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Meta-Analysis
. 2023 Aug;10(4):2740-2744.
doi: 10.1002/ehf2.14406. Epub 2023 Jun 1.

Cardiopulmonary exercise testing predicts prognosis in amyloid cardiomyopathy: a systematic review and meta-analysis

Anna Cantone  1 , Matteo Serenelli  1 , Federico Sanguettoli  1 , Daniele Maio  1 , Gioele Fabbri  1 , Beatrice Dal Passo  1 , Piergiuseppe Agostoni  2   3 , Giovanni Grazzi  4 , Gianluca Campo  1 , Claudio Rapezzi  5
Affiliations
Meta-Analysis

Cardiopulmonary exercise testing predicts prognosis in amyloid cardiomyopathy: a systematic review and meta-analysis

Anna Cantone et al. ESC Heart Fail. 2023 Aug.

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.

Keywords: Amyloidosis; CPET; Heart failure; Mortality; VE/VCO slope; VO2 peak.

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Figures

Figure 1
Figure 1
Outline of the search strategy. The images show the outline of the search strategy with the PRISMA flow‐chart.
Figure 2
Figure 2
Risk of mortality according to peak VO2 (A) and VE/VCO2 slope (B). The figure shows the pooled mortality hazard ration for 1‐unit increase in VO2 peak (panel A) and VE/VCO2 slope (B).
See this image and copyright information in PMC

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