Prognostic Significance of Peak Workload-to-Weight Ratio by Cardiopulmonary Exercise Testing in Chronic Heart Failure
Prognostic Significance of Peak Workload-to-Weight Ratio by Cardiopulmonary Exercise Testing in Chronic Heart Failure
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慢性心力衰竭心肺运动试验的峰值工作量与体重比的预后意义
DOI：
10.1016/j.amjcard.2023.01.052
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发表时间：
2023
期刊：
影响因子：
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通讯作者：
Anzai Toshihisa
中科院分区：
文献类型：
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作者：
Yasui Yutaro;Nakamura Kosuke;Omote Kazunori;Ishizaka Suguru;Takenaka Sakae;Mizuguchi Yoshifumi;Shimono Yui;Kazui Sho;Takahashi Yuki;Saiin Kohei;Naito Seiichiro;Tada Atsushi;Kobayashi Yuta;Sato Takuma;Kamiya Kiwamu;Nagai Toshiyuki;Anzai Toshihisa
心肺运动试验（CPET）期间峰值负荷体重比（PWR）的预后影响及其决定因素在慢性心力衰竭（CHF）患者中的作用尚不清楚。确定了2013年至2018年期间在北海道大学医院转诊接受CPET的514例CHF患者。主要结局是因心力衰竭恶化住院和死亡的复合终点。PWR计算为通过CPET标准化为体重（W/kg）的峰值工作负荷。与高PWR患者（n = 257）相比，低PWR患者（临界中位数1.38 [W/kg]，n = 257）年龄更大，贫血更严重。在CPET中，与高PWR患者相比，低PWR患者显示出降低的峰值耗氧量和受损的呼吸效率，而两组之间的峰值呼吸交换率无显著差异。在中位随访期3.3年（四分位距0.8 - 5.5）内，有89例患者发生事件。低PWR患者的复合事件发生率显著高于高PWR患者（对数秩p <0.0001）。在多变量考克斯回归中，较低的PWR与不良事件相关（风险比0.31，95%置信区间0.13 - 0.73，p = 0.008）。低血红蛋白浓度与PWR受损密切相关（β系数= 0.43，每增加1 g/100 ml，p <0.0001）。总之，PWR与较差的临床结局相关，其中血红蛋白与PWR密切相关。需要进一步的研究来确定针对运动负荷试验中达到峰值工作负荷的治疗方法，以改善CHF患者的结局。
The prognostic impact of peak workload-to-weight ratio (PWR) during cardiopulmonary exercise testing (CPET) and its determinants in patients with chronic heart failure (CHF) are not well understood. Consecutive 514 patients with CHF referred for CPET at the Hokkaido University Hospital between 2013 and 2018 were identified. The primary outcome was a composite of hospitalization because of worsening heart failure and death. PWR was calculated as peak workload normalized to body weight (W/kg) by CPET. Patients with low PWR (cut-off median 1.38 [W/kg], n = 257) were older and more anemic than those with high PWR (n = 257). In CPET, patients with low PWR displayed reduced peak oxygen consumption and impaired ventilatory efficiency compared with those with high PWR, whereas the peak respiratory exchange ratio was not significantly different between the 2 groups. There were 89 patients with events over a median follow-up period of 3.3 (interquartile range 0.8 to 5.5) years. The incidence of composite events was significantly higher in patients with low PWR than in those with high PWR (log-rank p <0.0001). In the multivariable Cox regression, lower PWR was associated with adverse events (hazard ratio 0.31, 95% confidence interval 0.13 to 0.73, p = 0.008). Low hemoglobin concentration was strongly related to impaired PWR (β coefficient = 0.43, per 1 g/100 ml increased, p <0.0001). In conclusion, PWR was associated with worse clinical outcomes, where blood hemoglobin was strongly related to PWR. Further study is required to identify therapies targeting peak workload achievements in exercise stress tests to improve the outcome in patients with CHF.