Estimating exercise PaCO2 in patients with heart failure with preserved ejection fraction.
Estimating exercise PaCO2 in patients with heart failure with preserved ejection fraction.
复制标题
估算射血分数保留的心力衰竭患者的运动 PaCO2。
DOI：
10.1152/japplphysiol.00474.2021
复制
发表时间：
2022
期刊：
影响因子：
--
通讯作者：
Babb,TonyG
中科院分区：
文献类型：
--
作者：
Balmain,BryceN;Tomlinson,AndrewR;MacNamara,JamesP;Sarma,Satyam;Levine,BenjaminD;Hynan,LindaS;Babb,TonyG
射血分数保留的心力衰竭（HFpEF）患者表现出 根据琼斯校正呼气末二氧化碳分压（PJCO 2）方程，可能影响运动预测性的心肺异常 （PJCO2= 5.5 + 0.9 × Petco2 − 2.1 × VT）。由于死腔/潮气量（VD/VT）计算还包括测量值，因此PJCO 2的VD/VT估计值也可能受到影响。由于采用无创性方法估计VD/VT可以节省患者的不适感、时间和费用，我们研究了呼气末CO2分压（PETCO 2）和PJCO 2是否可以用于估计13例HFpEF患者的VD/VT。PETCO 2是从呼气中测量的，与静息、恒定负荷（20 W）和峰值运动时的桡动脉血气同时测量。使用玻尔方程的Enghoff修正计算VD/VT[art]，使用PETCO 2（VD/VT[ET]）和PJCO 2（VD/VT[J]）代替计算VD/VT的估计值。PETCO 2与静息（-1.46 ± 2.63，P = 0.112）和运动峰值（0.66 ± 2.56，P = 0.392）相似，但在20 W时高估（-2.09 ± 2.55，P = 0.020）。PJCO 2与静息时（−1.29 ± 2.57，P = 0.119）和20 W时（−1.06 ± 2.29，P = 0.154）相似，但在峰值运动时被低估（1.90 ± 2.13，P = 0.009）。VD/VT[ET]在静息（−0.01 ± 0.03，P = 0.127）和运动峰值（0.01 ± 0.04，P = 0.210）时与VD/VT[art]相似，但在20 W时高估了VD/VT[art]（−0.02 ± 0.03，P = 0.025）。尽管在静息（−0.01 ± 0.03，P = 0.156）和20 W（−0.01 ± 0.03，P = 0.133）时VD/VT[J]与VD/VT[art]相似，但在运动峰值时VD/VT[J]低估了VD/VT[art]（0.03 ± 0.04，P = 0.013）。运动时PETCO 2和VD/VT[ET]较PJCO 2和VD/VT[J]能更好地估计峰值运动时的心功能。因此，只有在CPET期间采集动脉血不可行时，才应使用和VD/VT的估计值。NEW & NOTEWORTHYPETCO 2在峰值运动时比PJCO 2提供更好的估计值，VD/VT[ET]在峰值运动时比VD/VT[J]提供更好的估计值。虽然我们报告了显著的相关性，但我们没有发现和的估计值之间的一致性，也没有发现VD/VT[art]和VD/VT[art]的估计值之间的一致性。因此，应谨慎，只有在CPET期间采集动脉血不可行时，才应使用VD/VT的估计值。
Patients with heart failure with preserved ejection fraction (HFpEF) exhibit cardiopulmonary abnormalities that could affect the predictability of exercisefrom the Jones corrected partial pressure of end-tidal CO2(PJCO2) equation (PJCO2= 5.5 + 0.9 × PETCO2 − 2.1 × VT). Since the dead space to tidal volume (VD/VT) calculation also includesmeasurements, estimates of VD/VTfrom PJCO2may also be affected. Because using noninvasive estimates ofand VD/VTcould save patient discomfort, time, and cost, we examined whether partial pressure of end-tidal CO2(PETCO2) and PJCO2can be used to estimateand VD/VTin 13 patients with HFpEF. PETCO2 was measured from expired gases measured simultaneously with radial arterial blood gases at rest, constant-load (20 W), and peak exercise. VD/VT[art]was calculated using the Enghoff modification of the Bohr equation, and estimates of VD/VTwere calculated using PETCO2 (VD/VT[ET]) and PJCO2(VD/VT[J]) in place of. PETCO2 was similar toat rest (−1.46 ± 2.63,P= 0.112) and peak exercise (0.66 ± 2.56,P= 0.392), but overestimatedat 20 W (−2.09 ± 2.55,P= 0.020). PJCO2was similar toat rest (−1.29 ± 2.57,P= 0.119) and 20 W (−1.06 ± 2.29,P= 0.154), but underestimatedat peak exercise (1.90 ± 2.13,P= 0.009). VD/VT[ET]was similar to VD/VT[art]at rest (−0.01 ± 0.03,P= 0.127) and peak exercise (0.01 ± 0.04,P= 0.210), but overestimated VD/VT[art]at 20 W (−0.02 ± 0.03,P= 0.025). Although VD/VT[J]was similar to VD/VT[art]at rest (−0.01 ± 0.03,P= 0.156) and 20 W (−0.01 ± 0.03,P= 0.133), VD/VT[J]underestimated VD/VT[art]at peak exercise (0.03 ± 0.04,P= 0.013). Exercise PETCO2 and VD/VT[ET]provides better estimates ofand VD/VT[art]than PJCO2and VD/VT[J]does at peak exercise. Thus, estimates ofand VD/VTshould only be used if sampling arterial blood during CPET is not feasible.NEW & NOTEWORTHYPETCO2 provides a better estimate ofthan PJCO2at peak exercise, and VD/VT[ET]provides a better estimate of VD/VT[art]than VD/VT[J]at peak exercise. Although we reported significant correlations, we did not find an identity betweenand estimates of, nor did we find an identity between VD/VT[art]and estimates of VD/VT[art]. Thus, caution should be taken and estimates ofand VD/VTshould only be used if sampling arterial blood during CPET is not feasible.