Cornelis Justien, Taeymans Jan, Hens Wendy, Beckers Paul, Vrints Christiaan, Vissers Dirk
Faculty of Medicine and Health Sciences, University of Antwerp, Department of Rehabilitation Sciences and Physiotherapy, Universiteitsplein 1, CDE S0.22, B-2610 Wilrijk, Belgium.
Faculty of Medicine and Health Sciences, University of Antwerp, Department of Rehabilitation Sciences and Physiotherapy, Universiteitsplein 1, CDE S0.22, B-2610 Wilrijk, Belgium; Bern University of Applied Sciences (Health), Murtenstrasse 10, CH-3008 Bern, Switzerland; Faculty of Physical Education and Physical Therapy, Vrije Universiteit Brussel, Pleinlaan 2, B-1050 Elsene, Belgium.
Int J Cardiol. 2015 Mar 1;182:476-86. doi: 10.1016/j.ijcard.2015.01.029. Epub 2015 Jan 13.
The purpose of this review was to describe the occurrence of prognostic variables as derived from cardiopulmonary exercise testing (CPET) in patients with heart failure (HF), presenting exercise oscillatory ventilation (EOV) compared to patients without EOV. The effect of EOV on peak oxygen consumption (VO2), minute ventilation/carbon dioxide production (VE/VCO2) slope, oxygen uptake efficiency slope (OUES), rest and peak pulmonary end-tidal carbon dioxide pressure (PETCO2) was meta-analysed. A systematic search strategy was performed in five databases (Pubmed, Cochrane Library, PEDro, Science Direct and Web of Science) assessing 252 articles for eligibility. Nineteen citations met the inclusion criteria totalling 3032 patients with HF (EOV=1111; non-EOV=1921). The risk of bias was assessed by two researchers. Extracted data were pooled using random or fixed effects meta-analysis, if appropriate. The level of significance was set at p≤0.05. Overall, the presentation of EOV significantly indicated aggravated prognostic markers. Subgroup analysis revealed left ventricular ejection fraction (LVEF) and mode of CPET protocol as independent factors, whereas defining EOV significantly influenced the results. A meta-analysis of studies reporting hazard ratios for cardiovascular events demonstrated that HF patients with EOV run a fourfold risk for an adverse event compared to HF patients without EOV. In general, these findings suggest that the presence of EOV in patients with HF is associated with a deterioration of the prognostic CPET parameters. Furthermore, EOV can occur in HF patients with reduced as well as preserved ejection fraction. Further research on defining and assessing EOV in a more accurate and reproducible way is required.
本综述的目的是描述心力衰竭（HF）患者心肺运动试验（CPET）得出的预后变量的发生情况，这些患者表现出运动性振荡通气（EOV），并与无EOV的患者进行比较。对EOV对峰值耗氧量（VO2）、分钟通气量/二氧化碳产生量（VE/VCO2）斜率、摄氧效率斜率（OUES）、静息和峰值肺呼气末二氧化碳分压（PETCO2）的影响进行了荟萃分析。在五个数据库（PubMed、Cochrane图书馆、PEDro、Science Direct和Web of Science）中执行了系统检索策略，评估了252篇文章的入选资格。19篇文献符合纳入标准，共计3032例HF患者（EOV = 1111；非EOV = 1921）。由两名研究人员评估偏倚风险。如有合适的数据，采用随机或固定效应荟萃分析对提取的数据进行汇总。显著性水平设定为p≤0.05。总体而言，EOV的出现显著表明预后标志物加重。亚组分析显示左心室射血分数（LVEF）和CPET方案模式为独立因素，而定义EOV对结果有显著影响。对报告心血管事件风险比的研究进行的荟萃分析表明，与无EOV的HF患者相比，有EOV的HF患者发生不良事件的风险高四倍。一般来说，这些发现表明HF患者中EOV的存在与预后CPET参数的恶化有关。此外，EOV可发生在射血分数降低和保留的HF患者中。需要进一步研究以更准确和可重复的方式定义和评估EOV。
