Tsuneoka Hidekazu, Koike Akira, Nagayama Osamu, Sakurada Koji, Kato Jo, Sato Akira, Yamashita Takeshi, Aonuma Kazutaka
Cardiovascular Institute, Tokyo, Japan.
Int Heart J. 2012;53(2):102-7. doi: 10.1536/ihj.53.102.
Parameters obtained from cardiopulmonary exercise testing (CPX) are recognized for their high prognostic value in predicting future cardiac events in cardiac patients. Our group compared the prognostic value of CPX parameters between patients with sinus rhythm (SR) and patients with atrial fibrillation (AF).Peak O2 uptake (VO2), the ratio of the increase in VO2 to the increase in work rate (ΔVO2/ΔWR), and the slope of the increase in ventilation to the increase in CO2 output (VE-VCO2 slope) were obtained from CPX in 72 AF patients and 478 SR patients. The prognostic values of these indices were compared between the two groups.Six cardiac deaths and 25 cardiac events were observed in the AF group and 9 cardiac deaths and 96 cardiac events were observed in the SR group, over a prospective follow-up period of 1,192 days. The percentages of cardiac deaths and cardiac events were higher in the AF group than in the SR group. In a multivariate Cox proportional hazards analysis, peak VO2 was identified as a sole significant predictor of cardiac death and cardiac events in SR patients and VE-VCO2 slope was identified as a sole significant predictor of cardiac death and cardiac events in AF patients.Our results suggest that the VE-VCO2 slope is strongly predictive of future cardiac events in patients with AF and that peak VO2 is strongly predictive of future cardiac events in SR patients.
从心肺运动试验（CPX）获得的参数，因其在预测心脏病患者未来心脏事件方面具有较高的预后价值而得到认可。我们的研究小组比较了窦性心律（SR）患者和心房颤动（AF）患者CPX参数的预后价值。从72例AF患者和478例SR患者的CPX中获取了峰值摄氧量（VO2）、VO2增加量与工作率增加量的比值（ΔVO2/ΔWR）以及通气量增加量与二氧化碳排出量增加量的斜率（VE-VCO2斜率）。比较了两组这些指标的预后价值。在为期1192天的前瞻性随访期内，AF组观察到6例心脏死亡和25例心脏事件，SR组观察到9例心脏死亡和96例心脏事件。AF组心脏死亡和心脏事件的百分比高于SR组。在多变量Cox比例风险分析中，峰值VO2被确定为SR患者心脏死亡和心脏事件的唯一显著预测因子，而VE-VCO2斜率被确定为AF患者心脏死亡和心脏事件的唯一显著预测因子。我们的结果表明，VE-VCO2斜率对AF患者未来心脏事件具有很强的预测性，而峰值VO2对SR患者未来心脏事件具有很强的预测性。
