Cardiovascular Center, Health Authority No. 1, and University of Trieste, Trieste, Italy.
Divisione di Cardiologia Riabilitativa, Fondazione Salvatore Maugeri, IRCCS, Istituto Scientifico di Veruno, Veruno, Italy.
Chest. 2019 Aug;156(2):338-347. doi: 10.1016/j.chest.2019.03.013. Epub 2019 Mar 27.
We evaluated the prognostic meaning of the simple presence or absence of identifiable anaerobic threshold (AT) and respiratory compensation point (RCP) at cardiopulmonary exercise tests (CPETs) performed with a maximal incremental exercise protocol.
In the present multicenter study, we retrospectively analyzed data in 1,995 patients with heart failure with reduced ejection fraction (HFrEF). All underwent clinical and laboratory evaluation, echocardiography, and maximal CPET at baseline. The analysis was performed according to absence of identified AT and RCP (group 1: n = 292; 15%), presence of AT but absence of identified RCP (group 2: n = 920; 46%), and presence of both AT and RCP (group 3: n = 783; 39%). The study end point was the composite of cardiovascular mortality, urgent heart transplant, and left ventricular assist device implantation.
Median follow-up was 2.97 years (interquartile range, 1.50-5.35 years). Eighty-seven (30%), 169 (18%), and 111 (14%) events were observed in groups 1, 2, and 3, respectively (P = .025). Compared with results in group 3 (patients with the best survival), the likelihood of reaching the study end point increased 2.7 times when neither AT nor RCP were identified (hazard ratio, 2.74) and 1.4 times when only AT was identified (hazard ratio, 1.4). Moreover, adding the presence or absence of identified AT and RCP improved the prognostic power of peak oxygen uptake because a significant reclassification was obtained.
AT and RCP identification has a potential role in the prognostic stratification of HFrEF.
我们评估了心肺运动试验（CPET）中最大递增运动方案下简单有无可识别无氧阈（AT）和呼吸补偿点（RCP）对预后的意义。
在这项多中心研究中，我们回顾性分析了 1995 例射血分数降低的心力衰竭（HFrEF）患者的数据。所有患者均在基线时接受了临床和实验室评估、超声心动图和最大 CPET。分析根据有无可识别的 AT 和 RCP 进行（第 1 组：n=292，15%；第 2 组：n=920，46%；第 3 组：n=783，39%）。研究终点是心血管死亡、紧急心脏移植和左心室辅助装置植入的复合终点。
中位随访时间为 2.97 年（四分位距，1.50-5.35 年）。第 1、2 和 3 组分别有 87（30%）、169（18%）和 111（14%）例事件发生（P=0.025）。与第 3 组（生存情况最好的患者）相比，当既无法识别 AT 也无法识别 RCP 时，达到研究终点的可能性增加了 2.7 倍（危险比，2.74），仅识别到 AT 时增加了 1.4 倍（危险比，1.4）。此外，识别 AT 和 RCP 的存在与否可以改善最大摄氧量的预后预测能力，因为获得了显著的重新分类。
AT 和 RCP 的识别在心衰患者的预后分层中有一定作用。
