心肺运动试验在心力衰竭患者中的预后价值经得起时间的考验。
The prognostic utility of cardiopulmonary exercise testing stands the test of time in patients with heart failure.
机构信息
Department of Orthopaedics, University of New Mexico Health Sciences Center, HSSB Room 204F, MSC09 5230, Albuquerque, NM 87131, USA.
出版信息
J Cardiopulm Rehabil Prev. 2012 Jul-Aug;32(4):198-202. doi: 10.1097/HCR.0b013e318259f153.
INTRODUCTION
While the medical management strategy for patients with heart failure (HF) has dramatically changed, cardiopulmonary exercise testing (CPX) procedures and the data obtained have remained relatively stable. We are unaware of any previous investigation that has assessed differences in the prognostic utility of CPX in HF according to time period, reflecting differences in the clinical management of systolic HF.
METHODS
Subjects (n = 381) underwent CPX between April 1, 1993, and December 31, 2005, and the remaining 511 were tested between January 1, 2006, and October 28, 2010. Peak oxygen uptake ((Equation is included in full-text article.)O2) and the minute ventilation/carbon dioxide production ((Equation is included in full-text article.)E/(Equation is included in full-text article.)CO2) slope were ascertained for all tests.
RESULTS
Both the (Equation is included in full-text article.)E/(Equation is included in full-text article.)CO2 slope and peak (Equation is included in full-text article.)O2 were strong univariate predictors of adverse events in both subgroups. In the multivariate analysis, the (Equation is included in full-text article.)E/(Equation is included in full-text article.)CO2 slope was the strongest predictive marker while peak (Equation is included in full-text article.)O2 added predictive value and was retained in the regression for all scenarios. In subjects undergoing CPX before 2006, a (Equation is included in full-text article.)E/(Equation is included in full-text article.)CO2 slope 45 or greater and a peak (Equation is included in full-text article.)O2 of less than 10 mL · kg · min generated a hazard ratio of 4.2 (95% CI: 1.9-9.1, P < .001) when considering only mortality as an endpoint. In subjects undergoing CPX after 2006, a (Equation is included in full-text article.)E/(Equation is included in full-text article.)CO2 slope 45 or greater and a peak (Equation is included in full-text article.)O2 of less than 10 mL · kg · min generated a hazard ratio of 8.2 (95% CI: 4.7-14.3, P < .001) when considering only mortality as an endpoint.
CONCLUSION
The results of this study indicate that CPX continues to be a valuable clinical assessment in the present-day HF management.
简介
虽然心力衰竭（HF）患者的医学管理策略发生了重大变化，但心肺运动测试（CPX）程序和获得的数据仍然相对稳定。我们不知道以前有任何研究评估过根据时间点，CPX 在 HF 中的预后效用差异，这反映了收缩性 HF 临床管理的差异。
方法
受试者（n=381）于 1993 年 4 月 1 日至 2005 年 12 月 31 日期间进行 CPX 测试，其余 511 名受试者于 2006 年 1 月 1 日至 2010 年 10 月 28 日期间进行 CPX 测试。所有测试均确定了峰值摄氧量（(Equation is included in full-text article.)O2）和分钟通气量/二氧化碳产量（(Equation is included in full-text article.)E/(Equation is included in full-text article.)CO2）斜率。
结果
在两个亚组中，(Equation is included in full-text article.)E/(Equation is included in full-text article.)CO2 斜率和峰值 (Equation is included in full-text article.)O2 都是不良事件的强单变量预测因子。在多变量分析中，(Equation is included in full-text article.)E/(Equation is included in full-text article.)CO2 斜率是最强的预测标志物，而峰值 (Equation is included in full-text article.)O2 增加了预测值，并保留在所有情况下的回归中。在 2006 年之前进行 CPX 测试的受试者中，(Equation is included in full-text article.)E/(Equation is included in full-text article.)CO2 斜率为 45 或更高，峰值 (Equation is included in full-text article.)O2 为 10 mL·kg·min 以下，仅考虑死亡率作为终点时，危险比为 4.2（95%CI：1.9-9.1，P<.001）。在 2006 年之后进行 CPX 测试的受试者中，(Equation is included in full-text article.)E/(Equation is included in full-text article.)CO2 斜率为 45 或更高，峰值 (Equation is included in full-text article.)O2 为 10 mL·kg·min 以下，仅考虑死亡率作为终点时，危险比为 8.2（95%CI：4.7-14.3，P<.001）。
结论
这项研究的结果表明，CPX 在当今 HF 管理中仍然是一种有价值的临床评估。
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