Valentim Goncalves António, Pereira-da-Silva Tiago, Soares Rui, Feliciano Joana, Abreu Ana, Rio Pedro, Moreira Rita Ilhao, Cruz Ferreira Rui
Department of Cardiology, Hospital de Santa Marta, Centro Hospitalar Universitário de Lisboa Central Lisbon, Portugal.
Am J Cardiovasc Dis. 2020 Dec 15;10(5):578-584. eCollection 2020.
A decreased hypercapnic ventilatory response of the overweight patients would lower the ventilation equivalent of carbon dioxide (VE/VCO) slope but worsen prognosis. The aim of this study was to compare the prognostic ability of the VE/VCO slope and peak oxygen consumption (pVO) between normal and overweight heart failure (HF) patients.
Prospective evaluation of ambulatory patients with reduced left ventricular ejection fraction who underwent baseline assessment with a cardiopulmonary exercise test. The primary endpoint was cardiac death or urgent heart transplantation in the 5-year period of follow-up. The predictive power of VE/VCO slope and pVO were compared (area under the curve (AUC) analysis and Hanley & McNeil test), in the subgroups of patients with body mass index (BMI) of 18.5-24.9 kg/m and ≥ 25 kg/m. Statistical differences with a value < 0.05 were considered significant.
There were 270 enrolled patients, with a mean BMI of 27 ± 4 kg/m. No differences between normal and overweight patients (38.0% vs 29.8%, P=0.170) were found during the 5-year period for the primary endpoint. The VE/VCO slope was non-inferior to pVO in both groups at 1, 3 and 5 years of follow-up. The comparison of VE/VCO slope between groups revealed a significant lower AUC at 3 (0.921 vs 0.787, P=0.022) and 5 years (0.898 vs 0.787, P=0.044) of follow-up for overweight patients.
Despite VE/VCO slope provides a discriminative power at least as good as pVO for predicting adverse events in both normal and overweight HF patients, a significant lower predictive power was found in overweight patients.
超重患者的高碳酸通气反应降低会使二氧化碳通气当量（VE/VCO）斜率降低，但预后会恶化。本研究的目的是比较正常和超重心力衰竭（HF）患者中VE/VCO斜率和峰值耗氧量（pVO）的预后预测能力。
对左心室射血分数降低的门诊患者进行前瞻性评估，这些患者接受了心肺运动试验的基线评估。主要终点是随访5年期间的心源性死亡或紧急心脏移植。在体重指数（BMI）为18.5 - 24.9 kg/m²和≥25 kg/m²的患者亚组中，比较VE/VCO斜率和pVO的预测能力（曲线下面积（AUC）分析和Hanley & McNeil检验）。P值<0.05的统计学差异被认为具有显著性。
共纳入270例患者，平均BMI为27±4 kg/m²。在5年期间，正常和超重患者的主要终点无差异（38.0%对29.8%，P = 0.170）。在随访1、3和5年时，两组中VE/VCO斜率均不劣于pVO。组间VE/VCO斜率比较显示，超重患者在随访3年（0.921对0.787，P = 0.022）和5年（0.898对0.787，P = 0.044）时AUC显著更低。
尽管VE/VCO斜率在预测正常和超重HF患者不良事件方面具有至少与pVO一样好的判别能力，但超重患者的预测能力显著更低。
