{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,30]],"date-time":"2026-06-30T13:45:30Z","timestamp":1782827130908,"version":"3.54.5"},"reference-count":31,"publisher":"BMJ","issue":"1","license":[{"start":{"date-parts":[[2026,6,30]],"date-time":"2026-06-30T00:00:00Z","timestamp":1782777600000},"content-version":"unspecified","delay-in-days":180,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"name":"Fondazione Istituto Europeo di Oncologia e Centro Cardiologico Monzino-Career development fellowship-Robin Willixhofer"},{"DOI":"10.13039\/501100003196","name":"Italian Ministry of Health","doi-asserted-by":"crossref","award":["CUP=B43C24000090001"],"award-info":[{"award-number":["CUP=B43C24000090001"]}],"id":[{"id":"10.13039\/501100003196","id-type":"DOI","asserted-by":"crossref"}]},{"name":"Italian Ministry of Health-Ricerca Corrente to Centro Cardiologico Monzino IRCCS","award":["CUP=B43C24000090001"],"award-info":[{"award-number":["CUP=B43C24000090001"]}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["Open Heart"],"accepted":{"date-parts":[[2026,6,7]]},"published-print":{"date-parts":[[2026,1]]},"abstract":"<jats:sec>\n                    <jats:title>Aims<\/jats:title>\n                    <jats:p>\n                      Cardiopulmonary exercise testing (CPET) parameters are used for heart failure (HF) prognostication. While the ventilation to carbon dioxide production (VE\/VCO\n                      <jats:sub>2<\/jats:sub>\n                      ) slope \u226534 identifies high risk, patients with intermediate values remain heterogeneous. The VE\/VCO\n                      <jats:sub>2<\/jats:sub>\n                      Y-intercept, reflecting dead space ventilation at rest and its changes during effort, may refine prognostication.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We retrospectively analysed 2642 HF. Follow-up was 26 (9\u201363) months. The study endpoint was the composite of all-cause death, urgent transplant or left ventricular assist device implantation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Median age was 62 (53\u201370) years and left ventricular ejection fraction (LVEF) 33% (27%\u201339%). 27% of patients were New York Heart Association class III\u2013IV. During follow-up, 534 events occurred. Both VE\/VCO\n                      <jats:sub>\u2082<\/jats:sub>\n                      slope and peakVO\n                      <jats:sub>\u2082<\/jats:sub>\n                      were associated with outcome in univariable and multivariable models (HR 1.04, 95% CI 1.03 to 1.06; HR 0.90, 95% CI 0.88 to 0.93, p&lt;0.001, respectively). Y-intercept was not prognostic univariately but added independent value in multivariable models (HR 1.08, 95% CI 1.04 to 1.13, p&lt;0.001). Prognosis and clinical profiles improved from group A (VE\/VCO\n                      <jats:sub>2<\/jats:sub>\n                      slope \u226534, n=858) to B (28\u201334, n=943) to C (&lt;28, n=841). Group A versus C patients had lower LVEF (30% (25%\u201336%) vs 35% (30%\u201340%), p\n                      <jats:sub>trend<\/jats:sub>\n                      &lt;0.001), peakVO\n                      <jats:sub>\u2082<\/jats:sub>\n                      (12.7 (10.06\u201315.3) vs 17.7 (14.6\u201321.6) mL\/kg\/min, p\n                      <jats:sub>trend<\/jats:sub>\n                      &lt;0.001) and higher N-terminal pro-B-type natriuretic peptide (1400 (572\u20133122) vs 454 (174\u20131081) pg\/mL, p\n                      <jats:sub>trend<\/jats:sub>\n                      &lt;0.001). Only within group B, a high median Y-intercept (B1\u22653.9 L\/m) clearly identified patients with higher HF severity and worse survival than B2 (&lt;3.9 L\/m, log-rank p&lt;0.001).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>\n                      An increase in the VE\/VCO\n                      <jats:sub>2<\/jats:sub>\n                      slope is associated with a progressive lower survival. Y-intercept enhances risk assessment in HF with intermediate VE\/VCO\n                      <jats:sub>\u2082<\/jats:sub>\n                      slope values.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/openhrt-2026-004205","type":"journal-article","created":{"date-parts":[[2026,6,30]],"date-time":"2026-06-30T12:58:40Z","timestamp":1782824320000},"page":"e004205","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Beyond the slope: prognostic utility of the VE\/VCO\n                    <sub>2<\/sub>\n                    intercept in chronic heart failure"],"prefix":"10.1136","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8345-6382","authenticated-orcid":false,"given":"Piergiuseppe","family":"Agostoni","sequence":"first","affiliation":[{"name":"Centro Cardiologico Monzino Istituto di Ricovero e Cura a Carattere Scientifico, Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robin","family":"Willixhofer","sequence":"additional","affiliation":[{"name":"Centro Cardiologico Monzino Istituto di Ricovero e Cura a Carattere Scientifico, Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Arianna","family":"Galotta","sequence":"additional","affiliation":[{"name":"Centro Cardiologico Monzino Istituto di Ricovero e Cura a Carattere Scientifico, Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Filippo Maria","family":"Rubbo","sequence":"additional","affiliation":[{"name":"Monzino Cardiology Centre, Milan, Italy"},{"name":"Treatment of Cardiomyopathies, Cardiovascular Department, University of Trieste, Trieste, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stefano","family":"Grosdani","sequence":"additional","affiliation":[{"name":"Centro Cardiologico Monzino, Monzino Cardiology Centre, Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luca","family":"Felli","sequence":"additional","affiliation":[{"name":"Monzino Cardiology Centre, Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Raffaele","family":"Abete","sequence":"additional","affiliation":[{"name":"Cardiovascular Department, ASST Papa Giovanni XXIII, Bergamo, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vincenzo","family":"Castiglione","sequence":"additional","affiliation":[{"name":"Scuola Superiore Sant\u2019Anna, Pisa, Italy"},{"name":"Fondazione Toscana Gabriele Monasterio, Pisa, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elisabetta","family":"Salvioni","sequence":"additional","affiliation":[{"name":"Centro Cardiologico Monzino, Milano, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9985-7407","authenticated-orcid":false,"given":"Massimo","family":"Mapelli","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Sciences and Community Health, Centro Cardiologico Monzino, IRCCS, University of Milan, Milano, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carlo","family":"Vignati","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Sciences and Community Health, Centro Cardiologico Monzino, IRCCS, University of Milan, Milano, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Beatrice","family":"Pezzuto","sequence":"additional","affiliation":[{"name":"Heart Failure Unit, Monzino Cardiology Centre, Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Irene","family":"Mattavelli","sequence":"additional","affiliation":[{"name":"Heart Failure Unit, Monzino Cardiology Centre, Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carriere","family":"Cosimo","sequence":"additional","affiliation":[{"name":"Cardiothoracovascular Department, University of Trieste, Trieste, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nikita","family":"Baracchini","sequence":"additional","affiliation":[{"name":"Treatment of Cardiomyopathies, Cardiovascular Department, University of Trieste, Trieste, Italy"},{"name":"University of Trieste, Trieste, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Teresa Maria","family":"Capovilla","sequence":"additional","affiliation":[{"name":"Treatment of Cardiomyopathies, Cardiovascular Department, University of Trieste, Trieste, Italy"},{"name":"University of Trieste, Trieste, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Claudio","family":"Passino","sequence":"additional","affiliation":[{"name":"Fondazione G. Monasterio CNR Regione Toscana, Pisa, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anna","family":"Apostolo","sequence":"additional","affiliation":[{"name":"Centro Cardiologico Monzino Istituto di Ricovero e Cura a Carattere Scientifico, Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pietro","family":"Palermo","sequence":"additional","affiliation":[{"name":"Centro Cardiologico Monzino Istituto di Ricovero e Cura a Carattere Scientifico, Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeness","family":"Campodonico","sequence":"additional","affiliation":[{"name":"Centro Cardiologico Monzino Istituto di Ricovero e Cura a Carattere Scientifico, Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mauro C","family":"Contini","sequence":"additional","affiliation":[{"name":"Centro Cardiologico Monzino, Milano, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lucia","family":"Tricarico","sequence":"additional","affiliation":[{"name":"Universit\u00e0 degli Studi di Foggia, Foggia, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emanuele","family":"Barbato","sequence":"additional","affiliation":[{"name":"Department of Clinical and Molecular Medicine, Sapienza University of Rome, Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8749-8558","authenticated-orcid":false,"given":"Emiliano","family":"Fiori","sequence":"additional","affiliation":[{"name":"Department of Clinical and Molecular Medicine, Sapienza University of Rome, Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michele","family":"Senni","sequence":"additional","affiliation":[{"name":"Aziende Socio Sanitarie Territoriale Papa Giovanni XXIII, Bergamo, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Damiano","family":"Magr\u00ec","sequence":"additional","affiliation":[{"name":"Department of Clinical and Molecular Medicine, Sapienza University of Rome, Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Annamaria","family":"Iorio","sequence":"additional","affiliation":[{"name":"Cardiovascular Department, ASST Papa Giovanni XXIII, Bergamo, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Susanna","family":"Sciomer","sequence":"additional","affiliation":[{"name":"Department of Cardiology, La Sapienza University, Roma, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michele","family":"Correale","sequence":"additional","affiliation":[{"name":"Foggia University Hospital, Foggia, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0954-9871","authenticated-orcid":false,"given":"Gaia","family":"Cattadori","sequence":"additional","affiliation":[{"name":"Unit\u00e0 Operativa Cardiologia Riabilitativa, Ospedale S.Giuseppe, Multimedica Spa, IRCCS, Milan, Michigan, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michele","family":"Emdin","sequence":"additional","affiliation":[{"name":"Cardiovascular Medicine Division, Fondazione G. 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