Pardaens K, Van Cleemput J, Vanhaecke J, Fagard R H
Hypertension and Cardiovascular Rehabilitation Unit, Faculty of Medicine, University of Leuven, Belgium.
Acta Cardiol. 1999 Dec;54(6):345-54.
Peak oxygen uptake (VO2) is a powerful prognostic index, but maximal exercise testing in heart transplant candidates has a number of disadvantages. It is unknown whether it is possible to predict peak VO2 from a comprehensive dataset with parameters of heart and lung function at rest.
One hundred adult patients in sinus rhythm and with either idiopathic or ischaemic heart failure performed a graded cycle ergometer test until volitional fatigue and underwent radionuclide ventriculography, heart catheterization, and lung function measurements at rest.
Weight, height, age, gender and aetiology of heart failure explained 48% of the variance of peak VO2. On top of these anthropometric, demographic and clinical patient characteristics, 12% of the variance of peak VO2 was additionally explained by all resting measurements combined, i.e. radionuclide left ventricular ejection fraction, peak ejection rate, peak filling rate, cardiac frequency, mean right atrial pressure, pulmonary capillary wedge pressure, pulmonary artery pressures, cardiac output, forced vital capacity, forced expiratory volume in one second, and pulmonary diffusing capacity (cumulative R2 = 0.60); among these, pulmonary vascular resistance was the most important predictor (+6%; P < 0.001). Analyses in a subset of 43 male patients pointed out that systemic pressures and vascular resistance were not related to peak VO2.
On the basis of resting left ventricular function, haemodynamics, and routine pulmonary measurements, it is unlikely to accurately predict exercise tolerance in the majority of heart transplant candidates, i.e. patients with either idiopathic or ischaemic heart failure and able to exercise until exhaustion.
峰值摄氧量（VO2）是一项强有力的预后指标，但对心脏移植候选者进行最大运动测试存在诸多缺点。目前尚不清楚能否根据包含静息时心肺功能参数的综合数据集来预测峰值VO2。
100例窦性心律的成年患者，患有特发性或缺血性心力衰竭，进行分级踏车测力计测试直至自愿疲劳，并在静息状态下接受放射性核素心室造影、心导管检查和肺功能测量。
体重、身高、年龄、性别和心力衰竭病因解释了峰值VO2变异的48%。除了这些人体测量学、人口统计学和临床患者特征外，所有静息测量值综合起来又额外解释了峰值VO2变异的12%，即放射性核素左心室射血分数、峰值射血率、峰值充盈率、心率、平均右心房压、肺毛细血管楔压、肺动脉压、心输出量、用力肺活量、一秒用力呼气量和肺弥散量（累积R2 = 0.60）；其中，肺血管阻力是最重要的预测因素（增加6%；P < 0.001）。对43例男性患者亚组的分析指出，体循环压力和血管阻力与峰值VO2无关。
基于静息左心室功能、血流动力学和常规肺部测量，不太可能准确预测大多数心脏移植候选者（即患有特发性或缺血性心力衰竭且能够运动至疲惫的患者）的运动耐量。
