Renal function and peak exercise oxygen consumption in chronic heart failure with reduced left ventricular ejection fraction.
BACKGROUND
Chronic kidney disease is associated with sympathetic activation and muscle abnormalities, which may contribute to decreased exercise capacity. We investigated the correlation of renal function with peak exercise oxygen consumption (V̇O2) in heart failure (HF) patients. METHODS AND RESULTS: We recruited 2,938 systolic HF patients who underwent clinical, laboratory, echocardiographic and cardiopulmonary exercise testing. The patients were stratified according to estimated glomerular filtration rate (eGFR). Mean follow-up was 3.7 years. The primary outcome was a composite of cardiovascular death and urgent heart transplantation at 3 years. On multivariable regression, eGFR was predictor of peakV̇O2(P<0.0001). Other predictors were age, sex, body mass index, HF etiology, NYHA class, atrial fibrillation, resting heart rate, B-type natriuretic peptide, hemoglobin, and treatment. After adjusting for significant covariates, the hazard ratio for primary outcome associated with peakV̇O2<12 ml·kg(-1)·min(-1)was 1.75 (95% confidence interval (CI): 1.06-2.91; P=0.0292) in patients with eGFR ≥60, 1.77 (0.87-3.61; P=0.1141) in those with eGFR of 45-59, and 2.72 (1.01-7.37; P=0.0489) in those with eGFR <45 ml·min(-1)·1.73 m(-2). The area under the receiver-operating characteristic curve for peakV̇O2<12 ml·kg(-1)·min(-1)was 0.63 (95% CI: 0.54-0.71), 0.67 (0.56-0.78), and 0.57 (0.47-0.69), respectively. Testing for interaction was not significant.


CONCLUSIONS
Renal dysfunction is correlated with peakV̇O2. A peakV̇O2cutoff of 12 ml·kg(-1)·min(-1)offers limited prognostic information in HF patients with more severely impaired renal function.
Division of Cardiology, "S. Maugeri" Foundation, IRCCS, Institute of Cassano Murge.
Domenico
D
Scrutinio
Piergiuseppe
P
Agostoni
Loreto
L
Gesualdo
Ugo
U
Corrà
Alessandro
A
Mezzani
Massimo
M
Piepoli
Andrea
A
Di Lenarda
Annamaria
A
Iorio
Claudio
C
Passino
Damiano
D
Magrì
Daniele
D
Masarone
Elisa
E
Battaia
Davide
D
Girola
Federica
F
Re
Gaia
G
Cattadori
Gianfranco
G
Parati
Gianfranco
G
Sinagra
Giovanni Quinto
GQ
Villani
Giuseppe
G
Limongelli
Giuseppe
G
Pacileo
Marco
M
Guazzi
Marco
M
Metra
Maria
M
Frigerio
Mariantonietta
M
Cicoira
Chiara
C
Minà
Gabriella
G
Malfatto
Sergio
S
Caravita
Maurizio
M
Bussotti
Elisabetta
E
Salvioni
Fabrizio
F
Veglia
Michele
M
Correale
Angela B
AB
Scardovi
Michele
M
Emdin
Pantaleo
P
Giannuzzi
Paola
P
Gargiulo
Marta
M
Giovannardi
Pasquale
P
Perrone-Filardi
Rosa
R
Raimondo
Roberto
R
Ricci
Stefania
S
Paolillo
Stefania
S
Farina
Romualdo
R
Belardinelli
Andrea
A
Passantino
Rocco
R
La Gioia
D000328:Adult; D000368:Aged; D002908:Chronic Disease; D015444:Exercise; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000150:complications / Q000378:metabolism / Q000503:physiopathology; D006801:Humans; D007674:Kidney Diseases / Q000209:etiology / Q000401:mortality / Q000503:physiopathology; D007677:Kidney Function Tests; D008297:Male; D008875:Middle Aged; D010101:Oxygen Consumption; D013318:Stroke Volume