Renal Function and Peak Exercise Oxygen Consumption in Chronic Heart Failure With Reduced Left Ventricular Ejection Fraction

• Published in: Circulation Journal Vol. 79; no. 3; pp. 583 - 591
• Main Authors: Scrutinio, Domenico, Agostoni, Piergiuseppe, Gesualdo, Loreto, Corrà, Ugo, Mezzani, Alessandro, Piepoli, Massimo, Lenarda, Andrea Di, Iorio, Annamaria, Passino, Claudio, Magrì, Damiano, Masarone, Daniele, Battaia, Elisa, Girola, Davide, Re, Federica, Cattadori, Gaia, Parati, Gianfranco, Sinagra, Gianfranco, Villani, Giovanni Quinto, Limongelli, Giuseppe, Pacileo, Giuseppe, Guazzi, Marco, Metra, Marco, Frigerio, Maria, Cicoira, Mariantonietta, Minà, Chiara, Malfatto, Gabriella, Caravita, Sergio, Bussotti, Maurizio, Salvioni, Elisabetta, Veglia, Fabrizio, Correale, Michele, Scardovi, Angela B., Emdin, Michele, Giannuzzi, Pantaleo, Gargiulo, Paola, Giovannardi, Marta, Perrone-Filardi, Pasquale, Raimondo, Rosa, Ricci, Roberto, Paolillo, Stefania, Farina, Stefania, Belardinelli, Romualdo, Passantino, Andrea, Gioia, Rocco La, on behalf of the Metabolic Exercise test data combined with Cardiac and Kidney Indexes (MECKI) Score Research Group
• Format: Journal Article
• Language: English
• Published: Japan The Japanese Circulation Society 2015
• Subjects: Adult; Aged; Chronic Disease; Exercise; Female; Follow-Up Studies; Heart failure; Heart Failure - complications; Heart Failure - metabolism; Heart Failure - physiopathology; Humans; Kidney Diseases - etiology; Kidney Diseases - mortality; Kidney Diseases - physiopathology; Kidney Function Tests; Male; Middle Aged; Oxygen Consumption; Peak exercise oxygen consumption; Prognosis; Renal function; Stroke Volume
• ISSN: 1346-9843; 1347-4820
• DOI: 10.1253/circj.CJ-14-0806

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−1was 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−1was 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–1offers limited prognostic information in HF patients with more severely impaired renal function. (Circ J 2015; 79: 583–591)