Davies L C, Francis D P, Piepoli M, Scott A C, Ponikowski P, Coats A J
Royal Brompton Hospital, Sydney Street, London SW3 6NP, UK.
Heart. 2000 Feb;83(2):147-51. doi: 10.1136/heart.83.2.147.
To assess the value of cardiopulmonary exercise testing in predicting prognosis in a cohort of elderly patients with chronic heart failure (CHF).
A retrospective cohort study of all patients with CHF over the age of 70 years assessed between January 1992 and May 1997.
Tertiary centre.
50 patients (mean (SD) age 75.9 (4.5) years, 8 women) with CHF New York Heart Association (NYHA) class I (3 patients), II (25 patients), III (20 patients), and IV (2 patients). Follow up was complete for two years in all patients.
The patients underwent cardiopulmonary exercise testing (peak oxygen consumption 15.2 (4.5) ml/kg/min, minute ventilation/carbon dioxide production (VE/VCO(2)) slope 38.7 (11.8)); radionucleide ventriculography (left ventricular ejection fraction 32.8 (14.3)%); serum sodium measurement (139 (2.8) mmol/l); and echocardiography (left ventricular end diastolic dimension 6.1 (1.1) cm, left ventricular end systolic dimension 4.7 (1.5) cm). At the end of follow up in May 1999, 26 patients had died. The median follow up of the survivors was 47.7 months (interquartile range 31. 5-53.5 months). On univariate analysis VE/VCO(2) slope (p < 0.0001), NYHA class (p < 0.001), peak oxygen uptake (VO(2)) (p < 0.01), left ventricular end systolic dimension (p < 0.05), and serum sodium concentration (p < 0.05) had significant predictive power. Stepwise multivariate analysis identified only VE/VCO(2) slope (p < 0.01), NYHA class (p < 0.05), and peak VO(2) (p< 0.05) as conveying significant independent prognostic information.
Elderly patients with CHF have a high mortality, with the majority dead within two years. Cardiopulmonary exercise testing provides important information for risk stratification within this group and its use should not be neglected.
评估心肺运动试验对一组老年慢性心力衰竭（CHF）患者预后的预测价值。
对1992年1月至1997年5月间评估的所有70岁以上CHF患者进行回顾性队列研究。
三级中心。
50例CHF患者（平均（标准差）年龄75.9（4.5）岁，8名女性），纽约心脏协会（NYHA）心功能分级为I级（3例）、II级（25例）、III级（20例）和IV级（2例）。所有患者均完成了两年的随访。
患者接受了心肺运动试验（峰值摄氧量15.2（4.5）ml/kg/min，分钟通气量/二氧化碳产生量（VE/VCO₂）斜率38.7（11.8））；放射性核素心室造影（左心室射血分数32.8（14.3）%）；血清钠测定（139（2.8）mmol/l）；以及超声心动图检查（左心室舒张末期内径6.1（1.1）cm，左心室收缩末期内径4.7（1.5）cm）。在1999年5月随访结束时，26例患者死亡。幸存者的中位随访时间为47.7个月（四分位间距31.5 - 53.5个月）。单因素分析显示，VE/VCO₂斜率（p < 0.0001）、NYHA分级（p < 0.001）、峰值摄氧量（VO₂）（p < 0.01）、左心室收缩末期内径（p < 0.05）和血清钠浓度（p < 0.05）具有显著的预测能力。逐步多因素分析仅确定VE/VCO₂斜率（p < 0.01）、NYHA分级（p < 0.05）和峰值VO₂（p < 0.05）可传达显著的独立预后信息。
老年CHF患者死亡率高，大多数在两年内死亡。心肺运动试验为该组患者的危险分层提供重要信息，其应用不应被忽视。
