Arena Ross, Myers Jonathan, Guazzi Marco
Department of Physiology, Virginia Commonwealth University, Health Sciences Campus, Richmond, VA 23298-0224, USA.
Heart Fail Rev. 2008 Jun;13(2):245-69. doi: 10.1007/s10741-007-9067-5. Epub 2007 Nov 7.
A hallmark symptom of heart failure (HF) is exercise intolerance, typically evidenced by excessive shortness of breath, and/or fatigue with exertion. In recent years, the physiologic response to progressive exercise using direct measures of ventilation and gas exchange, commonly termed the cardiopulmonary exercise test (CPX), has evolved into an important clinical tool in the management of patients with HF. There is currently debate regarding the optimal CPX response to apply when stratifying risk for mortality, hospitalization, or other outcomes in patients with HF. Early studies in this area focused on the application of peak VO(2) in predicting outcomes in patients considered for transplantation. More recently, the focus of these studies has shifted to an emphasis on ventilatory inefficiency, in lieu of or in combination with peak VO(2), in estimating risk. The most widely studied index of ventilatory inefficiency has been the minute ventilation/carbon dioxide production (VE/VCO(2)) slope. A growing body of studies over the last decade has demonstrated that among patients with HF, the VE/VCO(2) slope more powerfully predicts mortality, hospitalization, or both, than peak VO(2). A number of investigations have also simultaneously examined the diagnostic importance of peak VO(2) and the VE/VCO(2) slope as well as their respective response to various interventions. This review examines the body of evidence which has used aerobic capacity and ventilatory efficiency as prognostic and diagnostic markers as well as endpoints in interventional trials. Based on this evidence, recommendations for future clinical and research applications of these CPX variables are provided.
心力衰竭（HF）的一个标志性症状是运动不耐受，通常表现为过度呼吸急促和/或运动时疲劳。近年来，使用通气和气体交换的直接测量方法对渐进性运动的生理反应，通常称为心肺运动试验（CPX），已发展成为管理HF患者的重要临床工具。目前，在对HF患者的死亡率、住院率或其他结局进行风险分层时，关于应用何种最佳CPX反应存在争议。该领域的早期研究集中在应用峰值VO₂来预测考虑移植患者的结局。最近，这些研究的重点已转向强调通气效率低下，以代替峰值VO₂或与峰值VO₂结合使用来估计风险。研究最广泛的通气效率低下指标是分钟通气量/二氧化碳产生量（VE/VCO₂）斜率。在过去十年中，越来越多的研究表明，在HF患者中，VE/VCO₂斜率比峰值VO₂更能有力地预测死亡率、住院率或两者。一些研究还同时检查了峰值VO₂和VE/VCO₂斜率的诊断重要性以及它们对各种干预措施的各自反应。本综述考察了将有氧运动能力和通气效率用作预后和诊断标志物以及干预试验终点的证据。基于这些证据，提供了关于这些CPX变量未来临床和研究应用的建议。
