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

2018-02Journal article Restricted access
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dc.contributor.authorPereira-da-Silva, Tiago
dc.contributor.authorSoares, Rui M.
dc.contributor.authorPapoila, Ana Luisa
dc.contributor.authorPinto, Iola
dc.contributor.authorFeliciano, Joana
dc.contributor.authorMorais, Luís Almeida
dc.contributor.authorAbreu, Ana
dc.contributor.authorFerreira, Rui Cruz
dc.date.accessioned2018-12-05T10:38:12Z
dc.date.available2018-12-05T10:38:12Z
dc.date.issued2018-02
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/VCO2 slope 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/VCO2 slope <39.0), sodium and creatinine levels and variations in end-tidal carbon dioxide partial pressure on exercise identified those with excellent prognosis. Conclusions: VE/VCO2 slope was the most accurate parameter for risk stratification in patients with heart failure and reduced ejection fraction. Those with VE/VCO2 slope >= 39.0 may benefit from heart transplantation.pt_PT
dc.description.versioninfo:eu-repo/semantics/publishedVersionpt_PT
dc.identifier.citationSilva, Tiago Pereira da; [et al] – Optimizing risk stratification in heart failure and the selection of candidates for heart transplantation. Revista Portuguesa de Cardiologia. ISSN 0870-2551. Vol. 37, N.º 2 (2018), pp. 129-137pt_PT
dc.identifier.doi10.1016/j.repc.2017.06.018pt_PT
dc.identifier.issn0870-2551
dc.identifier.issn0304-4750
dc.identifier.urihttp://hdl.handle.net/10400.21/9130
dc.language.isoengpt_PT
dc.peerreviewedyespt_PT
dc.publisherElsevier Españapt_PT
dc.relation.publisherversionhttps://reader.elsevier.com/reader/sd/pii/S2174204918300746?token=08B4191663293CCFEC65F8352FEEB6AB7BB1B3C86BE3E6E116880A5FFB2C868D22631BED04BF204F941DF1FE8B4F4D77pt_PT
dc.subjectCardiopulmonary exercise testingpt_PT
dc.subjectHeart failurept_PT
dc.subjectRisk stratificationpt_PT
dc.subjectEntilatory efficiency slopept_PT
dc.subjectProva de esforço cardiorespiratóriapt_PT
dc.subjectInsuficiência cardíacapt_PT
dc.subjectEstratificação de riscopt_PT
dc.subjectDeclive da eficiência ventilatóriapt_PT
dc.titleOptimizing risk stratification in heart failure and the selection of candidates for heart transplantationpt_PT
dc.title.alternativeAprimoramento da estratificação de risco na insuficiência cardíaca e da seleção de candidatos a transplantação cardíacapt_PT
dc.typejournal article
dspace.entity.typePublication
oaire.citation.endPage137pt_PT
oaire.citation.issue2pt_PT
oaire.citation.startPage129pt_PT
oaire.citation.titleRevista Portuguesa de Cardiologia (English Edition)pt_PT
oaire.citation.volume37pt_PT
person.familyNamePereira-da-Silva
person.familyNamePapoila
person.familyNamePinto
person.givenNameTiago
person.givenNameAna Luisa
person.givenNameIola
person.identifierR-000-ME5
person.identifier.ciencia-id251C-0273-1068
person.identifier.ciencia-id5715-2B2D-9ADC
person.identifier.orcid0000-0003-0467-2608
person.identifier.orcid0000-0002-2918-8364
person.identifier.orcid0000-0002-2945-1441
person.identifier.ridS-2515-2016
person.identifier.scopus-author-id6507532321
person.identifier.scopus-author-id34969436900
rcaap.rightsclosedAccesspt_PT
rcaap.typearticlept_PT
relation.isAuthorOfPublicationcdfdfa35-72a9-4ba3-8b57-65c1ace5ad74
relation.isAuthorOfPublication287e5ccb-e43a-42c7-a632-df8b2b0fd985
relation.isAuthorOfPublication137d7dcc-401e-4d4a-862f-1d955c6f7257
relation.isAuthorOfPublication.latestForDiscoverycdfdfa35-72a9-4ba3-8b57-65c1ace5ad74

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