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

Tiago Pereira-da-Silva1, Rui M Soares1, Ana Luísa Papoila2

  • 1Department of Cardiology, Hospital de Santa Marta, Centro Hospitalar de Lisboa Central, Lisbon, Portugal.

Revista Portuguesa De Cardiologia
|March 10, 2018
PubMed

Insights

Ventilatory efficiency (VE/VCO2) slope is the best predictor of outcomes in heart failure patients. A slope of 39.0 or higher suggests potential benefit from heart transplantation.

Area of Science:

  • Cardiology
  • Pulmonary Medicine
  • Transplantation Science

Background:

  • Heart transplantation candidate selection is complex.
  • Identifying accurate risk predictors is crucial for optimizing outcomes.
  • Heart failure with reduced ejection fraction (HFrEF) requires careful prognostic assessment.

Purpose of the Study:

  • To identify key risk predictors in heart failure patients.
  • To develop an optimized approach for selecting heart transplantation candidates.
  • To evaluate the prognostic accuracy of various parameters in HFrEF.

Main Methods:

  • Prospective assessment of ambulatory HFrEF patients (LVEF ≤40%).
  • Comprehensive baseline evaluation including clinical, laboratory, and exercise testing.
  • 60-month follow-up for cardiac death, urgent transplant, or mechanical support.

Main Results:

  • Ventilatory efficiency (VE/VCO2) slope, creatinine, and LVEF independently predicted adverse outcomes.
  • VE/VCO2 slope was the most accurate long-term risk predictor.
  • A VE/VCO2 slope threshold of 39.0 demonstrated high specificity and prognostic discrimination.

Conclusions:

  • VE/VCO2 slope is the premier parameter for risk stratification in HFrEF.
  • Patients with VE/VCO2 slope ≥39.0 may be optimal candidates for heart transplantation.
  • Further analysis of specific parameters can identify excellent prognosis in low-risk groups.
Abstract

Keywords:
Cardiopulmonary exercise testingConsumo de oxigénio de picoDeclive da eficiência ventilatóriaEstratificação de riscoHeart failureHeart transplantationInsuficiência cardíacaPeak oxygen consumptionProva de esforço cardiorrespiratóriaRisk stratificationTransplantação cardíacaVentilatory efficiency slope

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