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Optimizing risk stratification in heart failure and the selection of candidates for heart transplantation

2018-02Artigo científico Acesso aberto
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dc.contributor.authorPereira-da-Silva, Tiago
dc.contributor.authorPereira-da-Silva, Tiago
dc.contributor.authorM Soares, Rui
dc.contributor.authorPapoila, Ana Luísa
dc.contributor.authorPapoila, A.L.
dc.contributor.authorPinto, Iola
dc.contributor.authorFeliciano, Joana
dc.contributor.authorAlmeida-Morais, Luís
dc.contributor.authorAbreu, Ana
dc.contributor.authorCruz Ferreira, Rui
dc.contributor.institutionNOVA Medical School|Faculdade de Ciências Médicas (NMS|FCM)
dc.contributor.pblSociedade Portuguesa de Cardiologia | Elsevier
dc.date.accessioned2023-01-26T22:09:50Z
dc.date.available2023-01-26T22:09:50Z
dc.date.issued2018-02
dc.descriptionCopyright © 2018 Sociedade Portuguesa de Cardiologia. Publicado por Elsevier España, S.L.U. All rights reserved.
dc.description.abstractINTRODUCTION AND AIMS: Selecting patients for heart transplantation is challenging. We aimed to identify the most important risk predictors in heart failure and an approach to optimize the selection of candidates for heart transplantation. METHODS: Ambulatory patients followed in our center with symptomatic heart failure and left ventricular ejection fraction ≤40% prospectively underwent a comprehensive baseline assessment including clinical, laboratory, electrocardiographic, echocardiographic, and cardiopulmonary exercise testing parameters. All patients were followed for 60 months. The combined endpoint was cardiac death, urgent heart transplantation or need for mechanical circulatory support, up to 36 months. RESULTS: In the 263 enrolled patients (75% male, age 54±12 years), 54 events occurred. The independent predictors of adverse outcome were ventilatory efficiency (VE/VCO2) slope (HR 1.14, 95% CI 1.11-1.18), creatinine level (HR 2.23, 95% CI 1.14-4.36), and left ventricular ejection fraction (HR 0.96, 95% CI 0.93-0.99). VE/VCO2slope was the most accurate risk predictor at any follow-up time analyzed (up to 60 months). The threshold of 39.0 yielded high specificity (97%), discriminated a worse or better prognosis than that reported for post-heart transplantation, and outperformed peak oxygen consumption thresholds of 10.0 or 12.0 ml/kg/min. For low-risk patients (VE/VCO2slope <39.0), sodium and creatinine levels and variations in end-tidal carbon dioxide partial pressure on exercise identified those with excellent prognosis. CONCLUSIONS: VE/VCO2slope was the most accurate parameter for risk stratification in patients with heart failure and reduced ejection fraction. Those with VE/VCO2slope ≥39.0 may benefit from heart transplantation.en
dc.description.versionpublishersversion
dc.description.versionpublished
dc.format.extent9
dc.format.extent774308
dc.identifier.doi10.1016/j.repc.2017.06.018
dc.identifier.issn0870-2551
dc.identifier.otherPURE: 3734201
dc.identifier.otherPURE UUID: 15dace34-fc3f-46cd-bfec-cbe209a9e24b
dc.identifier.otherPubMed: 29519728
dc.identifier.otherWOS: 000432449800006
dc.identifier.otherScopus: 85042878744
dc.identifier.urihttp://hdl.handle.net/10362/148199
dc.language.isoeng
dc.peerreviewedyes
dc.subjectCardiopulmonary exercise testing
dc.subjectConsumo de oxigénio de pico
dc.subjectDeclive da eficiência ventilatória
dc.subjectEstratificação de risco
dc.subjectHeart failure
dc.subjectHeart transplantation
dc.subjectInsuficiência cardíaca
dc.subjectPeak oxygen consumption
dc.subjectProva de esforço cardiorrespiratória
dc.subjectRisk stratification
dc.subjectTransplantação cardíaca
dc.subjectVentilatory efficiency slope
dc.titleOptimizing risk stratification in heart failure and the selection of candidates for heart transplantationen
dc.typejournal article
degois.publication.firstPage129
degois.publication.issue2
degois.publication.lastPage137
degois.publication.titleRevista Portuguesa de Cardiologia
degois.publication.volume37
dspace.entity.typePublication
person.familyNamePereira-da-Silva
person.familyNamePapoila
person.givenNameTiago
person.givenNameAna Luisa
person.identifier.ciencia-id251C-0273-1068
person.identifier.orcid0000-0003-0467-2608
person.identifier.orcid0000-0002-2918-8364
person.identifier.ridS-2515-2016
person.identifier.scopus-author-id6507532321
rcaap.rightsopenAccess
relation.isAuthorOfPublication4c17c358-87c1-467d-82b3-91afa2999c2a
relation.isAuthorOfPublication5ce1bd05-e7a4-4bd0-9527-f511c0889095
relation.isAuthorOfPublication.latestForDiscovery5ce1bd05-e7a4-4bd0-9527-f511c0889095

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