Exercise oscillatory ventilation and prognosis in heart failure patients with reduced and mid-range ejection fraction
AIMS Exercise oscillatory ventilation (EOV) is a pivotal cardiopulmonary exercise test (CPET) parameter for the prognostic evaluation of patients with chronic heart failure (HF). It has been described in patients with HF and left ventricular ejection fraction (EF) <40% (HFrEF) and with HF and EF >50% (HFpEF), but no data are available for mid-range EF HF patients (HFmrEF). Study aim was to evaluate the prognostic role of EOV in HFmrEF patients. METHODS AND RESULTS We analyzed 1239 patients with HFmrEF and 4482 patients with HFrEF, enrolled in the MECKI score database, with a two-year follow-up. Study end-point was the composite of cardiovascular death, urgent heart transplant, and ventricular assist device implantation. We identified EOV in 968 cases (16 and 17% of cases in HFmrEF and HFrEF, respectively). HFrEF EOV+ patients were significantly older, and their parameters suggested a more severe HF than HFrEF EOV- patients. A similar behavior was found in HFmrEF EOV+ vs. EOV- patients. Kaplan-Meier analysis, irrespective of EF, showed that EOV is associated with a worse survival, and that patients with HFrEF and HFmrEF EOV+ had a significantly worse outcome than the EOV- of the same EF groups. EOV-associated survival differences in HFmrEF patients started after 18 months of follow-up. CONCLUSIONS EOV has similar prevalence and ominous prognostic value both in HFmrEF and HFrEF patients, indicating a group of patients in need of a more intensive follow-up and a more aggressive therapy. In HFmrEF, the survival curves between EOV+ and EOV- patients diverged only after 18 months.