Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, CA, USA; Stanford Cardiovascular Institute, Stanford, CA, USA; Department of Medicine, St Vincent's Hospital, University of Melbourne, Melbourne, Australia.
Division of Cardiology, Veterans Affairs Palo Alto Healthcare System, Palo Alto, CA, USA.
Int J Cardiol. 2018 Jul 15;263:75-79. doi: 10.1016/j.ijcard.2018.02.102. Epub 2018 Feb 27.
Percent of predicted peak VO (ppVO) is considered a standard measure for establishing disease severity, however, there are known limitations to traditional normative values. This study sought to compare ppVO from the newly derived "Fitness Registry and the Importance of Exercise: a National Database" (FRIEND) registry equation to conventional prediction equations in a clinical cohort of patients undergoing cardiopulmonary exercise testing (CPX).
We selected 1094 patients referred for evaluation of heart failure (HF) symptoms who underwent CPX. ppVO was calculated using the FRIEND, Wasserman/Hansen and Jones equations. Participants were followed for a median of 4.5 years [Interquartile range 3.5-6.0] for the composite endpoint of death, advanced HF therapy, or acute decompensated HF requiring hospital admission. Mean age was 48 ± 15 years and 62% were female. The FRIEND registry equation predicted the lowest ppVO (measured/predicted; 71 ± 31%), compared to the Wasserman/Hansen (74 ± 29%) and Jones equations (83 ± 33%) (p < 0.001). All expressions of peak VO were significant as univariate predictors of outcome with no significant differences between equations on pairwise analysis of receiver operating characteristic curves. When compared at a similar threshold of ppVO the event rate was significantly lower in the FRIEND registry equation versus the currently used Wasserman and Jones equations.
The use of the newly derived FRIEND registry equation predicts HF outcomes; however, it appears to predict a higher predicted VO; the clinical implication being a lower threshold of percent predicted peak VO should be considered when risk stratifying patients with HF.
预计峰值 VO（ppVO）的百分比被认为是确定疾病严重程度的标准衡量标准，但传统的标准值存在已知的局限性。本研究旨在将新推导的“健身登记处和运动的重要性：国家数据库”（FRIEND）登记处方程中的 ppVO 与接受心肺运动测试（CPX）的临床患者队列中的传统预测方程进行比较。
我们选择了 1094 名因心力衰竭（HF）症状接受 CPX 评估的患者。使用 FRIEND、Wasserman/Hansen 和 Jones 方程计算 ppVO。中位随访时间为 4.5 年[四分位距 3.5-6.0]，复合终点为死亡、晚期 HF 治疗或需要住院治疗的急性失代偿性 HF。平均年龄为 48±15 岁，62%为女性。与 Wasserman/Hansen（74±29%）和 Jones 方程（83±33%）相比，FRIEND 登记处方程预测的 ppVO 最低（实测/预测；71±31%）（p<0.001）。所有 VO 峰值的表达均为结局的单变量预测因子，且在两两分析中，ROC 曲线的方程之间没有显著差异。当以类似的 ppVO 阈值进行比较时，FRIEND 登记处方程的事件发生率明显低于当前使用的 Wasserman 和 Jones 方程。
新推导的 FRIEND 登记处方程可预测 HF 结局；然而，它似乎预测了更高的预测 VO；临床意义是在对 HF 患者进行风险分层时，应考虑将 ppVO 的百分比预测阈值降低。
