardiovascular Department, Papa Giovanni
XXIII Hospital, Italy
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MagrÌ D, Piepoli M, CorrÀ U, Gallo G, Maruotti A, Vignati C, Salvioni E, Mapelli M, Paolillo S, Perrone Filardi P, Girola D, Metra M, Scardovi AB, Lagioia R, Limongelli G, Senni M, Scrutinio D, Emdin M, Passino C, Lombardi C, Cattadori G, Parati G, Cicoira M, Correale M, Frigerio M, Clemenza F, Bussotti M, Guazzi M, Badagliacca R, Sciomer S, DI Lenarda A, Maggioni A, Sinagra G, Volpe M, Agostoni P. Cardiovascular Death Risk in Recovered Mid-Range Ejection Fraction Heart Failure: Insights From Cardiopulmonary Exercise Test. J Card Fail 2020; 26:932-943. [PMID: 32428671 DOI: 10.1016/j.cardfail.2020.04.021] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Revised: 03/13/2020] [Accepted: 04/17/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND Heart failure with midrange ejection fraction (HFmrEF) represents a heterogeneous category where phenotype, as well as prognostic assessment, remains debated. The present study explores a specific HFmrEF subset, namely those who recovered from a reduced EF (rec-HFmrEF) and, particularly, it focuses on the possible additive prognostic role of cardiopulmonary exercise testing. METHODS AND RESULTS We analyzed data from 4535 patients with HFrEF and 1176 patients with rec-HFmrEF from the Metabolic Exercise combined with Cardiac and Kidney Indexes database. The end point was cardiovascular death at 5 years. The median follow-up was 1343 days (25th-75th range 627-2403 days). Cardiovascular death occurred in 552 HFrEF and 61 rec-HFmrEF patients. The multivariate analysis confirmed an independent role of the MECKI score's variables in HFrEF (C-index = 0.744) whereas, in the rec-HFmrEF group, only age and peak oxygen uptake (pVO2) remained associated to the end point (C-index = 0.745). A peak oxygen uptake of ≤55% of predicted and a ventilatory efficiency of ≥31 resulted as the most accurate cut-off values in the outcome prediction. CONCLUSIONS Present data support the cardiopulmonary exercise test and, particularly, the peak oxygen uptake, as a useful tool in the rec-HFmrEF prognostic assessment. A peak VO2 of ≤55% predicted and ventilatory efficiency of ≥31 might help to identify a high-risk rec-HFmrEF subgroup.
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Affiliation(s)
- Damiano MagrÌ
- Department of Clinical and Molecular Medicine, Azienda Ospedaliera Sant'Andrea, "Sapienza" Università degli Studi di Roma, Roma, Italy
| | | | - Ugo CorrÀ
- Cardiology Department, Istituti Clinici Scientifici Maugeri, IRCCS, Veruno Institute, Veruno, Italy
| | - Giovanna Gallo
- Department of Clinical and Molecular Medicine, Azienda Ospedaliera Sant'Andrea, "Sapienza" Università degli Studi di Roma, Roma, Italy
| | - Antonello Maruotti
- Dipartimento di Giurisprudenza, Economia, Politica e Lingue Moderne - Libera Università Maria Ss Assunta, Roma, Italy; Department of Mathematics, University of Bergen, Bergen, Norway; School of Computing, University of Portsmouth, Portsmouth, UK
| | | | | | | | - Stefania Paolillo
- Department of Advanced Biomedical Sciences, Federico II University of Naples, Naples, Italy
| | | | - Davide Girola
- Clinica Hildebrand Centro di riabilitazione Brissago, Brissago, Switzerland
| | - Marco Metra
- Cardiology, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | | | - Rocco Lagioia
- Division of Cardiology, "S. Maugeri" Foundation, IRCCS, Institute of Cassano Murge, Bari, Italy
| | - Giuseppe Limongelli
- Cardiologia SUN, Ospedale Monaldi (Azienda dei Colli), Seconda Università di Napoli, Napoli, Italy
| | - Michele Senni
- Department of Cardiology, Heart Failure and Heart Transplant Unit, Azienda Ospedaliera Papa Giovanni XXIII, Bergamo, Italy
| | - Domenico Scrutinio
- Division of Cardiology, "S. Maugeri" Foundation, IRCCS, Institute of Cassano Murge, Bari, Italy
| | - Michele Emdin
- Fondazione Gabriele Monasterio, CNR-Regione Toscana, Pisa, Italy; Life Science Institute, Scuola Superiore Sant'Anna, Pisa, Italy
| | - Claudio Passino
- Fondazione Gabriele Monasterio, CNR-Regione Toscana, Pisa, Italy; Life Science Institute, Scuola Superiore Sant'Anna, Pisa, Italy
| | - Carlo Lombardi
- Cardiology, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Gaia Cattadori
- Unità Operativa Cardiologia Riabilitativa, Multimedica IRCCS, Milano, Italy
| | - Gianfranco Parati
- Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy; Department of Cardiovascular, Neural and Metabolic Sciences, San Luca Hospital, Istituto Auxologico Italiano, Milan, Italy
| | | | | | - Maria Frigerio
- Dipartimento Cardiologico "A. De Gasperis", Ospedale Cà Granda- A.O. Niguarda, Milano, Italy
| | - Francesco Clemenza
- Department for the Treatment and Study of Cardiothoracic Diseases and Cardiothoracic Transplantation IRCCS - ISMETT, Palermo, Italy
| | - Maurizio Bussotti
- Cardiac Rehabilitation Unit, Fondazione Salvatore Maugeri, IRCCS, Scientific Institute of Milan, Milan, Italy
| | - Marco Guazzi
- Cardiology University Department, Heart Failure Unit and Cardiopulmonary Laboratory, IRCCS Policlinico San Donato, San Donato Milano, Italy
| | - Roberto Badagliacca
- Dipartimento di Scienze Cardiovascolari, Respiratorie, Nefrologiche, Anestesiologiche e Geriatriche, "Sapienza", Rome University, Rome, Italy
| | - Susanna Sciomer
- Dipartimento di Scienze Cardiovascolari, Respiratorie, Nefrologiche, Anestesiologiche e Geriatriche, "Sapienza", Rome University, Rome, Italy
| | - Andrea DI Lenarda
- Cardiovascular Center, Health Authority n°1 and University of, Trieste, Trieste, Italy
| | | | - Gianfranco Sinagra
- Cardiovascular Department, Ospedali Riuniti and University of Trieste, Trieste, Italy
| | - Massimo Volpe
- Department of Clinical and Molecular Medicine, Azienda Ospedaliera Sant'Andrea, "Sapienza" Università degli Studi di Roma, Roma, Italy; IRCCS Neuromed, Pozzilli (Isernia), Italy
| | - Piergiuseppe Agostoni
- Centro Cardiologico Monzino, IRCCS, Milano, Italy; Department of Clinical sciences and Community Health, Cardiovascular Section, University of Milano, Milano, Italy.
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