Cardiopulmonary exercise testing and prognosis in severe heart failure: 14 mL/kg/min revisited
Cardiopulmonary exercise testing and prognosis in severe heart failure: 14 mL/kg/min revisited
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DOI：
10.1016/s0002-8703(00)90312-0
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发表时间：
2000-01-01
影响因子：
4.8
通讯作者：
Fowler, MB
中科院分区：
文献类型：
--
作者：
Myers, J;Gullestad, L;Fowler, MB
准确确定严重心力衰竭的预后在评估治疗方式的有效性和适当分配稀缺的移植资源方面变得越来越重要。峰值运动摄氧量似乎有一个重要的作用，心力衰竭患者的危险分层，但最佳的临界值，以区分幸存者从nonsurvivors是不清楚的。方法六百四十四名心力衰竭患者的评价超过10年的时间参加了这项研究。在进入研究时药物稳定后，所有参与者都进行了心肺运动试验。以死亡为终点进行生存分析。移植被视为删失事件。四年生存率确定的患者达到峰值摄氧量值大于和小于10，11，12，13，14，15，16，和17 mL/kg/min。结果随访VP信息是完整的队列的98.3%。在平均4年的随访期间，187例患者（29%）死亡，101例接受移植。精算1年和5年生存率分别为90.5%和73.4%。峰值呼吸氧摄取量（VO 2）是生存率的独立预测因子，并且是比达到的工作率和其他运动和临床变量更强的预测因子。通过将高于和低于每个峰值VO 2值（范围为10 - 17 mL/kg/min）的患者进行二分，获得了约20%的生存率差异，达到峰值VO 2以上的患者的生存率显著高于达到峰值VO 2以下的患者结论峰值VO 2是预测心力衰竭患者生存的重要指标，但是否存在最佳临界点尚不清楚。在多变量模型中，峰值VO 2可能更适合作为一个连续变量来预测严重慢性心力衰竭的预后。
Background Accurately establishing prognosis in severe heart failure has become increasingly important in assessing the efficacy of treatment modalities and in appropriately allocating scarce resources for transplantation. Peak exercise oxygen uptake appears to have on important role in risk stratification of patients with heart failure, but the optimal cutpoint value to separate survivors from nonsurvivors is not clear.Methods Six hundred forty-four patients referred for heart failure evaluation over a 10-year period participated in the study. After pharmacologic stabilization at entrance into the study, all participants underwent cardiopulmonary exercise testing. Survival analysis was performed with death as the end point. Transplantation was considered a censored event. Four-year survival was determined for patients who achieved peak oxygen uptake values greater than and less than 10, 11, 12, 13, 14, 15, 16, and 17 mL/kg/min.Results Follow-vp information was complete for 98.3% of the cohort. During a mean follow-up period of 4 years, 187 patients (29%) died and 101 underwent transplantation. Actuarial 1- and 5-year survival rates were 90.5% and 73.4%, respectively. Peak ventilatory oxygen uptake (VO2) was an independent predictor of survival and was a stronger predictor than work rate achieved and other exercise and clinical variables. A difference in survival of approximately 20% was achieved by dichotomizing patients above versus below each peak VO2 value ranging between 10 and 17 mL/kg/min, Survival rate was significantly higher among patients achieving a peak VO2 above than among those achieving a peak VO2 below each of these values (P < .01), but each cutpoint was similar in its ability to separate survivors from nonsurvivors.Conclusion Peak VO2 is an important measurement in predicting survival from heart failure, but whether on optimal cutpoint exists is not clear. Peak VO2 may be more appropriately used as a continuous variable in multivariate models to predict prognosis in severe chronic heart failure.