Ferreira Eloara V M, Ota-Arakaki Jaquelina S, Ramos Roberta P, Barbosa Priscila B, Almeida Melline, Treptow Erika C, Valois Fabricio M, Nery Luiz E, Neder J Alberto
Pulmonary Vascular Group, Division of Respiratory Diseases, Department of Medicine, São Paulo School of Medicine (EPM), Federal University of Sao Paulo (UNIFESP), Brazil Pulmonary Function and Clinical Exercise Physiology Unit, Division of Respiratory Diseases, Department of Medicine, São Paulo School of Medicine (EPM), Federal University of Sao Paulo (UNIFESP), Brazil.
Pulmonary Vascular Group, Division of Respiratory Diseases, Department of Medicine, São Paulo School of Medicine (EPM), Federal University of Sao Paulo (UNIFESP), Brazil
Eur J Prev Cardiol. 2014 Nov;21(11):1409-19. doi: 10.1177/2047487313494293. Epub 2013 Jun 20.
Increased ventilatory (.VE) response to carbon dioxide output (.VCO2) is a key finding of incremental cardiopulmonary exercise testing in both heart failure and pulmonary arterial hypertension (PAH). As with heart failure, measures of excessive exercise ventilation considering high-to-peak exercise .VE-VCO2 might have higher prognostic relevance than those restrained to sub-maximal exercise in PAH.
Cross-sectional and observational study on a tertiary center.
Eighty-four patients (36 idiopathic and 48 with associated conditions) were followed up for up to five years. Excessive exercise ventilation was calculated as a slope (Δ .VE/Δ .VCO2 to the respiratory compensation point (RCP) and to exercise cessation (PEAK)) and as a ratio (.VE-VCO2 at the anaerobic threshold (AT) and at PEAK).
Thirteen patients died and three had atrial septostomy. Multivariable regression analyses revealed that Δ .VE/Δ .VCO2(PEAK) <55 and .VE/.VCO2(PEAK) <57 were better related to prognosis than Δ .VE/Δ .VCO2(RCP) and .VE/.VCO2(AT) (p < 0.01). Δ oxygen uptake (.VO2)/Δ work rate >5.5 ml/min per W was the only other independent prognostic index. According to a Kaplan-Meier survival analysis, 96.9% (90.8% to 100%) of patients showing Δ .VE/Δ .VCO2(PEAK) <55 and Δ .VO2/Δ work rate >5.5 ml/min per W were free from a PAH-related event. In contrast, 74.7% (70.1% to 78.2%) with both parameters outside these ranges had a negative outcome.
Measurements of excessive exercise ventilation which consider all data points maximize the usefulness of incremental cardiopulmonary exercise testing in the prognosis evaluation of PAH.
在心力衰竭和肺动脉高压（PAH）患者的递增式心肺运动试验中，通气量（.VE）对二氧化碳排出量（.VCO2）的反应增加是一项关键发现。与心力衰竭一样，在PAH中，考虑从高到峰值运动的.VE-VCO2的过度运动通气量测量指标可能比那些局限于次最大运动量的指标具有更高的预后相关性。
在一家三级中心进行的横断面观察性研究。
对84例患者（36例特发性患者和48例伴有相关疾病的患者）进行了长达五年的随访。过度运动通气量计算为斜率（至呼吸补偿点（RCP）和运动终止点（PEAK）时的Δ.VE/Δ.VCO2）以及比值（无氧阈值（AT）和PEAK时的.VE-VCO2）。
13例患者死亡，3例接受了房间隔造口术。多变量回归分析显示，与Δ.VE/Δ.VCO2（RCP）和.VE/.VCO2（AT）相比，Δ.VE/Δ.VCO2（PEAK）<55和.VE/.VCO2（PEAK）<57与预后的相关性更好（p < 0.01）。Δ摄氧量（.VO2）/Δ工作负荷>5.5 ml/min per W是唯一的其他独立预后指标。根据Kaplan-Meier生存分析，Δ.VE/Δ.VCO2（PEAK）<55且Δ.VO2/Δ工作负荷>5.5 ml/min per W的患者中有96.9%（90.8%至100%）未发生与PAH相关的事件。相比之下，两个参数均超出这些范围的患者中有74.7%（70.1%至78.2%）预后不良。
考虑所有数据点的过度运动通气量测量可最大限度地提高递增式心肺运动试验在PAH预后评估中的有用性。
