Coeckelberghs Ellen, Buys Roselien, Goetschalckx Kaatje, Cornelissen Véronique A, Vanhees Luc
Department of Rehabilitation Sciences, KU Leuven and Department of Cardiovascular Diseases, University Hospitals of Leuven, Belgium.
Department of Rehabilitation Sciences, KU Leuven and Department of Cardiovascular Diseases, University Hospitals of Leuven, Belgium
Eur J Prev Cardiol. 2016 Feb;23(3):237-44. doi: 10.1177/2047487315569410. Epub 2015 Jan 29.
Peak exercise capacity is an independent predictor for mortality in patients with coronary artery disease. However, sometimes cardiopulmonary exercise tests are stopped prematurely. Therefore, submaximal exercise measures such as the oxygen uptake efficiency slope have been introduced. The aim of this study was to assess the prognostic value of the oxygen uptake efficiency slope and other exercise parameters, in patients with coronary artery disease.
Between 2000 and 2011, 1409 patients with coronary artery disease (age 60.7 ± 9.9 years; 1205 males) underwent cardiopulmonary exercise tests. A maximal effort was not reached in 161 (11.5%) patients. The oxygen uptake efficiency slope was calculated and information on mortality was obtained. Cox proportional hazards regression analyses were used to assess the relation of oxygen uptake efficiency slope and other gas exchange variables with all-cause and cardiovascular mortality. Receiver operating characteristic curve analyses was performed to define optimal cut-off values.
During an average follow-up of 7.45 ± 3.20 years (range 0.16-13.95 years), 158 patients died, among which 68 patients for cardiovascular reasons. The oxygen uptake efficiency slope was related to all-cause (hazard ratio: 0.568, p < 0.001) and cardiovascular (hazard ratio: 0.461, p < 0.001) mortality. When significant covariates were entered in the analysis, oxygen uptake efficiency slope remained related to mortality (p < 0.05). When other submaximal exercise parameters were added to the model, oxygen uptake efficiency slope and minute ventilation/carbon dioxide production slope also remained significantly related to mortality.
The oxygen uptake efficiency slope is an independent predictor for all-cause and cardiovascular mortality in patients with coronary artery disease, irrespective of a truly maximal effort during cardiopulmonary exercise tests. Furthermore, the oxygen uptake efficiency slope provides prognostic information, complementary to the minute ventilation/carbon dioxide production slope and peak exercise capacity.
运动能力峰值是冠心病患者死亡率的独立预测指标。然而，有时心肺运动试验会过早终止。因此，已引入诸如摄氧效率斜率等次极量运动指标。本研究旨在评估摄氧效率斜率及其他运动参数在冠心病患者中的预后价值。
2000年至2011年期间，1409例冠心病患者（年龄60.7±9.9岁；男性1205例）接受了心肺运动试验。161例（11.5%）患者未达到最大努力程度。计算摄氧效率斜率并获取死亡率信息。采用Cox比例风险回归分析评估摄氧效率斜率及其他气体交换变量与全因死亡率和心血管死亡率的关系。进行受试者工作特征曲线分析以确定最佳临界值。
在平均7.45±3.20年（范围0.16 - 13.95年）的随访期间，158例患者死亡，其中68例死于心血管原因。摄氧效率斜率与全因死亡率（风险比：0.568，p < 0.001）和心血管死亡率（风险比：0.461，p < 0.001）相关。当在分析中纳入显著协变量时，摄氧效率斜率仍与死亡率相关（p < 0.05）。当将其他次极量运动参数添加到模型中时，摄氧效率斜率和分钟通气量/二氧化碳产生斜率也仍与死亡率显著相关。
摄氧效率斜率是冠心病患者全因死亡率和心血管死亡率的独立预测指标，无论心肺运动试验期间是否达到真正的最大努力程度。此外，摄氧效率斜率提供了预后信息，是对分钟通气量/二氧化碳产生斜率和运动能力峰值的补充。
