Jankowska Ewa Anita, Witkowski Tomasz, Zymliński Robert, Ponikowska Beata, Petruk-Kowalczyk Jolanta, Szachniewicz Joanna, Reczuch Krzysztof, Borodulin-Nadzieja Ludmiła, Banasiak Waldemar, Ponikowski Piotr
Klinika Kardiologii 4 Wojskowego Szpitala Klinicznego we Wrocławiu.
Pol Arch Med Wewn. 2004 Mar;111(3):283-90.
In patients with chronic heart failure (CHF) augmented exercise ventilation is related to functional severity and increased mortality. Nevertheless, the optimal approach to the assessment of ventilatory response to controlled exercise has not been established.
The study was carried out to evaluate the clinical application of the measurement of ventilatory response to the early phase of exercise in the non-selected group of patients with CHF.
We investigated 180 consecutive patients with CHF (155 men, age: 59 +/- 11 years, left ventricle ejection fraction: 31 +/- 7%; NYHA class I/II/III/IV: 13/90/60/17). All patients underwent the cardiopulmonary exercise testing (CPX) with RER > 1.0 (mean peak oxygen consumption [peakVO2]: 15.5 +/- 4.8 ml/kg/min). Ventilatory response to exercise was assessed: 1) during the whole exercise--expressed as a correlation coefficient of linear regression describing the relationship between minute ventilation (VE) and carbon dioxide production (VCO2) during the whole exercise (VE-VCO2 100%); 2) during the early phase of exercise--expressed as VE-VCO2 derived from VE and VCO2 during first 180 seconds of exercise (VE-VCO2 180 s).
Ventilatory responses to early and maximal exercise were significantly augmented in CHF patients (VE-VCO2 100% -36.1 +/- 9.8, VE-VCO2 180% -34.4 +/- 10.3; p < 0.0001 vs values in the reference group without CHF). Ventilatory responses to early and whole exercise were strongly interrelated (r = 0.88, p < 0.0001). Indices of exercise ventilation correlated with the severity of CHF expressed as NYHA class (for VE-VCO2 100% and VE-VCO2 180 s -r = 0.52 and r = 0.51) and peak VO2 (for VE-VCO2 100% and VE-VCO2 180 s, r = -0.49 and r = -0.47, respectively) (p < 0.0001 for all correlations). Among echocardiographic parameters only right ventricular systolic pressure correlated with indices of exercise ventilation (for VE-VCO2 100% -r = 0.45, p = 0.001; for VE-VCO2 180 s -r = 0.35, p = 0.01). The reproducibility of indices of exercise ventilation was assessed in 19 CHF patients (another CPX during 2-9 days), and variability coefficients reached 7.8% for VE-VCO2 100% and 8.5% for VE-VCO2 180 s.
Indices of ventilatory response to both early and maximal exercise can significantly differentiate the CHF patients with regard to their exercise capacity, are highly reproducible, and may therefore constitute useful parameters carrying an important clinical message. The assessment of ventilatory response during the early stage of exercise seems to be of a particular significance in CHF patients who are unable to perform the maximal exercise effort, as diagnostic data obtained during first 180 seconds of exercise are in accordance to those derived from the standard maximal CPX.
在慢性心力衰竭（CHF）患者中，运动时通气增加与功能严重程度及死亡率升高相关。然而，评估对控制性运动的通气反应的最佳方法尚未确立。
本研究旨在评估在未选择的CHF患者组中测量运动早期通气反应的临床应用。
我们调查了180例连续的CHF患者（155例男性，年龄：59±11岁，左心室射血分数：31±7%；纽约心脏协会心功能分级I/II/III/IV级：13/90/60/17）。所有患者均进行了心肺运动试验（CPX），呼吸交换率（RER）>1.0（平均峰值耗氧量[peakVO2]：15.5±4.8 ml/kg/min）。评估运动通气反应：1）在整个运动过程中——表示为描述整个运动过程中分钟通气量（VE）与二氧化碳产生量（VCO2）之间关系的线性回归相关系数（VE-VCO2 100%）；2）在运动早期——表示为运动开始180秒内由VE和VCO2得出的VE-VCO2（VE-VCO2 180 s）。
CHF患者对早期和最大运动的通气反应显著增强（VE-VCO2 100% -36.1±9.8，VE-VCO2 180% -34.4±10.3；与无CHF的参照组相比，p<0.0001）。对早期和整个运动的通气反应密切相关（r = 0.88，p<0.0001）。运动通气指标与以纽约心脏协会心功能分级表示的CHF严重程度相关（对于VE-VCO2 100%和VE-VCO2 180 s，r分别为0.52和0.51），与peakVO2相关（对于VE-VCO2 100%和VE-VCO2 180 s，r分别为-0.49和-0.47）（所有相关性的p<0.0001）。在超声心动图参数中，仅右心室收缩压与运动通气指标相关（对于VE-VCO2 100%，r = 0.45，p = 0.001；对于VE-VCO2 180 s，r = 0.35，p = 0.01）。在19例CHF患者中评估了运动通气指标的可重复性（在2 - 9天内进行另一次CPX），VE-VCO2 100%的变异系数达到7.8%，VE-VCO2 180 s 的变异系数达到8.5%。
对早期和最大运动的通气反应指标能够显著区分CHF患者的运动能力，具有高度可重复性，因此可能构成携带重要临床信息的有用参数。在无法进行最大运动努力的CHF患者中，评估运动早期的通气反应似乎具有特殊意义，因为在运动开始180秒内获得的诊断数据与从标准最大CPX得出的数据一致。
