Wolfel Eugene E
Division of Cardiology, University of Colorado, Health Sciences Center, Denver, CO 80262, USA.
Curr Heart Fail Rep. 2006 Jun;3(2):81-8. doi: 10.1007/s11897-006-0006-x.
Cardiopulmonary exercise testing (CPET) has been used for the assessment of severity of heart failure (HF), secondary to left ventricular systolic dysfunction. Initial studies determined that oxygen consumption (VO2) during exercise, as a measure of functional capacity, correlated well with the hemodynamic responses related to chronic HF. These studies led to the use of peak VO2 as a prognostic indicator in chronic HF. In addition, the use of several ventilatory parameters, eg, minute ventilation/carbon dioxide production during submaximal and peak exercise, were shown to have additive and (in some studies) superior prognostic value in patients with chronic HF. However, most of these studies were performed before beta-adrenergic blockade became the main focus of therapy in chronic HF. Unlike other drugs used in the treatment of HF, these drugs do not consistently improve exercise capacity as measured by peak VO2. Several retrospective studies and one prospective study have examined the effect of long-term beta-blocker therapy on the prognostic value of CPET in patients with chronic HF. These studies indicate that patients on beta-blockers have improved overall cardiovascular outcomes compared with patients not on these drugs. In addition, peak exercise VO2 still has prognostic value in beta-blocked patients; however, the thresholds for increased risk and need for transplantation have to be lower than in patients not on these drugs. There appears to be a real demand for a comprehensive survival score tool that includes the use of beta-blockade, along with CPET performance.
心肺运动试验（CPET）已被用于评估继发于左心室收缩功能障碍的心力衰竭（HF）的严重程度。最初的研究确定，运动期间的耗氧量（VO2）作为功能能力的一项指标，与慢性HF相关的血流动力学反应密切相关。这些研究促使将峰值VO2用作慢性HF的预后指标。此外，在次最大运动和峰值运动期间使用几个通气参数，例如分钟通气量/二氧化碳产生量，已被证明在慢性HF患者中具有附加的以及（在一些研究中）更高的预后价值。然而，这些研究大多是在β-肾上腺素能阻滞剂成为慢性HF治疗的主要焦点之前进行的。与用于治疗HF的其他药物不同，这些药物并不能持续改善通过峰值VO2测量的运动能力。几项回顾性研究和一项前瞻性研究已经探讨了长期β受体阻滞剂治疗对慢性HF患者CPET预后价值的影响。这些研究表明，与未使用这些药物的患者相比，使用β受体阻滞剂的患者总体心血管结局得到改善。此外，峰值运动VO2在使用β受体阻滞剂的患者中仍具有预后价值；然而，风险增加和移植需求的阈值必须低于未使用这些药物的患者。似乎确实需要一种综合生存评分工具，该工具包括使用β受体阻滞剂以及CPET表现。
