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估算射血分数保留的心力衰竭患者的运动时疼痛。

Estimating exercise Pa in patients with heart failure with preserved ejection fraction.

机构信息

Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital, Dallas, Texas.

Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas.

出版信息

J Appl Physiol (1985). 2022 Jan 1;132(1):36-45. doi: 10.1152/japplphysiol.00474.2021. Epub 2021 Nov 11.

Abstract

Patients with heart failure with preserved ejection fraction (HFpEF) exhibit cardiopulmonary abnormalities that could affect the predictability of exercise [Formula: see text] from the Jones corrected partial pressure of end-tidal CO (PJ) equation (PJ = 5.5 + 0.9 × [Formula: see text] - 2.1 × V). Since the dead space to tidal volume (V/V) calculation also includes [Formula: see text] measurements, estimates of V/V from PJ may also be affected. Because using noninvasive estimates of [Formula: see text] and V/V could save patient discomfort, time, and cost, we examined whether partial pressure of end-tidal CO ([Formula: see text]) and PJ can be used to estimate [Formula: see text] and V/V in 13 patients with HFpEF. [Formula: see text] was measured from expired gases measured simultaneously with radial arterial blood gases at rest, constant-load (20 W), and peak exercise. V/V was calculated using the Enghoff modification of the Bohr equation, and estimates of V/V were calculated using [Formula: see text] (V/V) and PJ (V/V) in place of [Formula: see text]. [Formula: see text] was similar to [Formula: see text] at rest (-1.46 ± 2.63, = 0.112) and peak exercise (0.66 ± 2.56, = 0.392), but overestimated [Formula: see text] at 20 W (-2.09 ± 2.55, = 0.020). PJ was similar to [Formula: see text] at rest (-1.29 ± 2.57, = 0.119) and 20 W (-1.06 ± 2.29, = 0.154), but underestimated [Formula: see text] at peak exercise (1.90 ± 2.13, = 0.009). V/V was similar to V/V at rest (-0.01 ± 0.03, = 0.127) and peak exercise (0.01 ± 0.04, = 0.210), but overestimated V/V at 20 W (-0.02 ± 0.03, = 0.025). Although V/V was similar to V/V at rest (-0.01 ± 0.03, = 0.156) and 20 W (-0.01 ± 0.03, = 0.133), V/V underestimated V/V at peak exercise (0.03 ± 0.04, = 0.013). Exercise [Formula: see text] and V/V provides better estimates of [Formula: see text] and V/V than PJ and V/V does at peak exercise. Thus, estimates of [Formula: see text] and V/V should only be used if sampling arterial blood during CPET is not feasible. [Formula: see text] provides a better estimate of [Formula: see text] than PJ at peak exercise, and V/V provides a better estimate of V/V than V/V at peak exercise. Although we reported significant correlations, we did not find an identity between [Formula: see text] and estimates of [Formula: see text], nor did we find an identity between V/V and estimates of V/V. Thus, caution should be taken and estimates of [Formula: see text] and V/V should only be used if sampling arterial blood during CPET is not feasible.

摘要

射血分数保留的心力衰竭(HFpEF)患者表现出心肺异常,这可能会影响从琼斯校正的潮气末二氧化碳分压(PJ)方程(PJ = 5.5 + 0.9 × [Formula: see text] - 2.1 × V)中预测运动[Formula: see text]的能力。由于死腔与潮气量(V/V)的计算也包括[Formula: see text]测量,因此 PJ 估计的 V/V 也可能受到影响。因为使用无创估计[Formula: see text]和 V/V 可以节省患者的不适、时间和成本,所以我们检查了在 13 名 HFpEF 患者中,是否可以使用潮气末二氧化碳分压([Formula: see text])和 PJ 来估计[Formula: see text]和 V/V。[Formula: see text]是从同时测量的静息、恒负荷(20 W)和峰值运动时的桡动脉血气中测量的。V/V 使用 Enghoff 对 Bohr 方程的修正进行计算,并且使用[Formula: see text](V/V)和 PJ(V/V)代替[Formula: see text]计算 V/V 的估计值。[Formula: see text]与静息时的[Formula: see text]相似(-1.46 ± 2.63, = 0.112)和峰值运动时(0.66 ± 2.56, = 0.392),但在 20 W 时高估[Formula: see text](-2.09 ± 2.55, = 0.020)。PJ 在静息时与[Formula: see text]相似(-1.29 ± 2.57, = 0.119)和 20 W 时相似(-1.06 ± 2.29, = 0.154),但在峰值运动时低估[Formula: see text](1.90 ± 2.13, = 0.009)。V/V 在静息时与 V/V 相似(-0.01 ± 0.03, = 0.127)和峰值运动时相似(0.01 ± 0.04, = 0.210),但在 20 W 时高估 V/V(-0.02 ± 0.03, = 0.025)。尽管 V/V 在静息时与 V/V 相似(-0.01 ± 0.03, = 0.156)和 20 W 时相似(-0.01 ± 0.03, = 0.133),但 V/V 在峰值运动时低估了 V/V(0.03 ± 0.04, = 0.013)。在峰值运动时,运动[Formula: see text]和 V/V 比 PJ 和 V/V 提供了更好的[Formula: see text]和 V/V 估计值。因此,如果在 CPET 期间不能采样动脉血,则只能使用[Formula: see text]和 V/V 的估计值。[Formula: see text]在峰值运动时比 PJ 提供了更好的[Formula: see text]估计值,而 V/V 在峰值运动时比 V/V 提供了更好的 V/V 估计值。尽管我们报告了显著的相关性,但我们没有发现[Formula: see text]和估计的[Formula: see text]之间存在同一性,也没有发现 V/V 和估计的 V/V 之间存在同一性。因此,应该谨慎使用[Formula: see text]和 V/V 的估计值,如果在 CPET 期间不能采样动脉血,则只能使用它们。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/180f/8721897/ada2505b0564/jappl-00474-2021r01.jpg

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