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P244 BRISK WALKING CAN BE A MAXIMAL EFFORT IN HEART FAILURE PATIENTS. A COMPARISON OF CARDIOPULMONARY EXERCISE AND SIX–MINUTE WALKING TEST CARDIORESPIRATORY DATA. Eur Heart J Suppl 2022. [DOI: 10.1093/eurheartj/suac012.236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Abstract
Aims
Cardiopulmonary exercise test (CPET) and six–minute walking test (6MWT) are frequently used in heart failure (HF). CPET is a maximal exercise, whereas 6MWT is a self–selected constant load test usually considered a submaximal, and therefore safer, exercise but this has not been tested previously. The aim of this study was to compare the cardiorespiratory parameters collected during CPET and 6MWT in a large group of healthy subjects and patients with HF of different severity.
Methods and Results
Subjects performed a standard maximal CPET and a 6MWT wearing a portable device allowing breath–by–breath measurement of cardiorespiratory parameters. HF Patients were grouped according to their CPET peak oxygen uptake (peakV̇O2). One–hundred and fifty–five subjects were enrolled, of whom 40 were healthy (59±8 years; male 67%) and 115 were HF patients (69±10 years; male 80%; left ventricular ejection fraction 34.6±12.0%). CPET peakV̇O2 was 13.5±3.5 ml/kg/min in HF patients and 28.1±7.4 ml/kg/min in healthy (p < 0.001). 6MWT–V̇O2 was 98±20% of the CPET peakV̇O2 values in HF patients, while 72±20% in healthy subjects (p < 0.001). 6MWT–V̇O2 was >110% of CPET peakV̇O2 in 42% of more severe HF patients (peakV̇O2<12ml/kg/min). Similar results have been found for ventilation and heart rate. Of note, the slope of the relationship between V̇O2 at 6MWT, reported as percentage of CPET peakV̇O2 vs. 6MWT V̇O2 reported as absolute value, progressively increased as exercise limitation did.
Conclusions
6MWT must be perceived as a maximal or even supra–maximal exercise activity at least in patients with severe exercise limitation from HF. Our findings should influence the safety procedures needed for the 6MWT in HF.
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C73 PICK YOUR THRESHOLD! HOW TO CALCULATE THE ANAEROBIC THRESHOLD TO STRATIFY HEART FAILURE PROGNOSIS: A COMPARISON BETWEEN ABSOLUTE VALUE, PERCENTAGE OF PEAK VO2 OR PERCENTAGE OF PREDICTED MAXIMUM VO2 IN A LARGE MULTICENTER COHORT OF HFREF PATIENTS WHO UNDER. Eur Heart J Suppl 2022. [DOI: 10.1093/eurheartj/suac011.071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Abstract
Background
The anaerobic threshold (AT), identifies the moment during a maximal exercise when hyperventilation occurs in response to the introduction of an anaerobic metabolism. Its value is indicative of the subject‘s training and/or health, it can be used to guide training, rehabilitation or to define appropriateness to undergo major thoracic or abdominal surgery, and it is related to heart failure (HF) prognosis. AT can be expressed as absolute value or as the percentage of predicted maximum VO2 (VO2AT%pred). However, it is not uncommon to find papers that refer AT to the peak VO2 value achieved (VO2AT%peak), rather than its predicted value, but a direct comparison of the prognostic power of these different variables is missing. In this work, we aim to compare the risk–identifying ability of the AT value when expressed in these three different ways in a large population of HF patients. This will help identify which is more correct to use in assessing patient prognosis, especially when peakVO2 is not reached appropriately.
Methods
The population analyzed counts 7746 patients with HF with history of reduced EF (<40%), recruited between 1998 and 2020 within the MECKI score project. All patients underwent a maximal cardiopulmonary exercise test (CPET), executed in using a ramp protocol on an electronically braked cycle ergometer.
Results
The present study considered 6157 HF patients with identified AT during the CPET, with a median follow up of 1528 days (689–1826). The main characteristics are reported in Figure 1. Figure 2 shows stratification of patients according to these 3 variables divided in tertiles, considering cardiovascular death (combination of cardiovascular death, urgent transplant or LVAD implantation) as an end point. Comparing the AUC of the three variables considered, we found similar values between VO2AT and VO2AT%pred, while the peak VO2AT% value was significantly lower (p < 0.001), as shown in Figure 3A. Moreover VO2AT%pred is the only variable to maintain a comparable ROC to the peakVO2 one, with the others being significantly lower (Figure 3B).
Conclusions
VO2 at AT should always be expressed as % of predicted maximal VO2 to be reliable in predicting prognosis in HF patients. Moreover, evaluating a sub–maximal exercise, VO2AT%pred is the only variable to maintain a comparable prognostic power to the peakVO2 one.
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Corrigendum to "Long-term prognostic role of diabetes mellitus and glycemic control in heart failure patients with reduced ejection fraction: Insights from the MECKI Score database" [Int J Cardiol. 2020 Oct 15; 317: 103-110. PMID: 32360652]. Int J Cardiol 2021; 333:252. [PMID: 33640418 DOI: 10.1016/j.ijcard.2021.02.045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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