Department of Medicine, Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, David Geffen School of Medicine at UCLA, St. John's Cardiovascular Research Center, Torrance, CA.
Department of Medicine, Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, David Geffen School of Medicine at UCLA, St. John's Cardiovascular Research Center, Torrance, CA.
Chest. 2012 May;141(5):1284-1294. doi: 10.1378/chest.11-1270. Epub 2011 Oct 26.
The responses of oxygen uptake efficiency (ie, oxygen uptake/ventilation = VO(2)/VE) and its highest plateau (OUEP) during incremental cardiopulmonary exercise testing (CPET) in patients with chronic left heart failure (HF) have not been previously reported. We planned to test the hypothesis that OUEP during CPET is the best single predictor of early death in HF.
We evaluated OUEP, slope of VO(2) to log(VE) (oxygen uptake efficiency slope), oscillatory breathing, and all usual resting and CPET measurements in 508 patients with low-ejection-fraction (< 35%) HF. Each had further evaluations at other sites, including cardiac catheterization. Outcomes were 6-month all-reason mortality and morbidity (death or > 24 h cardiac hospitalization). Statistical analyses included area under curve of receiver operating characteristics, ORs, univariate and multivariate Cox regression, and Kaplan-Meier plots.
OUEP, which requires only moderate exercise, was often reduced in patients with HF. A low % predicted OUEP was the single best predictor of mortality (P < .0001), with an OR of 13.0 (P < .001). When combined with oscillatory breathing, the OR increased to 56.3, superior to all other resting or exercise parameters or combinations of parameters. Other statistical analyses and morbidity analysis confirmed those findings.
OUEP is often reduced in patients with HF. Low % predicted OUEP (< 65% predicted) is the single best predictor of early death, better than any other CPET or other cardiovascular measurement. Paired with oscillatory breathing, it is even more powerful.
慢性左心衰竭（HF）患者递增心肺运动试验（CPET）中摄氧量效率（即摄氧量/通气= VO 2 /VE）及其最高平台（OUEP）的反应尚未见报道。我们计划检验假设，即 CPET 期间的 OUEP 是 HF 早期死亡的最佳单一预测指标。
我们评估了 508 例低射血分数（<35%）HF 患者的 OUEP、VO 2 对 log（VE）斜率（摄氧量效率斜率）、振荡性呼吸以及所有常规静息和 CPET 测量值。每个人在其他地点进行了进一步评估，包括心导管检查。结局为 6 个月的全因死亡率和发病率（死亡或>24 小时心脏住院）。统计分析包括受试者工作特征曲线下面积、ORs、单变量和多变量 Cox 回归以及 Kaplan-Meier 图。
仅需要适度运动的 OUEP 在 HF 患者中常常降低。低预测 %的 OUEP 是死亡率的最佳单一预测指标（P<0.0001），OR 为 13.0（P<0.001）。当与振荡性呼吸结合时，OR 增加到 56.3，优于所有其他静息或运动参数或参数组合。其他统计分析和发病率分析证实了这些发现。
OUEP 在 HF 患者中常常降低。低预测 %的 OUEP（<65%预测）是早期死亡的最佳单一预测指标，优于任何其他 CPET 或其他心血管测量值。与振荡性呼吸相结合，它更强大。
