Clinical and Hemodynamic Associations and Prognostic Implications of Ventilatory Efficiency in Patients With Preserved Left Ventricular Systolic Function
Clinical and Hemodynamic Associations and Prognostic Implications of Ventilatory Efficiency in Patients With Preserved Left Ventricular Systolic Function
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DOI：
10.1161/circheartfailure.119.006729
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发表时间：
2020-05-01
影响因子：
9.7
通讯作者：
Lewis, Gregory D.
中科院分区：
文献类型：
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作者：
Nayor, Matthew;Xanthakis, Vanessa;Lewis, Gregory D.
背景：运动时的通气效率（排除二氧化碳所需的分钟通气量，VE/VCO 2）可有效预测射血分数降低的晚期心力衰竭患者的预后，但其对左心室收缩功能保留的高危人群的预后意义尚不清楚。我们的目的是在一个单中心的呼吸困难转诊队列（MGH-ExS [马萨诸塞州综合医院运动研究]）和一个大样本的社区居住参与者在FHS（心脏研究）的机械决定因素和预后的影响VE/VCO 2的特点：最大增量心肺运动试验进行。VE/VCO 2被评估为运动前和运动后无氧阈的斜率（VE/VCO 2（pre-VATslope），VE/VCO 2（post-VATslope）），运动过程中的斜率（VE/VCO 2（overall-slope）），以及30秒的最低值（VE/VCO 2（最低值））。
Background:Ventilatory efficiency (minute ventilation required to eliminate carbon dioxide, VE/VCO2) during exercise potently predicts outcomes in advanced heart failure with reduced ejection fraction, but its prognostic significance for at-risk individuals with preserved left ventricular systolic function is unclear. We aimed to characterize mechanistic determinants and prognostic implications of VE/VCO2 in a single-center dyspneic referral cohort (MGH-ExS [Massachusetts General Hospital Exercise Study]) and in a large sample of community-dwelling participants in the FHS (Framingham Heart Study).Methods:Maximum incremental cardiopulmonary exercise tests were performed. VE/VCO2 was assessed as the slope pre- and post-ventilatory anaerobic threshold (VE/VCO2(pre-VATslope), VE/VCO2(post-VATslope)), the slope throughout exercise (VE/VCO2(overall-slope)), and as the lowest 30-second value (VE/VCO2(nadir)).Results:In the MGH-ExS (N=493, age 56 +/- 15 years, 61% women, left ventricular ejection fraction 64 +/- 8%), higher VE/VCO2(nadir) was associated with lower peak exercise cardiac output and steeper increases in exercise pulmonary capillary wedge pressure (both P