Background:In patients with chronic heart failure (HF) the Metabolic Exercise Cardiac Kidney Indexes (MECKI) score, is a predictor of cardiovascular death and urgent heart transplantation. We investigated the relationship between age, exercise tolerance and the prognostic value of the MECKI score. Methods and Results: We analyzed data from 3,794 patients with chronic systolic HF. The primary endpoint was a composite of cardiovascular death and urgent heart transplantation. Older patients had higher prevalence of comorbidities and lower exercise performance compared with younger subjects (peak VO2, 925 vs. 1,351 L/min; P<0.0001; VE/VCO2 slope, 33.2 vs. 28.3; P>0.0001). The rate of the primary endpoint was 19% in the highest age quartile and 14% in the lowest quartile. At multivariable analysis, the independent predictors of the primary endpoint were left ventricular ejection fraction (LVEF), eGFR, peak VO2, serum Na+ and the use of β-blockers in patients aged ≥70 years, and LVEF, eGFR and peak VO2 in younger subjects. The MECKI risk score increased across age sub-groups, but on receiver operating characteristic curve analysis its prognostic power was similar in both patients aged ≥ 70 and <70 years. Conclusions:Older patients with HF are a high-risk population with lower exercise performance. The MECKI score increased according to age and maintained its prognostic value also in older patients.
Exercise performance is a prognostic indicator in elderly patients with chronic heart failure: application of metabolic exercise cardiac kidney indexes score / Carubelli, Valentina; Metra, Marco; Corrà, Ugo; Magri', Damiano; Passino, Claudio; Lombardi, Carlo; Scrutinio, Domenico; Correale, Michele; Cattadori, Gaia; Piepoli, Massimo F.; Salvioni, Elisabetta; Giovannardi, Marta; Raimondo, Rosa; Cicoira, Mariantonietta; Belardinelli, Romualdo; Guazzi, Marco; Limongelli, Giuseppe; Clemenza, Francesco; Parati, Gianfranco; Scardovi, Angela B.; Di Lenarda, Andrea; Bussotti, Maurizio; La Gioia, Rocco; Agostoni, Piergiuseppe. - In: CIRCULATION JOURNAL. - ISSN 1346-9843. - STAMPA. - 79:12(2015), pp. 2608-2615. [10.1253/circj.CJ-15-0026]
Exercise performance is a prognostic indicator in elderly patients with chronic heart failure: application of metabolic exercise cardiac kidney indexes score
MAGRI', DAMIANO;
2015
Abstract
Background:In patients with chronic heart failure (HF) the Metabolic Exercise Cardiac Kidney Indexes (MECKI) score, is a predictor of cardiovascular death and urgent heart transplantation. We investigated the relationship between age, exercise tolerance and the prognostic value of the MECKI score. Methods and Results: We analyzed data from 3,794 patients with chronic systolic HF. The primary endpoint was a composite of cardiovascular death and urgent heart transplantation. Older patients had higher prevalence of comorbidities and lower exercise performance compared with younger subjects (peak VO2, 925 vs. 1,351 L/min; P<0.0001; VE/VCO2 slope, 33.2 vs. 28.3; P>0.0001). The rate of the primary endpoint was 19% in the highest age quartile and 14% in the lowest quartile. At multivariable analysis, the independent predictors of the primary endpoint were left ventricular ejection fraction (LVEF), eGFR, peak VO2, serum Na+ and the use of β-blockers in patients aged ≥70 years, and LVEF, eGFR and peak VO2 in younger subjects. The MECKI risk score increased across age sub-groups, but on receiver operating characteristic curve analysis its prognostic power was similar in both patients aged ≥ 70 and <70 years. Conclusions:Older patients with HF are a high-risk population with lower exercise performance. The MECKI score increased according to age and maintained its prognostic value also in older patients.File | Dimensione | Formato | |
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