Prognostic power of ventilatory responses during submaximal exercise in patients with chronic heart disease
Prognostic power of ventilatory responses during submaximal exercise in patients with chronic heart disease
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DOI：
10.1378/chest.121.5.1581
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发表时间：
2002-05-01
期刊：
影响因子：
9.6
通讯作者：
Watanabe, H
中科院分区：
文献类型：
--
作者：
Koike, A;Itoh, H;Watanabe, H
背景：虽然已知在次最大运动期间获得的参数可用于预测心脏病患者的死亡率，但次最大参数是否优于峰值摄氧量（（V）优于点 O-2）一直存在争议。为此，我们旨在确定运动变量中预测慢性心脏病患者长期死亡率的最佳指数。方法：研究人群由连续 385 名慢性心脏病患者组成，他们在自行车测力计上进行了症状限制增量运动测试。使用逐次呼吸呼吸气体分析来估计点 O-2 上的峰值 (V)、点 O-2 上的 (V) 增加与工作效率 (WR) 增加的比率 [(V) 点 O-2/DeltaWR]，以及点 E 上每分钟通气量 (V) 的增加与点 O-2 上二氧化碳输出增加的比率 ((V) 点 O-2，) [Delta(V) 点 E/Delta(V) 点 E/Delta(V) 点 E O-2].结果：1,899 +/- 495 天的随访（平均值 +/- SD）后，发生了 33 例心血管相关死亡。与幸存者相比，非幸存者获得了比 O-2 点更低的峰值 (V)、比 O-2/DeltaWR 更低的峰值 (V)、以及比 E 点更高的 Delta(V)/比 CO2 点更高的 Delta(V)。在单变量 Cox 比例风险分析中，发现 O-2 点上的峰值 (V)、O-2/DeltaWR 点上的 (V) 和 E 点上的 Delta(V)/CO2 点上的 Delta(V) 是重要的生存预后指标。然而，多变量分析显示，(V) 相对于点 O-2/DeltaWR 是死亡率的独立预测因子，而 Delta(V) 相对于点 E/delta(V) 相对于点 CO2 是稍弱的预测因子。在此分析中，峰值 (V) 相对于点 O-2 的预后能力微不足道。结论：对于预测慢性心脏病患者的较差生存率，次最大呼吸气体指数很可能比峰值 (V) 相对于点 O-2 更敏感。
Background: Although parameters obtained during submaximal exercise are known to be useful for predicting mortality in cardiac patients, it has been a matter of debate whether the submaximal parameters are superior to peak oxygen uptake ((V) over dot O-2,). For this purpose, we aimed to determine the best index among exercise variables in predicting long-term mortality in patients with chronic heart disease.Methods: The study population consisted of 385 consecutive patients with chronic heart disease who performed a symptom-limited incremental exercise test on a cycle ergometer. Breath-by-breath respiratory gas analysis was used to estimate the peak (V) over dot O-2, the ratio of the increase in (V) over dot O-2 to the increase in work rate (WR) [(V) over dot O-2/DeltaWR], and the ratio of the increase in minute ventilation (V) over dot E to the increase in carbon dioxide output ((V) over dot O-2,) [Delta(V) over dot E/Delta(V) over dot O-2].Results: After 1,899 +/- 495 days of follow-up (mean +/- SD), 33 cardiovascular-related deaths occurred. Nonsurvivors achieved lower peak (V) over dot O-2, lower (V) over dot O-2/DeltaWR, and higher Delta(V) over dot E/Delta(V) over dot CO2 compared to the survivors. In the univariate Cox proportional hazards analysis, peak (V) over dot O-2, (V) O-2/DeltaWR, and Delta(V) over dot E/Delta(V) over dot CO2 were found to be significant prognostic indexes of survival. However, multivariate analysis revealed (V) over dot O-2/DeltaWR as an independent predictor of mortality and Delta(V) over dot E/delta(V) over dot CO2 as a slightly weaker predictor. In this analysis, the prognostic power of peak (V) over dot O-2 was insignificant.Conclusion: Submaximal respiratory gas indexes are very likely to be more sensitive than peak (V) over dot O-2 for predicting poor survival in ambulatory patients with chronic heart disease.