心肺运动试验预测慢性心力衰竭患者持续性室性心律失常。

Cardiopulmonary exercise test predicts sustained ventricular arrhythmias in chronic heart failure.

机构信息

Department of Cardiology, University of Foggia, Viale Pinto 1, 71100, Foggia, Italy,

出版信息

Neth Heart J. 2013 Jan;21(1):36-43. doi: 10.1007/s12471-012-0339-x.

DOI:10.1007/s12471-012-0339-x

PMID:23151817

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC3528864/

Abstract

BACKGROUND

The cardiopulmonary exercise test (CPX) is an affordable tool for risk prediction in patients with chronic heart failure (CHF). We aimed to determine the role of CPX parameters in predicting the risk of incidence of sustained ventricular arrhythmias (SVA) in CHF.

METHODS

Sixty-one consecutive patients with CHF enrolled in the Daunia Heart Failure Registry underwent CPX and were followed for 327 ± 247 days. Clinical follow-up was performed every month and anticipated in case of re-hospitalisation for cardiac disease. Incidence of SVA was evaluated by direct clinical examination (ECG, ambulatory ECG).

RESULTS

Patients with episodes of SVA (N 14) showed lower values of pVO2 and PetCO2, and higher values of VE/VCO2, VE/VCO2 slope, and VE%. After correction for age, gender, diabetes, ischaemic heart disease and left ventricular ejection fraction, peak VO2 (hazard ratio (HR) 0.68, 95 % confidence interval (CI) 0.51-0.91, p < 0.05), VE% (HR 1.38, 95 % CI 1.04-1.84, p < 0.05), VE/VCO2 (HR 1.38, 95 % CI 1.04-1.82, p < 0.05), VE/VCO2 slope (HR 1.77, 95 % CI 1.31-2.39, p < 0.01), PetCO2 (HR 0.66, 95 % CI 0.50-0.88, p < 0.01) were found as predictors of SVA. At Kaplan-Meier analysis, lower event-free rates were found in subjects with peak VO2 values below median (log rank p < 0.05), values of VE/VCO2 above mean (p < 0.05), higher VE/VCO2 slope tertiles (p <0.05), and values of PetCO2 below median (p < 0.05).

CONCLUSIONS

CPX provides prognostic independent information for risk of SVA in subjects with CHF.

摘要

背景

心肺运动试验（CPX）是一种经济实惠的工具，可用于预测慢性心力衰竭（CHF）患者的风险。我们旨在确定 CPX 参数在预测 CHF 患者持续性室性心律失常（SVA）发生率风险中的作用。

方法

Daunia 心力衰竭注册研究纳入了 61 例连续的 CHF 患者，进行 CPX 检查，并随访 327±247 天。每月进行临床随访，并在因心脏疾病再次住院时进行预期随访。通过直接临床检查（心电图、动态心电图）评估 SVA 的发生率。

结果

发生 SVA 发作的患者（N=14）的 pVO2 和 PetCO2 值较低，VE/VCO2、VE/VCO2 斜率和 VE% 值较高。在校正年龄、性别、糖尿病、缺血性心脏病和左心室射血分数后，峰值 VO2（风险比（HR）0.68，95%置信区间（CI）0.51-0.91，p<0.05）、VE%（HR 1.38，95%CI 1.04-1.84，p<0.05）、VE/VCO2（HR 1.38，95%CI 1.04-1.82，p<0.05）、VE/VCO2 斜率（HR 1.77，95%CI 1.31-2.39，p<0.01）、PetCO2（HR 0.66，95%CI 0.50-0.88，p<0.01）被发现是 SVA 的预测因素。在 Kaplan-Meier 分析中，在峰值 VO2 值低于中位数（对数秩 p<0.05）、VE/VCO2 值高于平均值（p<0.05）、VE/VCO2 斜率 tertiles 值较高（p<0.05）和 PetCO2 值低于中位数的患者中，无事件生存率较低（p<0.05）。