Cicoira Mariantonietta, Davos Constantinos H, Francis Darrel P, Doehner Wolfram, Zanolla Luisa, Franceschini Lorenzo, Piepoli Massimo F, Coats Andrew J S, Zardini Piero, Poole-Wilson Philip A, Anker Stefan D
Divisione Clinicizzata di Cardiologia, Università degli Studi di Verona, Italy.
J Card Fail. 2004 Oct;10(5):421-6. doi: 10.1016/j.cardfail.2003.12.009.
Peak oxygen consumption (pVO2) reflects oxygen extraction from the skeletal muscles, but is routinely corrected for body weight. We hypothesized that correcting pVO2 for lean tissue rather than total body weight would improve the prediction of prognosis in patients with chronic heart failure (CHF).
A total of 272 CHF outpatients (mean age 61 +/- 12 years, New York Heart Association [NYHA] class 2.3 +/- 0.8) underwent a cardiopulmonary exercise testing and body composition assessment by dual-energy X-ray absorptiometry. During a median follow-up of 608 days (range 8-3656), 75 patients died. Univariate survival analysis showed strong survival prediction from pVO2 adjusted for total weight or lean tissue (chi2 17.7, P < .001; chi2 27.5, P < .0001, respectively). Both predicted survival significantly in bivariate analysis, (chi2 4.6, P = .032; chi2 16.6, P < .0001). The predictive effects were independent of exercise protocol (treadmill versus cycle ergometer) (both P < .001). Multivariate analysis showed that pVO2 adjusted for lean tissue had prognostic importance independently of NYHA class, ejection fraction, and ventilation and carbon dioxide production slope (P < .05 for each). In patients with NYHA class I and II (n = 160), pVO2 adjusted for lean tissue predicted outcome (P = .03).
Adjustment for lean tissue instead for body weight increases the prognostic power of pVO2, particularly in patients with mild heart failure.
峰值摄氧量（pVO2）反映了从骨骼肌摄取的氧气量，但通常会根据体重进行校正。我们假设，用瘦组织而非总体重来校正pVO2，将改善对慢性心力衰竭（CHF）患者预后的预测。
共有272例CHF门诊患者（平均年龄61±12岁，纽约心脏协会[NYHA]心功能分级为2.3±0.8级）接受了心肺运动试验，并通过双能X线吸收法进行了身体成分评估。在中位随访608天（范围8 - 3656天）期间，75例患者死亡。单因素生存分析显示，校正总体重或瘦组织后的pVO2具有很强的生存预测能力（分别为χ2 17.7，P < 0.001；χ2 27.5，P < 0.0001）。在双因素分析中，两者均显著预测生存（χ2 4.6，P = 0.032；χ2 16.6，P < 0.0001）。预测效果与运动方案（跑步机与功率自行车）无关（P均< 0.001）。多因素分析显示，校正瘦组织后的pVO2具有独立于NYHA分级、射血分数以及通气和二氧化碳产生斜率的预后重要性（每项P < 0.05）。在NYHA I级和II级患者（n = 160）中，校正瘦组织后的pVO2可预测预后（P = 0.03）。
用瘦组织而非体重进行校正可提高pVO2的预后预测能力，尤其是在轻度心力衰竭患者中。
