Institute of Clinical Medicine, Department of Medicine, University of Eastern Finland, Kuopio, Finland.
Central Finland Health Care District, Jyväskylä, Finland.
Scand J Med Sci Sports. 2021 Oct;31(10):1949-1961. doi: 10.1111/sms.14012. Epub 2021 Jul 12.
Cardiorespiratory optimal point (COP) during exercise may be a potentially clinically useful cardiopulmonary exercise testing (CPET) variable, but its prognostic relevance for adverse cardiovascular disease (CVD) outcomes is unknown. We aimed to assess the association of COP during exercise with fatal mortality outcomes and the extent to which COP could improve the prediction of CVD mortality. Cardiorespiratory optimal point, the minimum value of the ventilatory equivalent for oxygen (VE/VO2) in a given minute of a CPET, was defined in 2,205 men who underwent CPET. Hazard ratios (HRs) (95% confidence intervals [CIs]) for outcomes and measures of risk discrimination for CVD mortality were calculated. During a median follow-up of 28.8 years, 402 fatal CHDs, 607 fatal CVDs, and 1,348 all-cause mortality events occurred. COP was continually associated with each outcome in a dose-response manner. On adjustment for established and emerging risk factors, the HRs (95% CIs) for fatal CHD, fatal CVD, and all-cause mortality were 3.05 (1.94-4.81), 2.82 (1.91-4.18) and 2.46 (1.85-3.27), respectively, per standard deviation increase in COP. After further adjustment for high sensitivity C-reactive protein, the HRs were 2.82 (1.78-4.46), 2.57 (1.73-3.81), and 2.27 (1.70-3.02), respectively. Addition of COP to a CVD mortality risk prediction model containing established risk factors was associated with a C-index change of 0.0139 (0.0040 to 0.0238; p = 0.006) at 25 years. COP during exercise is directly associated with fatal cardiovascular and all-cause mortality events in dose-response fashions. COP during exercise may improve the prediction of the long-term risk for CVD mortality.
运动时的心肺最佳点（COP）可能是心肺运动测试（CPET）中一个潜在的临床有用变量，但它对不良心血管疾病（CVD）结局的预后相关性尚不清楚。我们旨在评估运动时 COP 与致命死亡率结局的相关性，以及 COP 在多大程度上可以提高 CVD 死亡率预测的准确性。CPET 中每分钟通气当量与摄氧量之比（VE/VO2）的最小值定义为 2205 名接受 CPET 的男性中的 COP。计算了 CVD 死亡率结局的危险比（HR）（95%置信区间[CI]）和风险区分度的测量值。在中位随访 28.8 年期间，发生了 402 例致命性 CHD、607 例致命性 CVD 和 1348 例全因死亡事件。COP 与每种结局均呈剂量反应关系。在调整了既定和新兴的危险因素后，COP 每标准差增加时，致命性 CHD、致命性 CVD 和全因死亡率的 HR（95%CI）分别为 3.05（1.94-4.81）、2.82（1.91-4.18）和 2.46（1.85-3.27）。进一步调整超敏 C 反应蛋白后，HR 分别为 2.82（1.78-4.46）、2.57（1.73-3.81）和 2.27（1.70-3.02）。将 COP 添加到包含既定危险因素的 CVD 死亡率风险预测模型中，与 25 年时 C 指数的变化相关，变化值为 0.0139（0.0040 至 0.0238；p=0.006）。运动时的 COP 与致命性心血管和全因死亡率事件呈剂量反应关系。运动时的 COP 可能改善 CVD 死亡率长期风险的预测。
