Czubaszewski Łukasz, Straburzyńska-Lupa Anna, Migaj Jacek, Straburzyńska-Migaj Ewa
University of Physical Education in Poznań.
Cardiol J. 2018;25(6):701-708. doi: 10.5603/CJ.a2017.0070. Epub 2017 Jun 14.
Cardiopulmonary exercise testing (CPET) is the gold standard in the evaluation of patients with chronic heart failure (CHF). However, this test is relatively expensive, assessment of its results requires experience, and in Poland it is available only in tertiary health care centers. Many heart rate (HR) parameters taken during a standard electrocardiographic (ECG) exercise test also shows prognostic values. Thus, the aim of this study is to compare prognostic values of ventilatory and HR parameters in exercise testing in CHF patients, and to find out if HR parameters can be used instead of ventilatory in the evaluation of a prognosis.
One hundred thirty two men (mean age 49 ± 11 years) with CHF with reduced left ventricu-lar ejection fraction (< 45%) underwent a treadmill CPET using a modified Bruce's protocol, during which both HR and ventilatory parameters were measured. The patients were followed for 27 ± 13 months after CPET.
Mortality was 28% (n = 37). Non-survivors demonstrated significantly shorter exercise time (342 ± 167 vs. 525 ± 342 s, p < 0.001), lower maximal HR (122 ± 22 vs. 138 ± 21 bpm, p < 0.001), smaller difference between maximal HR and at rest (36 ± 19 vs. 52 ± 21 bpm, p < 0.001), and lower HR recovery rate (HRR; 16 ± 10 vs. 24 ± 13 bpm, p = 0.002), chronotropic index (CHI; 0.45 ± 0.23 vs. 0.61 ± 0.23, p < 0.001), peak oxygen consumption (13.82 ± 4.62 vs. 18.54 ± 5.68 mL/kg/min, p < 0.001) and oxygen uptake efficiency slope (OUES) value (1.56 ± 0.58 vs. 1.94 ± 0.63, p = 0.001), and higher ventilation to carbon dioxide production (VE/VCO2) slope value (40.56 ± 9.11 vs. 33.33 ± 7.36, p < 0.001). Two parameters that showed good prognostic value and availability in a routine CPET were chosen for receiver operating characteristic analysis, VE/VCO2 slope and CHI, which showed cut-off values of 35 (sensitivity 74%, specificity 71%, p < 0.001) and 64 (sensitivity 74%, specificity 68%, p < 0.001) respectively.
Heart rate parameters show significant prognostic values; CHI is the best of them, however, it is weaker than VE/VCO2 slope. HR parameters show somewhat weaker prognostic values in comparison with ventilatory parameters, yet they may be useful in cases of CPET unavailability.
心肺运动试验（CPET）是评估慢性心力衰竭（CHF）患者的金标准。然而，该检查相对昂贵，对其结果的评估需要经验，并且在波兰仅在三级医疗保健中心才能进行。在标准心电图（ECG）运动试验期间测得的许多心率（HR）参数也显示出预后价值。因此，本研究的目的是比较CHF患者运动试验中通气参数和HR参数的预后价值，并探究HR参数是否可用于替代通气参数来评估预后。
132名左心室射血分数降低（<45%）的CHF男性患者（平均年龄49±11岁）采用改良的布鲁斯方案进行平板CPET，在此期间测量HR和通气参数。CPET后对患者进行了27±13个月的随访。
死亡率为28%（n = 37）。未存活者的运动时间明显较短（342±167 vs. 525±342秒，p < 0.001），最大心率较低（122±22 vs. 138±21次/分钟，p < 0.001），最大心率与静息心率之间的差值较小（36±19 vs. 52±21次/分钟，p < 0.001），心率恢复率（HRR；16±10 vs. 24±13次/分钟，p = 0.002）、变时指数（CHI；0.45±0.23 vs. 0.61±0.23，p < 0.001）、峰值耗氧量（13.82±4.62 vs. 18.54±5.68毫升/千克/分钟，p < 0.001）和摄氧效率斜率（OUES）值（1.56±0.58 vs. 1.94±0.63，p = 0.
