开发心肺运动预后评分以优化心力衰竭风险分层：（P）e（R）i（O）dic（B）reathing during（E）xercise（PROBE）研究。
Development of a cardiopulmonary exercise prognostic score for optimizing risk stratification in heart failure: the (P)e(R)i(O)dic (B)reathing during (E)xercise (PROBE) study.
机构信息
Cardiopulmonary Unit, University of Milano, Milano, Italy.
出版信息
J Card Fail. 2010 Oct;16(10):799-805. doi: 10.1016/j.cardfail.2010.04.014. Epub 2010 Jun 20.
BACKGROUND
Cardiopulmonary exercise testing (CPET) provides powerful information on risk of death in heart failure (HF). We sought to define the relative and additive contribution of the 3 landmark (CPET) prognostic markers--peak oxygen consumption (VO₂), minute ventilation/carbon dioxide production (VE/VCO₂) slope, and exercise periodic breathing (EPB)-to the overall risk of cardiac death and to develop a prognostic score for optimizing risk stratification in HF patients.
METHODS AND RESULTS
A total of 695 stable HF patients (average LVEF: 25 ± 8%) underwent a symptom-limited CPET maximum test after familiarization and were prospectively tracked for cardiac mortality. At multivariable Cox analysis EPB emerged as the strongest prognosticator. Using a statistical bootstrap technique (5000 data resamplings), point estimates, and 95% confidence intervals were obtained. Thirty-two configurations were adopted to classify patients into a given cell, according to EPB presence or absence and values of the 2 other covariates. Configurations without EPB and with VE/VCO₂ slope ≤30 were not significantly different from 0 (reference value). Statistical power of configurations increased with higher VE/VCO₂ slope and lower peak VO₂. This prompted us to formulate a score including EPB as a discriminating variable, the (P)e(R)i(O)dic (B)reathing during (E)xercise (PROBE), which ranges between -1 and 1, with zero as reference configuration, that would help to optimize the prognostic accuracy of CPET-derived variables. The greatest PROBE score impact was provided by EPB, followed by VE/VCO₂ slope, whereas peak VO₂ added minimal prognostic power.
CONCLUSIONS
EPB with an elevated VE/VCO₂ slope leads to the highest and most precise PROBE score, whereas no additional risk information emerges when EPB is present with a peak VO₂ ≤10 mL O₂·kg⁻¹·min⁻¹. PROBE score appears to provide a step forward for optimizing CPET use in HF prognostic definition.
背景
心肺运动测试（CPET）可提供心力衰竭（HF）患者死亡风险的有力信息。我们旨在确定 3 个标志性（CPET）预后标志物——峰值摄氧量（VO₂）、分钟通气量/二氧化碳产生量（VE/VCO₂）斜率和运动周期性呼吸（EPB）——对心脏死亡的相对和附加贡献，并为 HF 患者的预后分层制定预测评分。
方法和结果
共 695 例稳定的 HF 患者（平均 LVEF：25±8%）在熟悉后进行了症状限制的 CPET 最大测试，并前瞻性地跟踪心脏死亡率。在多变量 Cox 分析中，EPB 是最强的预后因素。使用统计 bootstrap 技术（5000 次数据重采样），获得点估计值和 95%置信区间。采用 32 种配置根据 EPB 的存在与否以及其他 2 个协变量的值将患者分类到给定的细胞中。没有 EPB 且 VE/VCO₂斜率≤30 的配置与 0（参考值）无显著差异。配置的统计能力随 VE/VCO₂斜率升高和峰值 VO₂降低而增加。这促使我们制定了一个评分，包括 EPB 作为区分变量，即（P）e（R）i（O）dic（B）reathing during（E）xercise（PROBE），范围为-1 到 1，以零为参考配置，有助于优化 CPET 衍生变量的预后准确性。最大的 PROBE 评分影响来自 EPB，其次是 VE/VCO₂斜率，而峰值 VO₂仅提供最小的预后能力。
结论
当 VE/VCO₂斜率升高并伴有 EPB 时，会产生最高和最精确的 PROBE 评分，而当 EPB 存在且峰值 VO₂≤10 mL O₂·kg⁻¹·min⁻¹时，不会出现额外的风险信息。PROBE 评分似乎为优化 HF 预后定义中的 CPET 使用提供了一个新的方法。
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