Distinct Impact of Noncardiac Comorbidities on Exercise Capacity and Functional Status in Chronic Heart Failure

被引:7
作者
Martens, Pieter [1 ]
Augusto, Silvio N. [2 ]
Finet, J. Emanuel [1 ]
Tang, W. H. Wilson [1 ,2 ,3 ]
机构
[1] Heart Vasc & Thorac Inst, Kaufman Ctr Heart Failure Treatment & Recovery, Cleveland Clin, Dept Cardiovasc Med, Cleveland, OH USA
[2] Lerner Res Inst, Cleveland Clin, Dept Cardiovasc & Metab Sci, Cleveland, OH USA
[3] Heart Vasc & Thorac Inst, Cleveland Clin, Dept Cardiovasc Med, 9500 Euclid Ave,Desk J3-4, Cleveland Hts, OH 44195 USA
关键词
cluster analysis; comorbidities; exercise capacity; functional status; heart failure; PRESERVED EJECTION FRACTION; IRON-DEFICIENCY; THERAPY;
D O I
10.1016/j.jchf.2023.05.018
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Background: Noncardiac comorbidities (NCCs) are common in patients with heart failure (HF), but how they jointly affect exercise capacity and functional status is relatively unexplored.Objectives: This study sought to investigate the cumulative effects of NCC on exercise capacity and functional status in chronic HF.Methods: Baseline NCC-status was assessed in HF-ACTION (Heart Failure: A Controlled Trial Investigating Outcomes of Exercise Training), IRONOUT-HF (Oral Iron Repletion Effects on Oxygen Uptake in Heart Failure), NEAT-HFpEF (Nitrate's Effect on Activity Tolerance in Heart Failure With Preserved Ejection Fraction), INDIE-HFpEF (Inorganic Nitrite Delivery to Improve Exercise Capacity in HFpEF), and RELAX-HFpEF (Phosphodiesterase-5 Inhibition to Improve Clinical Status and Exercise Capacity in Heart Failure with Preserved Ejection Fraction) trials, and relations with peak Vo(2) and 6-minute walk test (6MWT), Kansas City Cardiomyopathy Questionnaire (KCCQ), and all-cause death were determined according to HF type (with reduced vs preserved ejection fraction). Cluster analysis of the different NCCs was performed.Results: A total of 2,777 patients were evaluated (mean age: 60 +/- 13 years; median NCC burden in HF with preserved vs reduced ejection fraction: 3 [IQR: 2-4] vs 2 [IQR: 1-3]; P < 0.001). Obesity played a more important role in HF with preserved ejection fraction in limiting peak Vo(2) and 6MWT. There was a progressive decline in peak Vo(2), 6MWT, and KCCQ with increasing NCC burden. Cluster analysis revealed 3 NCC clusters: cluster 1: predominance of stroke and cancer; cluster 2: predominance of chronic kidney disease and peripheral vascular disease; and cluster 3: predominance of obesity and diabetes. Patients in cluster 3 had the worst peak Vo(2), 6MWT, and KCCQ despite having the lowest N-terminal pro-B-type natriuretic peptide and exhibited diminished response to aerobic exercise training (peak Vo(2)P(interaction) = 0.045); however, it had similar risk for all-cause death as cluster 1, whereas cluster 2 had higher risk of death than cluster 1 (HR: 1.60 [95% CI: 1.25-2.04]; P < 0.001).Conclusions: NCC type and burden have a significant and cumulative effect on exercise capacity, occur in clusters, and are associated with clinical outcomes in patients with chronic HF.
引用
收藏
页码:1365 / 1376
页数:12
相关论文
共 25 条
[1]   Anemia and Iron Deficiency in Heart Failure: Current Concepts and Emerging Therapies [J].
Anand, Inder S. ;
Gupta, Pankaj .
CIRCULATION, 2018, 138 (01) :80-98
[2]   Effect of Inorganic Nitrite vs Placebo on Exercise Capacity Among Patients With Heart Failure With Preserved Ejection Fraction The INDIE-HFpEF Randomized Clinical Trial [J].
Borlaug, Barry A. ;
Anstrom, Kevin J. ;
Lewis, Gregory D. ;
Shah, Sanjiv J. ;
Levine, James A. ;
Koepp, Gabe A. ;
Givertz, Michael M. ;
Felker, G. Michael ;
LeWinter, Martin M. ;
Mann, Douglas L. ;
Margulies, Kenneth B. ;
Smith, Andrew L. ;
Tang, W. H. Wilson ;
Whellan, David J. ;
Chen, Horng H. ;
Davila-Roman, Victor G. ;
McNulty, Steven ;
Desvigne-Nickens, Patrice ;
Hernandez, Adrian F. ;
Braunwald, Eugene ;
Redfield, Margaret M. .
JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION, 2018, 320 (17) :1764-1773
[3]   Impact of non-cardiovascular comorbidities on the quality of life of patients with chronic heart failure: a scoping review [J].
Comin-Colet, Josep ;
Martin Lorenzo, Teresa ;
Gonzalez-Dominguez, Almudena ;
Oliva, Juan ;
Jimenez Merino, Silvia .
HEALTH AND QUALITY OF LIFE OUTCOMES, 2020, 18 (01)
[4]   2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines [J].
Heidenreich, Paul A. ;
Bozkurt, Biykem ;
Aguilar, David ;
Allen, Larry A. ;
Byun, Joni J. ;
Colvin, Monica M. ;
Deswal, Anita ;
Drazner, Mark H. ;
Dunlay, Shannon M. ;
Evers, Linda R. ;
Fang, James C. ;
Fedson, Savitri E. ;
Fonarow, Gregg C. ;
Hayek, Salim S. ;
Hernandez, Adrian F. ;
Khazanie, Prateeti ;
Kittleson, Michelle M. ;
Lee, Christopher S. ;
Link, Mark S. ;
Milano, Carmelo A. ;
Nnacheta, Lorraine C. ;
Sandhu, Alexander T. ;
Stevenson, Lynne Warner ;
Vardeny, Orly ;
Vest, Amanda R. ;
Yancy, Clyde W. .
JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, 2022, 79 (17) :E253-E421
[5]   Effects of cognitive behavioural therapy for depression in heart failure patients: a systematic review and meta-analysis [J].
Jeyanantham, Kishaan ;
Kotecha, Dipak ;
Thanki, Devsaagar ;
Dekker, Rebecca ;
Lane, Deirdre A. .
HEART FAILURE REVIEWS, 2017, 22 (06) :731-741
[6]   What Are Adaptive Platform Clinical Trials and What Role May They Have in Cardiovascular Medicine? [J].
Lawler, Patrick R. ;
Hochman, Judith S. ;
Zarychanski, Ryan .
CIRCULATION, 2022, 145 (09) :629-632
[7]   Effect of Oral Iron Repletion on Exercise Capacity in Patients With Heart Failure With Reduced Ejection Fraction and Iron Deficiency The IRONOUT HF Randomized Clinical Trial [J].
Lewis, Gregory D. ;
Malhotra, Rajeev ;
Hernandez, Adrian F. ;
McNulty, Steven E. ;
Smith, Andrew ;
Felker, G. Michael ;
Tang, W. H. Wilson ;
Larue, Shane J. ;
Redfield, Margaret M. ;
Semigran, Marc J. ;
Givertz, Michael M. ;
Van Buren, Peter ;
Whellan, David ;
Anstrom, Kevin J. ;
Shah, Monica R. ;
Desvigne-Nickens, Patrice ;
Butler, Javed ;
Braunwald, Eugene .
JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION, 2017, 317 (19) :1958-1966
[8]   VALUE OF PEAK EXERCISE OXYGEN-CONSUMPTION FOR OPTIMAL TIMING OF CARDIAC TRANSPLANTATION IN AMBULATORY PATIENTS WITH HEART-FAILURE [J].
MANCINI, DM ;
EISEN, H ;
KUSSMAUL, W ;
MULL, R ;
EDMUNDS, LH ;
WILSON, JR .
CIRCULATION, 1991, 83 (03) :778-786
[9]   Catheter Ablation for Atrial Fibrillation with Heart Failure [J].
Marrouche, Nassir F. ;
Brachmann, Johannes ;
Andresen, Dietrich ;
Siebels, Juergen ;
Boersma, Lucas ;
Jordaens, Luc ;
Merkely, Bela ;
Pokushalov, Evgeny ;
Sanders, Prashanthan ;
Proff, Jochen ;
Schunkert, Heribert ;
Christ, Hildegard ;
Vogt, Juergen ;
Baensch, Dietmar .
NEW ENGLAND JOURNAL OF MEDICINE, 2018, 378 (05) :417-427
[10]   The effect of intravenous ferric carboxymaltose on cardiac reverse remodelling following cardiac resynchronization therapy-the IRON-CRT trial [J].
Martens, Pieter ;
Dupont, Matthias ;
Dauw, Jeroen ;
Nijst, Petra ;
Herbots, Lieven ;
Dendale, Paul ;
Vandervoort, Pieter ;
Bruckers, Liesbeth ;
Tang, Wai Hong Wilson ;
Mullens, Wilfried .
EUROPEAN HEART JOURNAL, 2021, 42 (48) :4905-+