Cardiovascular Death Risk in Recovered Mid-Range Ejection Fraction Heart Failure: Insights From Cardiopulmonary Exercise Test.

Raw data of the paper: Cardiovascular Death Risk in Recovered Mid-Range Ejection Fraction Heart Failure: Insights From Cardiopulmonary Exercise Test. 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.本论文配套原始数据集：射血分数中间值康复型心力衰竭患者的心血管死亡风险——基于心肺运动试验的研究洞察。背景 射血分数中间值心力衰竭（HFmrEF）属于异质性疾病范畴，其表型分型与预后评估方案仍存在广泛争议。本研究聚焦于一类特殊的HFmrEF亚组，即既往射血分数降低后现已康复的患者（rec-HFmrEF），并重点探讨心肺运动试验在该亚组患者预后评估中的潜在附加价值。方法与结果 本研究从代谢运动联合心脏与肾脏指数（MECKI）数据库中，纳入4535例射血分数降低型心力衰竭（HFrEF）患者与1176例rec-HFmrEF患者进行数据分析。本研究的主要终点为5年心血管死亡事件，中位随访时间为1343天（四分位间距为627~2403天）。最终共有552例HFrEF患者与61例rec-HFmrEF患者发生心血管死亡事件。多因素分析结果证实，MECKI评分的相关变量在HFrEF患者中具有独立预后预测价值（C指数=0.744）；而在rec-HFmrEF患者组中，仅年龄与峰值摄氧量（pVO2）与终点事件存在独立关联（C指数=0.745）。本研究确定的结局预测最佳截断值为：峰值摄氧量≤预测值的55%、通气效率≥31。结论 本研究数据证实，心肺运动试验，尤其是峰值摄氧量，可作为rec-HFmrEF患者预后评估的有效工具。峰值摄氧量≤预测值55%、通气效率≥31的指标，有助于精准识别rec-HFmrEF高危亚组患者。