功能性运动储备对心力衰竭患者的预后价值。

Prognostic usefulness of the functional aerobic reserve in patients with heart failure.

机构信息

LeBauer Cardiovascular Research Foundation, Greensboro, NC, USA.

出版信息

Am Heart J. 2010 Nov;160(5):922-7. doi: 10.1016/j.ahj.2010.08.003.

DOI:10.1016/j.ahj.2010.08.003

PMID:21095281

Abstract

BACKGROUND

Peak oxygen consumption derived from cardiopulmonary exercise (CPX) testing provides important prognostic information in patients with heart failure (HF). The oxygen consumption at the ventilatory threshold (VT) has also been shown to be prognostic. However, the VT cannot always be detected in patients with HF. Other variables such as the difference between peak oxygen consumption and oxygen consumption at the VT (termed the functional aerobic reserve [FAR]) may also provide prognostic information. The purpose of this study was to determine the prognostic value of an undetectable VT and FAR.

METHODS

Eight hundred seventy-four patients with chronic, systolic HF (70% male, age 54 ± 14 years, ejection fraction 29% ± 12%) underwent CPX and were tracked for 2 years for major events (death, transplant, and left ventricular assist device implantation).

RESULTS

Patients were divided into 2 subgroups based on whether VT could be detected or not. There were 141 major events during the 2-year follow-up. Kaplan-Meier analysis for the 2 VT subgroups demonstrated worse prognoses for patients with a nondetectable VT versus those with a detectable VT (P < .001). Based on receiver operating characteristic curve analysis (FAR = 0 mlO₂ kg⁻¹ min⁻¹ for patients with undetectable VT), the optimal cut-point for FAR was ≤/>3 mlO₂ kg min⁻¹ (sensitivity/specificity 69%/60%). Cox regression analysis identified the FAR as a significant univariate predictor of risk and was retained in multivariate analysis.

CONCLUSION

In conclusion, these data reveal that an undetectable VT and the FAR during CPX testing can provide useful prognostic information in patients with HF.

摘要

背景

心肺运动（CPX）测试得出的峰值耗氧量可提供心力衰竭（HF）患者重要的预后信息。通气阈（VT）的耗氧量也已被证明具有预后价值。然而，HF 患者的 VT 并不总能被检测到。其他变量，如峰值耗氧量与 VT 耗氧量之差（称为功能有氧储备[FAR]），也可能提供预后信息。本研究旨在确定不可检测的 VT 和 FAR 的预后价值。

方法

874 例慢性收缩性 HF 患者（70%为男性，年龄 54±14 岁，射血分数 29%±12%）接受 CPX 检查，并在 2 年内对主要事件（死亡、移植和左心室辅助装置植入）进行随访。

结果

根据 VT 是否可检测，患者被分为 2 个亚组。在 2 年的随访中，发生了 141 起主要事件。对 2 个 VT 亚组的 Kaplan-Meier 分析表明，VT 不可检测的患者预后较 VT 可检测的患者差（P<0.001）。基于受试者工作特征曲线分析（FAR=0 mlO₂ kg⁻¹ min⁻¹，用于 VT 不可检测的患者），FAR 的最佳截断值为≤/>3 mlO₂ kg min⁻¹（灵敏度/特异性为 69%/60%）。Cox 回归分析将 FAR 确定为风险的显著单变量预测因素，并保留在多变量分析中。