VCU Pauley Heart Center (Drs Canada, Park, Chiabrando, Del Buono, Trankle, Kadariya, Carbone, and Abbate, Mr Ravindra, and Mss van Wezenbeek and Billingsley), Department of Kinesiology & Health Sciences, College of Humanities & Sciences (Dr Carbone and Ms Billingsley), and Department of Pharmacotherapy and Outcome Sciences (Drs Wohlford and Van Tassell), Virginia Commonwealth University, Richmond; Interventional Cardiology Service, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina (Dr Chiabrando); Department of Cardiovascular and Thoracic Sciences, Catholic University of the Sacred Heart, Rome, Italy (Dr Del Buono); Department of Psychology, Virginia State University, Petersburg (Dr Keen); and Department of Physical Therapy, College of Applied Health Sciences, University of Illinois at Chicago (Dr Arena).
J Cardiopulm Rehabil Prev. 2022 Jan 1;42(1):39-44. doi: 10.1097/HCR.0000000000000605.
Cardiopulmonary exercise testing (CPX) is a well-established assessment with important insight into prognosis and therapeutic efficacy in patients with heart failure (HF). Prior studies have identified several clinical differences between Black or African American (B-AA) and Caucasian patients with HF. Differences in key CPX responses between these two groups require further investigation.
Using a database consisting of subjects with symptomatic HF who had undergone CPX for inclusion in various prospective randomized clinical trials, we identified 198 (n = 94 [47%] B-AA; n = 105 [53%] Caucasian) patients with a qualifying baseline CPX. Significant univariate predictors of peak oxygen uptake (V˙o2peak) were included in a multivariate linear regression model.
When compared with Caucasian patients, B-AA were younger (mean ± SD = 54.8 ± 10.0 vs 57.9 ± 9.6 yr, P = .03), had higher C-reactive protein (CRP) (median [IQR] = 4.9 [2.3, 8.8] vs 1.9 [0.6, 5.5] mg/L, P < .0001), lower hemoglobin (13.0 ± 1.8 vs 13.8 ± 1.6 g/dL, P = .003), and lower left ventricular ejection fraction (LVEF) (40 [32, 51] vs 53 [43, 59]%, P < .00010). During CPX, B-AA patients also had lower V˙o2peak (14.6 ± 3.9 vs 17.6 ± 4.8 mL·kg-1·min-1, P < .0001). No differences were observed between B-AA and Caucasian in the minute ventilation/carbon dioxide production (V˙e/V˙co2) slope (P = .14). The difference in V˙o2peak between B-AA and Caucasian was largely attenuated after adjusting for age, body mass index, CRP, N-terminal pro-brain natriuretic peptide, hemoglobin, LVEF, and peak HR (14.1: 95% CI, 13.2-14.9 vs 15.6: 95% CI, 14.4-16.8 mL·kg-1·min-1, P = .053).
Directly measured V˙o2peak was significantly lower in B-AA than in Caucasians with HF. This is largely explained by differences in clinical characteristics, whereas no significant differences were observed in the V˙e/V˙co2 slope.
心肺运动测试（CPX）是一种经过充分验证的评估方法，可深入了解心力衰竭（HF）患者的预后和治疗效果。先前的研究已经确定了黑人和非裔美国人（B-AA）与白人 HF 患者之间存在几种临床差异。这两组之间关键 CPX 反应的差异需要进一步研究。
我们使用一个包含接受 CPX 以纳入各种前瞻性随机临床试验的有症状 HF 患者的数据库，确定了 198 名（n=94 [47%] B-AA；n=105 [53%] 白人）具有合格基线 CPX 的患者。将显著的单变量预测因素纳入多元线性回归模型。
与白人患者相比，B-AA 更年轻（平均值±标准差=54.8±10.0 与 57.9±9.6 岁，P=0.03），C 反应蛋白（CRP）更高（中位数[IQR]=4.9[2.3, 8.8] 与 1.9[0.6, 5.5]mg/L，P<0.0001），血红蛋白更低（13.0±1.8 与 13.8±1.6g/dL，P=0.003），左心室射血分数（LVEF）更低（40[32, 51] 与 53[43, 59]%，P<0.00010）。在 CPX 期间，B-AA 患者的 V˙o2peak 也较低（14.6±3.9 与 17.6±4.8mL·kg-1·min-1，P<0.0001）。B-AA 和白人之间的分钟通气量/二氧化碳产量（V˙e/V˙co2）斜率没有差异（P=0.14）。在调整年龄、体重指数、CRP、N 末端脑利钠肽前体、血红蛋白、LVEF 和峰值 HR 后，B-AA 和白人之间的 V˙o2peak 差异大大减弱（14.1：95%CI，13.2-14.9 与 15.6：95%CI，14.4-16.8mL·kg-1·min-1，P=0.053）。
直接测量的 V˙o2peak 在 B-AA 中明显低于 HF 白人。这在很大程度上是由于临床特征的差异所致，而 V˙e/V˙co2 斜率没有明显差异。
