Toste Alexandra, Soares Rui M, Feliciano Joana, Andreozzi Valeska, Silva Sofia, Alves Sandra, Ferreira Lurdes, Abreu Ana, Ferreira Rui Cruz
Serviço de Cardiologia, Hospital de Santa Maria, Lisboa, Portugal.
Rev Port Cardiol. 2010 Sep;29(9):1305-20.
Cardiopulmonary exercise testing (CPET) is an objective method for assessment of functional capacity and for prognostic stratification of patients with chronic heart failure (CHF). In this study, we analyzed the prognostic value of a recently described CPET-derived parameter, the minute ventilation to carbon dioxide production slope normalized for peak oxygen consumption (VE/VCO2 slope/pVO2).
We prospectively studied 157 patients with stable CHF and dilated cardiomyopathy who performed maximal CPET using the modified Bruce protocol. The prognostic value of VE/VCO2 slope/pVO2 was determined and compared with traditional CPET parameters.
During follow-up 37 patients died and 12 were transplanted. Mean follow-up in surviving patients was 29.7 months (12-36). Cox multivariate analysis revealed that VE/VCO2 slope/pVO2 had the greatest prognostic power of all the parameters studied. A VE/VCO2 slope/pVO2 of > or = 2.2 signaled cases at higher risk.
Normalization of the ventilatory response to exercise for peak oxygen consumption appears to increase the prognostic value of CPET in patients with CHF.
心肺运动试验（CPET）是评估慢性心力衰竭（CHF）患者功能能力和进行预后分层的一种客观方法。在本研究中，我们分析了一种最近描述的源自CPET的参数——经峰值耗氧量标准化的每分通气量与二氧化碳产生斜率（VE/VCO2斜率/pVO2）的预后价值。
我们前瞻性地研究了157例稳定型CHF和扩张型心肌病患者，这些患者使用改良的Bruce方案进行了最大CPET。确定了VE/VCO2斜率/pVO2的预后价值，并与传统的CPET参数进行了比较。
在随访期间，37例患者死亡，12例接受了移植。存活患者的平均随访时间为29.7个月（12 - 36个月）。Cox多变量分析显示，在所有研究参数中，VE/VCO2斜率/pVO2具有最大的预后能力。VE/VCO2斜率/pVO2≥2.2表明病例处于较高风险。
经峰值耗氧量对运动通气反应进行标准化似乎增加了CPET在CHF患者中的预后价值。
