Lu Zhinan, Huang Jie, Sun Xingguo, Tan Xiaoyue, Li Zixu, Hu Shengshou
State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China.
State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China. Email:
Zhonghua Xin Xue Guan Bing Za Zhi. 2015 Jan;43(1):44-50.
To assess the cardiopulmonary exercise testing (CPET) derived performance of oxygen uptake and ventilation efficiency parameters, including oxygen uptake efficiency plateau (OUEP) , oxygen uptake efficiency slope (OUES), V·E/V·CO2 slope and lowest V·E/V·CO2, in patients with end-stage chronic heart failure (CHF) and evaluate their clinical value on monitoring cardiac function and hemodynamic status.
A total of 26 end-stage CHF patients considered for heart transplantation were enrolled in this study. CPET, echocardiography and invasive hemodynamic examinations with Swan-Ganz flowing balloon catheter were performed. Correlation analysis was made between oxygen uptake and ventilation efficiency parameters from CPET and echocardiographic and hemodynamic parameters.
OUEP and OUES showed good correlation with peak oxygen consumption (peak V·O2) (r = 0.535, P < 0.01;r = 0.840, P < 0.001). In end-stage CHF patients, the slope of OUEP with respect to peak V·O2 is about 32, but the slope of OUES with respect to peak V·O2 is only about 2. The difference was 16 times. The change of OUEP was more sensitive and significant than those of OUES and peak V·O2 (P < 0.05). OUEP, peak V·O2 (%pred), V·E/V·CO2 slope and lowest V·E/V·CO2 were all correlated well with non-invasive hemodynamic parameters peak cardiac output (r = 0.535, P < 0.01; r = 0.652, P < 0.001; r = -0.640, P < 0.001; r = -0.606, P = 0.001 respectively) and peak cardiac index (r = 0.556, P < 0.01;r = 0.772, P < 0.001; r = -0.641, P < 0.001; r = -0.620, P < 0.001 respectively) derived from CPET, but not correlated with invasive hemodynamic parameters cardiac output and cardiac index at rest (P > 0.05). Both peak V·O2 (%pred) and V·E/V·CO2 slope were significantly correlated with invasive hemodynamic parameters systolic pulmonary arterial pressure (r = -0.424, P < 0.05; r = 0.509, P < 0.01) and mean pulmonary arterial pressure (r = -0.479, P < 0.05; r = 0.405, P < 0.05). Peak V·O2 (%pred) was also significantly correlated with pulmonary capillary wedge pressure (r = -0.415, P < 0.05), and V·E/V·CO2 slope was significantly correlated with pulmonary vascular resistance (r = 0.429, P < 0.05).
The oxygen uptake and ventilation efficiency parameters derived from CPET, including peak V·O2, OUEP, lowest V·E/V·CO2 and V·E/V·CO2 slope etc, are objectively monitoring and evaluating cardiac function and hemodynamic status. And they are useful for optimizing clinical management of patients with end-stage CHF.
评估心肺运动试验（CPET）得出的摄氧量和通气效率参数的表现，包括摄氧量效率平台（OUEP）、摄氧量效率斜率（OUES）、V·E/V·CO2斜率和最低V·E/V·CO2，用于终末期慢性心力衰竭（CHF）患者，并评估它们在监测心功能和血流动力学状态方面的临床价值。
本研究共纳入26例考虑进行心脏移植的终末期CHF患者。进行了CPET、超声心动图检查以及使用Swan-Ganz漂浮导管进行的有创血流动力学检查。对CPET的摄氧量和通气效率参数与超声心动图和血流动力学参数进行相关性分析。
OUEP和OUES与峰值耗氧量（peak V·O2）显示出良好的相关性（r = 0.535，P < 0.01；r = 0.840，P < 0.001）。在终末期CHF患者中，OUEP相对于peak V·O2的斜率约为32，但OUES相对于peak V·O2的斜率仅约为2。差异为16倍。OUEP的变化比OUES和peak V·O2的变化更敏感且更显著（P < 0.05）。OUEP、peak V·O2（%pred）、V·E/V·CO2斜率和最低V·E/V·CO2与CPET得出的无创血流动力学参数峰值心输出量（r分别为0.535，P < 0.01；r = 0.652，P < 0.001；r = -0.640，P < 0.001；r = -0.606，P = 0.001）和峰值心脏指数（r分别为0.556，P < 0.01；r = 0.772，P < 0.001；r = -0.641，P < 0.001；r = -0.620，P < 0.001）均具有良好的相关性，但与静息时的有创血流动力学参数心输出量和心脏指数无相关性（P > 0.05）。peak V·O2（%pred）和V·E/V·CO2斜率均与有创血流动力学参数收缩期肺动脉压（r = -0.424，P < 0.05；r = 0.509，P < 0.01）和平均肺动脉压（r = -0.479，P < 0.05；r = 0.405，P < 0.05）显著相关。peak V·O2（%pred）也与肺毛细血管楔压显著相关（r = -0.415，P < 0.05），V·E/V·CO2斜率与肺血管阻力显著相关（r = 0.429，P < 0.05）。
CPET得出的摄氧量和通气效率参数，包括peak V·O2、OUEP、最低V·E/V·CO2和V·E/V·CO2斜率等，可客观地监测和评估心功能和血流动力学状态。并且它们有助于优化终末期CHF患者的临床管理。
