Davies Lewis Ceri, Wensel Roland, Georgiadou Panagiota, Cicoira Mariantonietta, Coats Andrew J S, Piepoli Massimo F, Francis Darrel P
National Heart and Lung Institute, Imperial College of Science, Technology and Medicine, London, UK.
Eur Heart J. 2006 Mar;27(6):684-90. doi: 10.1093/eurheartj/ehi672. Epub 2005 Dec 7.
Predicting survival from peak exercise oxygen uptake (peak VO2) in chronic heart failure (CHF) is hindered by its reduction if exercise duration is submaximal. The oxygen uptake efficiency slope (OUES) is a non-linear description of the ventilatory response to exercise, which has the potential to describe abnormalities even early in exercise. We evaluated the physiology of OUES and assessed its potential for prognostic information in patients with CHF.
Two hundred and forty-three patients with CHF (mean age 59+/-12 years) underwent cardiopulmonary exercise testing between May 1992 and July 1996. Mean peak VO2 was 16.2+/-6.7 mL/kg/min, VE/VCO2 slope 38+/-12.5, ventilatory anaerobic threshold 10.9+/-3.5 mL/kg/min, and OUES 1.6+/-0.7 L/min. The value for each variable fell across the New York Heart Association classes (P<0.0001 by analysis of variance for each). When only the first 50% of each exercise test was used to calculate the variables, the value obtained for OUES changed the least (peak VO2 25% difference and OUES 1% difference). After a median of 9 years of follow-up, 139 patients (57%) had died. Each of the exercise variables was a significant univariate predictor of prognosis but in a multivariable model, only OUES was identified as the sole significant independent prognostic variable.
OUES provides an effective, independent measure of pathological exercise physiology. Its numerical value is relatively insensitive to the duration of exercise data from which it is calculated. Its prognostic value seems to be stronger than the best available existing measures of exercise physiology.
在慢性心力衰竭（CHF）中，如果运动持续时间未达到最大值，峰值运动摄氧量（peak VO2）会降低，这阻碍了对其生存情况的预测。摄氧量效率斜率（OUES）是对运动通气反应的非线性描述，甚至在运动早期就有可能描述异常情况。我们评估了OUES的生理学特征，并评估了其在CHF患者中提供预后信息的潜力。
1992年5月至1996年7月期间，243例CHF患者（平均年龄59±12岁）接受了心肺运动测试。平均peak VO2为16.2±6.7 mL/kg/min，VE/VCO2斜率为38±12.5，通气无氧阈值为10.9±3.5 mL/kg/min，OUES为1.6±0.7 L/min。每个变量的值在纽约心脏协会的心功能分级中均下降（每个变量经方差分析P<0.0001）。当仅使用每次运动测试的前50%来计算变量时，OUES获得的值变化最小（peak VO2差异25%，OUES差异1%）。经过9年的中位随访，139例患者（57%）死亡。每个运动变量都是预后的显著单变量预测指标，但在多变量模型中，只有OUES被确定为唯一显著的独立预后变量。
OUES提供了一种有效的、独立的病理性运动生理学测量方法。其数值对计算它所依据的运动数据持续时间相对不敏感。其预后价值似乎比现有的最佳运动生理学测量方法更强。
