Peak VO2 and VE/VCO2 slope in patients with heart failure:: A prognostic comparison
Peak VO2 and VE/VCO2 slope in patients with heart failure:: A prognostic comparison
复制标题
DOI：
10.1016/j.ahj.2003.07.014
复制
发表时间：
2004-02-01
影响因子：
4.8
通讯作者：
Peberdy, MA
中科院分区：
文献类型：
--
作者：
Arena, R;Myers, J;Peberdy, MA
运动试验与通气呼气分析已被证明是评估心力衰竭（HF）患者的一种有价值的工具。峰值耗氧量（峰值VO2）仍然被认为是评估心衰预后的金标准。最近，微小通气-二氧化碳生成关系（VE/VCO2斜率）在心衰患者中被证明具有预后意义，在一些研究中，其效果优于峰值VO2。方法1993年4月1日至2001年10月19日，对确诊HF的213例患者进行运动试验。研究了峰值VO2和VE/VCO2斜率预测心脏相关死亡率和住院率的能力。结果单因素Cox回归分析显示，峰值VO2和VE/VCO2斜率均是心脏相关死亡率和住院率的显著预测因子（P < 0.01）。多变量分析显示，VO2峰值增加了预测心脏相关住院的VE/VCO2斜率的附加价值，但没有增加心脏相关死亡率。受试者工作特征曲线分析表明，VE/VCO2斜率在预测心脏相关死亡率方面明显优于峰值VO2 （P < 0.05）。虽然受试者工作特征曲线下的VE/VCO2斜率面积大于峰值VO2在预测心脏相关住院方面（0.77 vs 0.73），但差异无统计学意义（P = 0.14）。结论这些结果增加了现有的知识体系，支持在心衰中使用心肺运动试验。应考虑修订临床指南，以反映除VO2峰值外VE/VCO2斜率对预后的重要性。
Background Exercise testing with ventilatory expired gas analysis has proven to be a valuable tool for assessing patients with heart failure (HF). Peak oxygen consumption (peak VO2) continues to be considered the gold standard for assessing prognosis in HF. The minute ventilation - carbon dioxide production relationship (VE/VCO2 slope) has recently demonstrated prognostic significance in patients with HF, and in some studies, it has outperformed peak VO2.Methods Two hundred thirteen subjects, in whom HF was diagnosed, underwent exercise testing between April 1, 1993, and October 19, 2001. The ability of peak VO2 and VE/VCO2 slope to predict cardiac-related mortality and hospitalization was examined.Results Peak VO2 and VE/VCO2 slope were demonstrated with univariate Cox regression analysis both to be significant predictors of cardiac-related mortality and hospitalization (P < .01). Multivariate analysis revealed that peak VO2 added additional value to the VE/VCO2 slope in predicting cardiac-related hospitalization, but not cardiac mortality. The VE/VCO2 slope was demonstrated with receiver operating characteristic curve analysis to be significantly better than peak VO2 in predicting cardiac-related mortality (P < .05). Although area under the receiver operating characteristic curve for the VE/VCO2 slope was greater than peak VO2 in predicting cardiac-related hospitalization (0.77 vs 0.73), the difference was not statistically significant (P = .14).Conclusions These results add to the present body of knowledge supporting the use of cardiopulmonary exercise testing in HF. Consideration should be given to revising clinical guidelines to reflect the prognostic importance of the VE/VCO2 slope in addition to peak VO2.