Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
J Card Fail. 2017 Nov;23(11):777-782. doi: 10.1016/j.cardfail.2017.07.397. Epub 2017 Jul 20.
Impaired exercise capacity is one of the hallmarks of heart failure with preserved ejection fraction (HFpEF), but the clinical and hemodynamic correlates and prognostic value of exercise testing in patients with HFpEF is unknown.
Patients with HFpEF (left ventricular ejection fraction [LVEF] ≥45%) and pulmonary hypertension underwent cardiopulmonary exercise test (CPX) to measure maximal (peak VO) and submaximal (ventilatory equivalent for carbon dioxide [VE/VCO] slope) exercise capacity. In addition, right heart catheterization was performed. Patients were grouped in tertiles based on the VE/VCO slope. Univariate and multivariate regression analyses were performed. A Cox regression analysis was performed to determine the mortality during follow-up.
We studied 88 patients: mean age 73 ± 9 years, 67% female, mean LVEF 58%, median N-terminal pro-B-type natriuretic peptide (NT-proBNP) 840 (interquartile range 411-1938) ng/L. Patients in the highest VE/VCO tertile had the most severe HF, as reflected in higher New York Heart Association functional class and higher NT-proBNP plasma levels (all P < .05 for trend), whereas LVEF was similar between the groups. Multivariable regression analysis with backward elimination on invasive hemodynamic measurements showed that VE/VCO slope was independently associated with pulmonary vascular resistance (PVR). Cox regression analysis showed that increased VE/VCO slope (but not peak VO) was independently associated with increased mortality.
Increased VE/VCO slope was associated with more severe disease and higher PVR and was independently associated with increased mortality in patients with HFpEF.
运动能力受损是射血分数保留的心力衰竭（HFpEF）的特征之一，但 HFpEF 患者运动试验的临床和血液动力学相关性及其预后价值尚不清楚。
患有 HFpEF（左心室射血分数 [LVEF] ≥45%）和肺动脉高压的患者接受心肺运动测试（CPX）以测量最大（峰值 VO）和亚最大（二氧化碳通气当量 [VE/VCO]斜率）运动能力。此外，还进行了右心导管检查。根据 VE/VCO 斜率将患者分为三分位组。进行单变量和多变量回归分析。进行 Cox 回归分析以确定随访期间的死亡率。
我们研究了 88 名患者：平均年龄 73±9 岁，67%为女性，平均 LVEF 为 58%，中位数 N 末端 pro-B 型利钠肽（NT-proBNP）为 840（四分位距 411-1938）ng/L。VE/VCO 斜率最高的 tertile 患者 HF 最严重，反映在纽约心脏协会功能分级更高和 NT-proBNP 血浆水平更高（所有趋势 P<0.05），而各组之间的 LVEF 相似。对有创血液动力学测量进行向后消除的多变量回归分析显示，VE/VCO 斜率与肺血管阻力（PVR）独立相关。Cox 回归分析显示，VE/VCO 斜率增加（而非峰值 VO）与死亡率增加独立相关。
VE/VCO 斜率增加与疾病更严重、PVR 更高相关，与 HFpEF 患者死亡率增加独立相关。
