Cardiac Reserve and Exercise Capacity: Insights from Combined Cardiopulmonary and Exercise Echocardiography Stress Testing
Cardiac Reserve and Exercise Capacity: Insights from Combined Cardiopulmonary and Exercise Echocardiography Stress Testing
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DOI：
10.1016/j.echo.2020.08.015
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发表时间：
2021-01-04
影响因子：
6.5
通讯作者：
Masi, Stefano
中科院分区：
文献类型：
--
作者：
Pugliese, Nicola Riccardo;De Biase, Nicolo;Masi, Stefano
背景：心肺功能运动试验（CPET）是无创评估峰值耗氧量（VO 2）的金标准。为了提高对不耐受机制的分析，我们研究了运动负荷超声心动图测量是否与心力衰竭（HF）患者运动过程中直接测量的峰值VO 2有关。方法：我们对30名健康对照和357名患者进行了限制性分级斜坡自行车CPET运动负荷超声心动图。113例有发生HF的风险（美国心脏病学会/美国心脏协会A-B期）和244例HF C期，（HFpEF，n = 101）或射血分数降低结果：与对照组相比，峰值VO 2显著降低（P <0.01），与对照组相比，峰值VO 2显著降低（P <0.01），与对照组相比，峰值VO 2显著降低（P <0.01），与对照组相比，峰值VO 2显著降低（P <0.01），与对照组相比，峰值VO 2显著降低（P <0.01（23，21.7-29.7 mL/kg/min;中位数，四分位距）至A-B期（18，15.4-20.7 mL/kg/min）和阶段C（HFpEF：13.6，11.8-16.8 mL/kg/min; HFrEF：14.2，10.7-17.5 mL/kg/min）。预测峰值VO 2的回归模型显示，峰值左心室（LV）收缩期瓣环组织速度（S '）、峰值三尖瓣环平面收缩期偏移/收缩期肺动脉压（右心室-肺动脉耦合）和低负荷左心房（LA）储层应变/E/e'除峰值心率、每搏输出量和工作负荷外，左心房顺应性是独立的预测因子（校正后的R-2 = 0.76，P <0.0001）。该模型在房颤受试者（n = 49）和使用（n = 224）和不使用（n = 163）β受体阻滞剂的受试者中成功测试（所有P <0.01）。峰S'在预测峰值VO 2 < 10 mL/kg/min时显示出最高的准确性（与模型的其他心脏变量相比，临界点20 mL/kg/min（临界点> 12.5 cm/sec，曲线下面积= 0.84，P < .0001（P < .05）。结论：除心率和每搏输出量外，峰值VO 2与LV收缩功能、LA顺应性和右心室-肺动脉耦合的测量直接相关，且与工作负荷、年龄、和性别心脏力学的评价可能会提供更多的见解，从HF阶段A-C的受试者的努力不耐受的原因。
Background: Cardiopulmonary exercise testing (CPET) represents the gold standard to estimate peak oxygen consumption (VO2) noninvasively. To improve the analysis of the mechanisms behind effort intolerance, we examined whether exercise stress echocardiography measurements relate to directly measured peak VO2 during exercise in a large cohort of patients within the heart failure (HF) spectrum.Methods: We performed a symptom-limited graded ramp bicycle CPET exercise stress echocardiography in 30 healthy controls and 357 patients: 113 at risk of developing HF (American College of Cardiology/American Heart Association stage A-B) and 244 in HF stage C with preserved (HFpEF, n = 101) or reduced ejection fraction (HFrEF, n = 143).Results: Peak VO2 significantly decreased from controls (23, 21.7-29.7 mL/kg/minute; median, interquartile range) to stage A-B (18, 15.4-20.7 mL/kg/minute) and stage C (HFpEF: 13.6, 11.8-16.8 mL/kg/minute; HFrEF: 14.2, 10.7-17.5 mL/kg/minute). A regression model to predict peak VO2 revealed that peak left ventricular (LV) systolic annulus tissue velocity (S'), peak tricuspid annular plane systolic excursion/systolic pulmonary artery pressure (right ventricle-pulmonary artery coupling), and low-load left atrial (LA) reservoir strain/E/e' (LA compliance) were independent predictors, in addition to peak heart rate, stroke volume, and workload (adjusted R-2 = 0.76, P < .0001). The model was successfully tested in subjects with atrial fibrillation (n = 49) and with (n = 224) and without (n = 163) beta-blockers (all P < .01). Peak S' showed the highest accuracy in predicting peak VO2 < 10 mL/kg/minute (cut point 20 mL/kg/minute (cut point > 12.5 cm/sec, area under the curve = 0.84, P < .0001) in comparison with the other cardiac variables of the model (P < .05).Conclusions: Peak VO2 is directly related to measures of LV systolic function, LA compliance, and right ventricle-pulmonary artery coupling, in addition to heart rate and stroke volume and independently of workload, age, and sex. The evaluation of cardiac mechanics may provide more insights into the causes of effort intolerance in subjects from HF stages A-C.