Exercise Performance Is a Prognostic Indicator in Elderly Patients With Chronic Heart Failure　– Application of Metabolic Exercise Cardiac Kidney Indexes Score –

Valentina Carubelli; Marco Metra; Ugo Corrà; Damiano Magrì; Claudio Passino; Carlo Lombardi; Domenico Scrutinio; Michele Correale; Gaia Cattadori; Massimo F. Piepoli; Elisabetta Salvioni; Marta Giovannardi; Rosa Raimondo; Mariantonietta Cicoira; Romualdo Belardinelli; Marco Guazzi; Giuseppe Limongelli; Francesco Clemenza; Gianfranco Parati; Angela B. Scardovi; Andrea Di Lenarda; Maurizio Bussotti; Rocco La Gioia; Piergiuseppe Agostoni; on behalf of the MECKI score research group

doi:10.1253/circj.CJ-15-0026

Heart Failure

Exercise Performance Is a Prognostic Indicator in Elderly Patients With Chronic Heart Failure　– Application of Metabolic Exercise Cardiac Kidney Indexes Score –

Valentina Carubelli, Marco Metra, Ugo Corrà, Damiano Magrì, Claudio Passino, Carlo Lombardi, Domenico Scrutinio, Michele Correale, Gaia Cattadori, Massimo F. Piepoli, Elisabetta Salvioni, Marta Giovannardi, Rosa Raimondo, Mariantonietta Cicoira, Romualdo Belardinelli, Marco Guazzi, Giuseppe Limongelli, Francesco Clemenza, Gianfranco Parati, Angela B. Scardovi, Andrea Di Lenarda, Maurizio Bussotti, Rocco La Gioia, Piergiuseppe Agostoni, on behalf of the MECKI score research group

Author information

Valentina Carubelli
Division of Cardiology, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University and Civil Hospital of Brescia
Marco Metra
Division of Cardiology, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University and Civil Hospital of Brescia
Ugo Corrà
Division of Cardiology Rehabilitation, “S. Maugeri” Foundation, IRCCS, Scientific Institute of Veruno
Damiano Magrì
Department of Clinical and Molecular Medicine, Azienda Ospedaliera Sant’Andrea, “Sapienza” University of Rome
Claudio Passino
Gabriele Monasterio Foundation, CNR-Regione Toscana
Scuola Superiore S. Anna
Carlo Lombardi
Division of Cardiology, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University and Civil Hospital of Brescia
Domenico Scrutinio
Division of Cardiology, “S. Maugeri” Foundation, IRCCS, Institute of Cassano Murge
Michele Correale
Department of Cardiology, University of Foggia
Gaia Cattadori
Centro Cardiologico Monzino, IRCCS
Massimo F. Piepoli
UOC Cardiologia, G da Saliceto Hospital
Elisabetta Salvioni
Centro Cardiologico Monzino, IRCCS
Marta Giovannardi
Centro Cardiologico Monzino, IRCCS
Rosa Raimondo
“S. Maugeri” Foundation, IRCCS, Institute of Tradate, Department of Medicine and Cardiorespiratory Rehabilitation, Unit of Cardiac Rehabilitation
Mariantonietta Cicoira
Section of Cardiology, Department of Medicine, University of Verona
Romualdo Belardinelli
Division of Cardiac Rehabilitation, Azienda Ospedali Riuniti
Marco Guazzi
Heart Failure Unit, IRCCS Policlinico San Donato
Giuseppe Limongelli
Cardiology SUN, Monaldi Hospital (Azienda dei Colli), Second University of Naples
Francesco Clemenza
ISMETT (Mediterranean Institute for Transplantation and Advanced Specialized Therapies)
Gianfranco Parati
Department of Health Science, University of Milan Bicocca & Department of Cardiology, San Luca Hospital, Istituto Auxologico Italiano
Angela B. Scardovi
Cardiology Division, Santo Spirito Hospital
Andrea Di Lenarda
Cardiovascular Center, Health Authority no.°1 and University of Trieste
Maurizio Bussotti
Division of Cardiology, Salvatore Maugeri Foundation, IRCCS, Institute of Milan
Rocco La Gioia
Division of Cardiology, “S. Maugeri” Foundation, IRCCS, Institute of Cassano Murge
Piergiuseppe Agostoni
Centro Cardiologico Monzino, IRCCS
Department of Clinical Sciences and Community Health, University of Milan
on behalf of the MECKI score research group

Keywords: Cardiopulmonary exercise test, Elderly, Exercise performance, Heart failure, MECKI score

JOURNAL FREE ACCESS FULL-TEXT HTML

2015 Volume 79 Issue 12 Pages 2608-2615

DOI https://doi.org/10.1253/circj.CJ-15-0026

Editorial (79-12 pp.2547-2548)

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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 V̇O₂, 925 vs. 1,351 L/min; P<0.0001; V̇E/V̇CO₂slope, 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 V̇O₂, serum Na⁺and the use of β-blockers in patients aged ≥70 years, and LVEF, eGFR and peak V̇O₂in younger subjects. The MECKI risk score increased across age subgroups, 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. (Circ J 2015; 79: 2608–2615)

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