{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,19]],"date-time":"2026-02-19T03:35:10Z","timestamp":1771472110531,"version":"3.50.1"},"reference-count":36,"publisher":"Oxford University Press (OUP)","issue":"1","license":[{"start":{"date-parts":[[2025,12,19]],"date-time":"2025-12-19T00:00:00Z","timestamp":1766102400000},"content-version":"vor","delay-in-days":2179,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2020,1,1]],"date-time":"2020-01-01T00:00:00Z","timestamp":1577836800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100003196","name":"Italian Ministry of Health","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100003196","id-type":"DOI","asserted-by":"publisher"}]},{"name":"Italian Ministry of Health"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2020,2,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Aims<\/jats:title>\n                    <jats:p>Ventilation vs. carbon dioxide production (VE\/VCO2) is among the strongest cardiopulmonary exercise testing prognostic parameters in heart failure (HF). It is usually reported as an absolute value. The current definition of normal VE\/VCO2 slope values is inadequate, since it was built from small groups of subjects with a particularly limited number of women and elderly. We aimed to define VE\/VCO2 slope prediction formulas in a sizable population and to test whether the prognostic power of VE\/VCO2 slope in HF was different if expressed as a percentage of the predicted value or as an absolute value.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods and results<\/jats:title>\n                    <jats:p>We calculated the linear regressions between age and VE\/VCO2 slope in 1136 healthy subjects (68% male, age 44.9 \u00b1 14.5, range 13\u201383 years). We then applied age-adjusted and sex-adjusted formulas to predict VE\/VCO2 slope to HF patients included in the metabolic exercise test data combined with cardiac and kidney indexes score database, which counts 6112 patients (82% male, age 61.4 \u00b1 12.8, left ventricular ejection fraction 33.2 \u00b1 10.5%, peakVO2 14.8 \u00b1 4.9, mL\/min\/kg, VE\/VCO2 slope 32.7 \u00b1 7.7) from 24 HF centres. Finally, we evaluated whether the use of absolute values vs. percentages of predicted VE\/VCO2 affected HF prognosis prediction (composite of cardiovascular mortality + urgent transplant or left ventricular assist device). We did so in the entire cardiac and kidney indexes score population and separately in HF patients with severe (peakVO2 &amp;lt; 14 mL\/min\/kg, n = 2919, 61.1 events\/1000 pts\/year) or moderate (peakVO2 \u2265 14 mL\/min\/kg, n = 3183, 19.9 events\/1000 pts\/year) HF. In the healthy population, we obtained the following equations: female, VE\/VCO2 = 0.052 \u00d7 Age + 23.808 (r = 0.192); male, VE\/VCO2 = 0.095 \u00d7 Age + 20.227 (r = 0.371) (P = 0.007). We applied these formulas to calculate the percentages of predicted VE\/VCO2 values. The 2-year survival prognostic power of VE\/VCO2 slope was strong, and it was similar if expressed as absolute value or as a percentage of predicted value (AUCs 0.686 and 0.690, respectively). In contrast, in severe HF patients, AUCs significantly differed between absolute values (0.637) and percentages of predicted values (0.650, P = 0.0026). Moreover, VE\/VCO2 slope expressed as a percentage of predicted value allowed to reclassify 6.6% of peakVO2 &amp;lt; 14 mL\/min\/kg patients (net reclassification improvement = 0.066, P = 0.0015).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>The percentage of predicted VE\/VCO2 slope value strengthens the prognostic power of VE\/VCO2 in severe HF patients, and it should be preferred over the absolute value for HF prognostication. Furthermore, the widespread use of VE\/VCO2 slope expressed as percentage of predicted value can improve our ability to identify HF patients at high risk, which is a goal of utmost clinical relevance.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/ehf2.12582","type":"journal-article","created":{"date-parts":[[2020,1,1]],"date-time":"2020-01-01T17:37:08Z","timestamp":1577900228000},"page":"368-377","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":16,"title":["Gender and Age Normalization and Ventilation Efficiency During Exercise in Heart Failure with Reduced Ejection Fraction"],"prefix":"10.1093","volume":"7","author":[{"given":"Elisabetta","family":"Salvioni","sequence":"first","affiliation":[{"name":"Centro Cardiologico Monzino, IRCCS , Via Parea 4, Milan, 20138 ,","place":["Italy"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ugo","family":"Corr\u00e0","sequence":"additional","affiliation":[{"name":"Cardiology Department, Istituti Clinici Scientifici Maugeri, IRCCS, Veruno Institute , Veruno ,","place":["Italy"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Massimo","family":"Piepoli","sequence":"additional","affiliation":[{"name":"UOC Cardiologia, G da Saliceto Hospital , Piacenza ,","place":["Italy"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sara","family":"Rovai","sequence":"additional","affiliation":[{"name":"Centro Cardiologico Monzino, IRCCS , Via Parea 4, Milan, 20138 ,","place":["Italy"]},{"name":"Universit\u00e0 degli Studi di Padova , Padova ,","place":["Italy"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Michele","family":"Correale","sequence":"additional","affiliation":[{"name":"Department of Cardiology, University of Foggia , Foggia ,","place":["Italy"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Stefania","family":"Paolillo","sequence":"additional","affiliation":[{"name":"Department of Advanced Biomedical Sciences, Federico II University of Naples , Naples ,","place":["Italy"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mario","family":"Pasquali","sequence":"additional","affiliation":[{"name":"Dipartimento di medicina e scienze dell'invecchiamento, Universit\u00e0 G. D'Annunzio , Chieti ,","place":["Italy"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Damiano","family":"Magr\u00ec","sequence":"additional","affiliation":[{"name":"Department of Clinical and Molecular Medicine, Azienda Ospedaliera Sant'Andrea, \u201cSapienza\u201d Universit\u00e0 degli Studi di Roma , Roma ,","place":["Italy"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Giuseppe","family":"Vitale","sequence":"additional","affiliation":[{"name":"Cardiovascular Rehabilitation Unit, Buccheri La Ferla Fatebenefratelli Hospital , Palermo ,","place":["Italy"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Laura","family":"Fusini","sequence":"additional","affiliation":[{"name":"Centro Cardiologico Monzino, IRCCS , Via Parea 4, Milan, 20138 ,","place":["Italy"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Massimo","family":"Mapelli","sequence":"additional","affiliation":[{"name":"Centro Cardiologico Monzino, IRCCS , Via Parea 4, Milan, 20138 ,","place":["Italy"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Carlo","family":"Vignati","sequence":"additional","affiliation":[{"name":"Centro Cardiologico Monzino, IRCCS , Via Parea 4, Milan, 20138 ,","place":["Italy"]},{"name":"Department of Clinical Sciences and Community Health, Cardiovascular Section, University of Milano , Milano ,","place":["Italy"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rocco","family":"Lagioia","sequence":"additional","affiliation":[{"name":"Division of Cardiology, \u201cS. 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