Cardiopulmonary exercise testing predicts prognosis in amyloid cardiomyopathy: a systematic review and meta‐analysis
Abstract Background The clinical value of cardiopulmonary exercise testing (CPET) in cardiac amyloidosis (CA) is uncertain. Due to the growing prevalence of the disease and the current availability of disease‐modifying drugs, prognostic stratification is becoming fundamental to optimizing the cost‐e...
| Main Authors: | , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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Wiley
2023-08-01
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| Series: | ESC Heart Failure |
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| Online Access: | https://doi.org/10.1002/ehf2.14406 |
| _version_ | 1827891529956458496 |
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| author | Anna Cantone Matteo Serenelli Federico Sanguettoli Daniele Maio Gioele Fabbri Beatrice Dal Passo Piergiuseppe Agostoni Giovanni Grazzi Gianluca Campo Claudio Rapezzi |
| author_facet | Anna Cantone Matteo Serenelli Federico Sanguettoli Daniele Maio Gioele Fabbri Beatrice Dal Passo Piergiuseppe Agostoni Giovanni Grazzi Gianluca Campo Claudio Rapezzi |
| author_sort | Anna Cantone |
| collection | DOAJ |
| description | Abstract Background The clinical value of cardiopulmonary exercise testing (CPET) in cardiac amyloidosis (CA) is uncertain. Due to the growing prevalence of the disease and the current availability of disease‐modifying drugs, prognostic stratification is becoming fundamental to optimizing the cost‐effectiveness of treatment, patient phenotyping, follow‐up, and management. Peak VO2 and VE/VCO2 slope are currently the most studied CPET variables in clinical settings, and both demonstrate substantial, independent prognostic value in several cardiovascular diseases. We aim to study the association of peak VO2 and VE/VCO2 slope with prognosis in patients with CA. Methods and results We performed a systematic review and searched for clinical studies performing CPET for prognostication in patients with transthyretin‐CA and light‐chain‐CA. Studies reporting hazard ratio (HR) for mortality and peak VO2 or VE/VCO2 slope were further selected for quantitative analysis. HRs were pooled using a random‐effect model. Five studies were selected for qualitative and three for quantitative analysis. A total of 233 patients were included in the meta‐analysis. Mean peak VO2 resulted consistently depressed, and VE/VCO2 slope was increased. Our pooled analysis showed peak VO2 (pooled HR 0.89, 95% CI 0.84–0.94) and VE/VCO2 slope (pooled HR 1.04, 95% CI 1.01–1.07) were significantly associated with the risk of death in CA patients, with no significant statistical heterogeneity for both analyses. Conclusions CPET is a valuable tool for prognostic stratification in CA, identifying patients at increased risk of death. Large prospective clinical trials are needed to confirm this exploratory finding. |
| first_indexed | 2024-03-12T21:27:07Z |
| format | Article |
| id | doaj.art-edb5185a3af047f8aa536e9f2797be01 |
| institution | Directory Open Access Journal |
| issn | 2055-5822 |
| language | English |
| last_indexed | 2024-03-12T21:27:07Z |
| publishDate | 2023-08-01 |
| publisher | Wiley |
| record_format | Article |
| series | ESC Heart Failure |
| spelling | doaj.art-edb5185a3af047f8aa536e9f2797be012023-07-28T06:30:48ZengWileyESC Heart Failure2055-58222023-08-011042740274410.1002/ehf2.14406Cardiopulmonary exercise testing predicts prognosis in amyloid cardiomyopathy: a systematic review and meta‐analysisAnna Cantone0Matteo Serenelli1Federico Sanguettoli2Daniele Maio3Gioele Fabbri4Beatrice Dal Passo5Piergiuseppe Agostoni6Giovanni Grazzi7Gianluca Campo8Claudio Rapezzi9Cardiovascular Institute Azienda Ospedaliero‐Universitaria di Ferrara Ferrara ItalyCardiovascular Institute Azienda Ospedaliero‐Universitaria di Ferrara Ferrara ItalyCardiovascular Institute Azienda Ospedaliero‐Universitaria di Ferrara Ferrara ItalyCardiovascular Institute Azienda Ospedaliero‐Universitaria di Ferrara Ferrara ItalyCardiovascular Institute Azienda Ospedaliero‐Universitaria di Ferrara Ferrara ItalyCardiovascular Institute Azienda Ospedaliero‐Universitaria di Ferrara Ferrara ItalyCentro Cardiologico Monzino, IRCCS Milan ItalyCenter for Exercise Science and Sport University of Ferrara Ferrara ItalyCardiovascular Institute Azienda Ospedaliero‐Universitaria di Ferrara Ferrara ItalyCardiovascular Institute University of Ferrara Ferrara ItalyAbstract Background The clinical value of cardiopulmonary exercise testing (CPET) in cardiac amyloidosis (CA) is uncertain. Due to the growing prevalence of the disease and the current availability of disease‐modifying drugs, prognostic stratification is becoming fundamental to optimizing the cost‐effectiveness of treatment, patient phenotyping, follow‐up, and management. Peak VO2 and VE/VCO2 slope are currently the most studied CPET variables in clinical settings, and both demonstrate substantial, independent prognostic value in several cardiovascular diseases. We aim to study the association of peak VO2 and VE/VCO2 slope with prognosis in patients with CA. Methods and results We performed a systematic review and searched for clinical studies performing CPET for prognostication in patients with transthyretin‐CA and light‐chain‐CA. Studies reporting hazard ratio (HR) for mortality and peak VO2 or VE/VCO2 slope were further selected for quantitative analysis. HRs were pooled using a random‐effect model. Five studies were selected for qualitative and three for quantitative analysis. A total of 233 patients were included in the meta‐analysis. Mean peak VO2 resulted consistently depressed, and VE/VCO2 slope was increased. Our pooled analysis showed peak VO2 (pooled HR 0.89, 95% CI 0.84–0.94) and VE/VCO2 slope (pooled HR 1.04, 95% CI 1.01–1.07) were significantly associated with the risk of death in CA patients, with no significant statistical heterogeneity for both analyses. Conclusions CPET is a valuable tool for prognostic stratification in CA, identifying patients at increased risk of death. Large prospective clinical trials are needed to confirm this exploratory finding.https://doi.org/10.1002/ehf2.14406AmyloidosisCPETHeart failureMortalityVO2 peakVE/VCO slope |
| spellingShingle | Anna Cantone Matteo Serenelli Federico Sanguettoli Daniele Maio Gioele Fabbri Beatrice Dal Passo Piergiuseppe Agostoni Giovanni Grazzi Gianluca Campo Claudio Rapezzi Cardiopulmonary exercise testing predicts prognosis in amyloid cardiomyopathy: a systematic review and meta‐analysis ESC Heart Failure Amyloidosis CPET Heart failure Mortality VO2 peak VE/VCO slope |
| title | Cardiopulmonary exercise testing predicts prognosis in amyloid cardiomyopathy: a systematic review and meta‐analysis |
| title_full | Cardiopulmonary exercise testing predicts prognosis in amyloid cardiomyopathy: a systematic review and meta‐analysis |
| title_fullStr | Cardiopulmonary exercise testing predicts prognosis in amyloid cardiomyopathy: a systematic review and meta‐analysis |
| title_full_unstemmed | Cardiopulmonary exercise testing predicts prognosis in amyloid cardiomyopathy: a systematic review and meta‐analysis |
| title_short | Cardiopulmonary exercise testing predicts prognosis in amyloid cardiomyopathy: a systematic review and meta‐analysis |
| title_sort | cardiopulmonary exercise testing predicts prognosis in amyloid cardiomyopathy a systematic review and meta analysis |
| topic | Amyloidosis CPET Heart failure Mortality VO2 peak VE/VCO slope |
| url | https://doi.org/10.1002/ehf2.14406 |
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