VE/VCO2 is slope is associated with abnormal resting haemodynamics and a predictor of long-term survival in chronic heart failure
VE/VCO2 is slope is associated with abnormal resting haemodynamics and a predictor of long-term survival in chronic heart failure
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DOI：
10.1016/j.ejheart.2005.10.003
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发表时间：
2006-06-01
影响因子：
18.2
通讯作者：
Roussos, Charis
中科院分区：
文献类型：
--
作者：
Nanas, Serafim N.;Nanas, John N.;Roussos, Charis
背景资料：慢性心力衰竭（CHF）患者存在运动性呼吸过度，但其病理生理机制尚未完全阐明。我们的目的是确定运动引起的呼吸过度，静息血流动力学测量和有效性的呼吸反应（V-E/V-CO2斜率）作为一个死亡预测在CHF patient.Methods：98例CHF患者（90 M/8 F）进行了限制性平板运动心肺功能试验（CPET）之间的关系。右心导管检查和放射性核素心室造影在72 h内进行CPET.Results：27例患者死于心脏原因在20 +/-6个月的随访。死亡组的最大耗氧量（V（O2）p）较低（16.5 ± 4.9vs. 20.2+/-6，1，ml/kg/min，p = 0.003）、更陡的V-E/V-CO2斜率（34.8 +/-8.3 vs. 28.9 +/-4.8，p <0.001）和更高的肺毛细血管楔压（PCWP）（19.5 +/-8.6 vs. 11.7 +/-6.5 min Hg，p = 0.008）。多因素生存分析显示，V-E/V-CO2斜率作为一个连续变量是独立的预后因素（卡方2：8.5，相对危险度：1。1，95% CI：1.03 - 1.18，p = 0.004）。V-E/V-CO2斜率>= 34的患者总死亡率为52%，V-E/V-CO2斜率<34的患者总死亡率为18%（对数秩：18.5，p <0.001）。在一个患者亚组（V（O2）p：10 - 18 ml/kg/min）中，V-E/V-CO2斜率是死亡率的重要预测因子（相对风险：6.2，95% CI：1.7 - 22.2，p = 0.002）。V-E/V-CO2斜率高的患者具有较高的静息PCWP（19.9 ± 9.1 vs.11.3 ± 5.7mmHg，p <0.001），V-E/V-CO2斜率与PCWP显著相关（r：0.57，p <0.001）。间质性肺水肿可能是这些患者运动时通气不足的病理生理机制。(c)2005年欧洲心脏病学会。Elsevier B.V.出版，保留所有权利。
Background: Patients with chronic heart failure (CHF) present with exercise-induced hyperpnea, but its pathophysiological mechanism has not been thoroughly investigated. We aimed to determine the relationship between exercise-induced hyperpnea, resting haemodynamic measurements and the validity of ventilatory response (V-E/V-CO2 slope) as a mortality predictor in CHF patients.Methods: Ninety-eight CHF patients (90M/8F) underwent a symptom-limited treadmill cardiopulmonary exercise test (CPET). Right heart catheterization and radionuclide ventriculography were performed within 72 h of CPET.Results: Twenty-seven patients died from cardiac causes during 20 +/- 6 months follow-up. Non-survivors ' had a lower peak oxygen consumption (V(O2)p), (16.5 +/- 4.9vs. 20.2 +/- 6,1, ml/kg/min,p=0.003), a steeper V-E/V-CO2 slope (34.8 +/- 8.3 vs. 28.9 +/- 4.8, p < 0.001) and a higher pulmonary capillary wedge pressure (PCWP) (19.5 +/- 8.6 vs. 11.7 +/- 6.5 min Hg, p=0.008) than survivors. By multivariate survival analysis, the V-E/V-CO2 slope as a continuous variable was an independent prognostic factor (chi(2) : 8.5, relative risk: 1. 1, 95% CI: 1.03 -1.18, p = 0.004). Overall mortality was 52% in patients with V-E/V-CO2 slope >= 34 and 18% in those with V-E/V-CO2 slope < 34 (log rank: 18.5, p < 0.001). In a subgroup of patients (V(O2)p: 10-18 ml/kg/min), V-E/V-CO2 slope was a significant predictor of mortality (relative risk: 6.2, 95% CI: 1.7-22.2, p=0.002). Patients with high V-E/V-CO2 slope had higher resting PCWP (19.9 +/- 9.1 vs. 11.3 +/- 5.7 mmHg, p < 0.001) and V-E/V-CO2 slope correlated significantly with PCWP (r: 0.57, p < 0.001).Conclusions: The V-E/V-CO2 slope, as an index of ventilatory response to exercise, improves the fisk stratification of CHF patients. Interstitial pulmonary oedema may be a pathophysiological mechanism of inefficient ventilation during exercise in these patients. (c) 2005 European Society of Cardiology. Published by Elsevier B.V. All rights reserved.