Contribution of peak respiratory exchange ratio to peak VO2 prognostic reliability in patients with chronic heart failure and severely reduced exercise capacity
Contribution of peak respiratory exchange ratio to peak VO2 prognostic reliability in patients with chronic heart failure and severely reduced exercise capacity
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DOI：
10.1016/s0002-8703(03)00100-5
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发表时间：
2003-06-01
影响因子：
4.8
通讯作者：
Giannuzzi, P
中科院分区：
文献类型：
--
作者：
Mezzani, A;Corrà, U;Giannuzzi, P
研究背景：我们评估了峰值呼吸交换率（pRER）作为一个努力充分性的指标对慢性心力衰竭（CHF）和运动能力降低患者峰值VO 2预测可靠性的影响，这些患者的峰值VO 2可能因患者动机差而被低估。（年龄60 ± 10岁，射血分数26% ± 7%，纽约心脏协会分级2.2 ± 0.6），其中193例患者的峰值VO 2>10但大于或等于14 mL/kg/min（运动能力降低），其中80人的峰值VO 2小于或等于10 mL/kg/min（严重降低运动能力）。随访期间（19.6 +/-14个月）发生了72例心血管死亡和6例I级心脏移植。峰值VO 2小于或等于10的患者的2年生存率为69%，峰值VO 2> 10但小于或等于14的患者的2年生存率为83%（P <0.0001）。然而，在峰值VO 2 ≤10的患者组中，pRER ≥1.15的患者的2年生存率为52%，该pRER值（但不≥1、≥1.05或≥1.10）是复合终点的唯一独立预测因素（χ（2）= 4.73，P = 0.03）。相反，在峰值VO 2 ≤10的患者中，PRER值< 1.15的患者的生存率为83%，与峰值VO 2>10但小于或等于14的患者的生存率相当。以确定他们的动机，并确保他们的峰值VO 2预测可靠性。
Background We evaluated the influence of peak respiratory exchange ratio (pRER), as an index of effort adequacy, on peak VO2 prognostic reliability in patients with chronic heart failure (CHF) and reduced exercise capacity, whose peak VO2 may be underestimated because of poor patient motivation.Methods A cardiopulmonary exercise test was performed in 570 patients with CHF (age 60 +/- 10 years, ejection fraction 26% +/- 7%, New York Heart Association class 2.2 +/- 0.6), 193 of whom had a peak VO2 that was >10 but greater than or equal to14 mL/kg/min (reduced exercise capacity) and 80 of whom had a peak VO2 less than or equal to10 mL/kg/min (severely reduced exercise capacity).Results Seventy-eight events (72 cardiovascular deaths and 6 status I heart transplantations) occurred during follow-up (19.6 +/- 14 months). The 2-year survival rate was 69% in patients with a peak VO2 less than or equal to10 and 83% in patients with a peak VO2 > 10 but less than or equal to14 (P < .0001). However, in the group of patients with a peak VO2 ≤10, patients who had a pRER ≥1.15 had a 2-year survival rate of 52%, and this pRER value (but not ≥1, ≥1.05, or ≥1.10) was the only independent predictor of the composite end point (χ(2) = 4.73, P = .03). Conversely, in the group of patients with a peak VO2 ≤10, patients who had a pRER value < 1.15 had a survival rate of 83%, which was comparable with that of the group of patients with a peak VO2 >10 but less than or equal to14.Conclusion Patients with CHF and severely reduced exercise capacity should be encouraged to exercise to an RER as close as possible to 1.15, to ascertain their motivation and ensure their peak VO2 prognostic reliability.