Assessment of symptoms and exercise capacity in cyanotic patients with congenital heart disease
Assessment of symptoms and exercise capacity in cyanotic patients with congenital heart disease
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DOI：
10.1378/chest.125.2.368
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发表时间：
2004-02-01
期刊：
影响因子：
9.6
通讯作者：
Kleber, FX
中科院分区：
文献类型：
--
作者：
Gläser, S;Optiz, CF;Kleber, FX
目的：紫绀型先天性心脏病患者通常被认为受到低氧血症的限制。为了将运动耐量与心脏异常的严重程度联系起来，并进一步描述受影响患者的呼吸困难特征，我们检查了 25 名患有未经矫正的紫绀型先天性心脏病的成年人。设计和背景：在大学医院进行队列研究。方法：在跑步机上进行症状限制心肺运动试验 (CPX)。对每次呼吸的呼出气体进行分析，结合休息和运动期间的血气分析来评估最大运动表现、通气量和通气效率。通过能力指数和纽约心脏协会等级对症状进行评估，并将结果与 101 名健康志愿者进行比较。结果：随着运动（从 49 +/- 12 至 36 +/- 10 mm Hg），PaO2 下降 26 +/- 8%（平均值 +/- SD），而 PaCO2 与对照受试者相比仅略有下降。与对照受试者相比，峰值摄氧量 (O-2) 显着降低：16.7 +/- 6.6 mL/kg/min vs 36.1 +/- 7.7 mL/kg/min。休息时（每分钟通气量 [E]/二氧化碳输出量 [CO2] 比率为 70 +/- 18；对照受试者，53 +/- 11；p < 0.005）和运动期间（E VS CO2 斜率，58 +/- 31；对照受试者，26 +/- 4；p < 0.005）通气效率明显受损。休息时，通气效率与静息 pH 值和 PaO2 相关，而运动时则与 PaO2 相关。运动期间的通气效率与观察到的症状具有最强的相关性，而低氧血症和峰值 O-2 与症状状态没有显着相关。结论：紫绀型先天性心脏病患者的 CPX 提供了有用的参数，可以更好地定义这些患者的症状状态。通气效率最好地反映了疾病相关因素的总和。与单独的 O-2 峰值和紫绀程度相比，该参数提供了额外且独立的信息。
Objectives: Patients with cyanotic congenital heart disease are generally thought to be limited by hypoxemia. To correlate exercise tolerance to the severity of the cardiac abnormality and to further characterize dyspnea in affected patients, we examined 25 adults with uncorrected cyanotic congenital heart disease.Design and setting: Cohort study at a university hospital.Methods: Symptom-limited cardiopulmonary exercise testing (CPX) was performed on a treadmill. Expiratory gas was analyzed breath by breath for evaluation of maximal exercise performance, ventilation, and ventilatory efficiency in combination with blood gas analysis during rest and exercise. Symptoms were assessed by the ability index and New York Heart Association class, and the results were compared to 101 healthy volunteers.Results: PaO2 decreased by 26 +/- 8% (mean +/- SD) with exercise (from 49 +/- 12 to 36 +/- 10 mm Hg), while PaCO2 was only slightly decreased compared to control subjects. Peak oxygen uptake (O-2) was significantly reduced when compared to control subjects: 16.7 +/- 6.6 mL/kg/min vs 36.1 +/- 7.7 mL/kg/min. Ventilatory efficiency was markedly impaired at rest (minute ventilation [E]/carbon dioxide output [CO2] ratio of 70 +/- 18; control subjects, 53 +/- 11; p < 0.005) and during exercise (E VS CO2 slope, 58 +/- 31; control subjects, 26 4; p < 0.005). At rest, ventilatory efficiency was correlated to resting pH and PaO2, while during exercise it was linked to PaO2. Ventilatory efficiency during exercise had the strongest correlation with observed symptoms, while hypoxemia and peak O-2 were not significantly associated with symptomatic state.Conclusion: CPX in patients with cyanotic congenital heart disease provides helpful parameters that better define the symptomatic state of these patients. The summation of disease-related factors is best reflected by ventilatory efficiency. This parameter offers additional and independent information when compared to peak O-2 and the extent of cyanosis alone.