Tang Yi, Luo Qin, Liu Zhihong, Ma Xiuping, Zhao Zhihui, Huang Zhiwei, Gao Liu, Jin Qi, Xiong Changming, Ni Xinhai
Center for Pulmonary Vascular Diseases, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
Center for Pulmonary Vascular Diseases, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
J Am Heart Assoc. 2017 Jun 30;6(7):e005037. doi: 10.1161/JAHA.116.005037.
Few published studies have evaluated the power of the oxygen uptake efficiency slope (OUES) to predict outcomes in patients with idiopathic pulmonary arterial hypertension (IPAH), who typically die of right-sided heart failure. Our study sought to evaluate the power of OUES to predict clinical worsening and mortality in patients with IPAH.
Patients with newly diagnosed IPAH who underwent symptom-limited cardiopulmonary exercise testing from November 11, 2010, to June 25, 2015, in our hospital were prospectively enrolled and followed for up to 66 months. Clinical worsening and mortality were recorded. A total of 210 patients with IPAH (159 women; mean age, 32±10 years) were studied with a median follow-up of 41 months. Thirty-one patients died, 1 patient underwent lung transplantation, and 85 patients presented with clinical worsening. The univariate analysis revealed that OUES, OUESI (OUESI=OUES/body surface area), peak oxygen uptake (V˙O2), peak V˙O2/kg, ventilation (V˙E)/carbon dioxide output (V˙CO2) slope, peak systolic blood pressure, heart rate recovery, pulmonary vascular resistance, cardiac index, N-terminal prohormone brain natriuretic peptide, and World Health Organization functional class were all predictive of clinical worsening and mortality (all <0.05). Multivariate analysis demonstrated that OUESI and cardiac index were independently predictive of clinical worsening, and OUESI and N-terminal prohormone brain natriuretic peptide were independently predictive of mortality. Patients with OUESI ≤0.52 m had a worse 5-year survival rate than patients with OUESI >0.52 m (41.9% versus 89.8%, <0.0001).
The OUES, a submaximal parameter obtained from cardiopulmonary exercise testing, provides prognostic information for predicting clinical worsening and mortality in patients with IPAH.
很少有已发表的研究评估摄氧效率斜率（OUES）预测特发性肺动脉高压（IPAH）患者预后的能力，这类患者通常死于右心衰竭。我们的研究旨在评估OUES预测IPAH患者临床恶化和死亡率的能力。
2010年11月11日至2015年6月25日在我院接受症状限制心肺运动试验的新诊断IPAH患者被前瞻性纳入研究并随访长达66个月。记录临床恶化情况和死亡率。共研究了210例IPAH患者（159例女性；平均年龄32±10岁），中位随访时间为41个月。31例患者死亡，1例患者接受了肺移植，85例患者出现临床恶化。单因素分析显示，OUES、OUESI（OUESI = OUES/体表面积）、峰值摄氧量（V˙O2）、峰值V˙O2/体重、通气（V˙E）/二氧化碳排出量（V˙CO2）斜率、收缩压峰值、心率恢复、肺血管阻力、心脏指数、N末端脑钠肽前体和世界卫生组织功能分级均能预测临床恶化和死亡率（均P<0.05）。多因素分析表明，OUESI和心脏指数独立预测临床恶化，OUESI和N末端脑钠肽前体独立预测死亡率。OUESI≤0.52 m的患者5年生存率低于OUESI>0.52 m的患者（41.9%对89.8%，P<0.0001）。
OUES是从心肺运动试验中获得的次极量参数，可为预测IPAH患者的临床恶化和死亡率提供预后信息。
