Development of a ventilatory classification system in patients with heart failure
Development of a ventilatory classification system in patients with heart failure
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DOI：
10.1161/circulationaha.107.686576
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发表时间：
2007-05-08
期刊：
影响因子：
37.8
通讯作者：
Guazzi, Marco
中科院分区：
文献类型：
--
作者：
Arena, Ross;Myers, Jonathan;Guazzi, Marco
背景-通气效率，通常通过分钟通气量(VE)-二氧化碳生成（VCO2）斜率来评估，是心力衰竭人群的一个强有力的预后指标。本研究的目的是通过开发一个将VE/VCO2切断点与心脏相关事件相关联的通气分级系统，来完善VE/VCO2斜率的预后能力。方法和结果- 448名诊断为心力衰竭的受试者被纳入本分析。通过心肺运动试验测定VE/VCO2斜率。在心肺运动试验后，随访受试者2年的主要心脏事件（死亡、移植或左心室辅助装置植入）。在2年的追踪期间，共发生81例心脏相关事件（64例死亡，10例心脏移植，7例左心室辅助装置植入）。受试者工作特征曲线分析显示，总体VE/VCO2斜率分类方案显著（曲线下面积：0.78 [95% CI, 0.73 ~ 0.83], P < 0.001）。在试验敏感性和特异性的基础上，建立了以下通气分级体系：(1)通气分级（VC） I = 45.0。vc I至vc IV的受试者人数分别为144人、149人、112人、43人。Kaplan-Meier分析显示，VC I、II、III和IV期患者的无事件生存率分别为97.2%、85.2%、72.3%和44.2% （log-rank为86.8;P < 0.001）。结论：基于运动VE/VCO2斜率的多级分类系统对心力衰竭严重程度的整个频谱的风险负担进行分层。因此，建议应用这种分类来改善心力衰竭的临床决策。
Background - Ventilatory efficiency, commonly assessed by the minute ventilation (VE)-carbon dioxide production (VCO2) slope, is a powerful prognostic marker in the heart failure population. The purpose of the present study is to refine the prognostic power of the VE/VCO2 slope by developing a ventilatory class system that correlates VE/VCO2 cut points to cardiac-related events. Methods and Results - Four hundred forty-eight subjects diagnosed with heart failure were included in this analysis. The VE/VCO2 slope was determined via cardiopulmonary exercise testing. Subjects were tracked for major cardiac events (mortality, transplantation, or left ventricular assist device implantation) for 2 years after cardiopulmonary exercise testing. There were 81 cardiac-related events (64 deaths, 10 heart transplants, and 7 left ventricular assist device implantations) during the 2-year tracking period. Receiver operating characteristic curve analysis revealed the overall VE/VCO2 slope classification scheme was significant (area under the curve: 0.78 [95% CI, 0.73 to 0.83], P < 0.001). On the basis of test sensitivity and specificity, the following ventilatory class system was developed: (1) ventilatory class (VC) I: = 45.0. The numbers of subjects in VCs I through IV were 144, 149, 112, and 43, respectively. Kaplan-Meier analysis revealed event-free survival for subjects in VC I, II, III, and IV was 97.2%, 85.2%, 72.3%, and 44.2%, respectively (log-rank 86.8; P < 0.001). Conclusions - A multiple-level classificatory system based on exercise VE/VCO2 slope stratifies the burden of risk for the entire spectrum of heart failure severity. Application of this classification is therefore proposed to improve clinical decision making in heart failure.