Departamento de Cardiologia, Hospital de Santa Marta, Centro Hospitalar Central de Lisboa, Lisboa - Portugal.
Arq Bras Cardiol. 2022 Sep;119(3):413-423. doi: 10.36660/abc.20210620.
There is evidence suggesting that a peak oxygen uptake (pVO2) cut-off of 10ml/kg/min provides a more precise risk stratification in cardiac resynchronization therapy (CRT) patients.
To compare the prognostic power of several cardiopulmonary exercise testing (CPET) parameters in this population and assess the discriminative ability of the guideline-recommended pVO2cut-off values.
Prospective evaluation of consecutive heart failure (HF) patients with left ventricular ejection fraction ≤40%. The primary endpoint was a composite of cardiac death and urgent heart transplantation (HT) in the first 24 follow-up months, and was analysed by several CPET parameters for the highest area under the curve (AUC) in the CRT group. A survival analysis was performed to evaluate the risk stratification provided by several different cut-offs. p values <0.05 were considered significant.
A total of 450 HF patients, of which 114 had a CRT device. These patients had a higher baseline risk profile, but there was no difference regarding the primary outcome (13.2% vs 11.6%, p =0.660). End-tidal carbon dioxide pressure at anaerobic threshold (PETCO2AT)had the highest AUC value, which was significantly higher than that of pVO2in the CRT group (0.951 vs 0.778, p =0.046). The currently recommended pVO2cut-off provided accurate risk stratification in this setting (p <0.001), and the suggested cut-off value of 10 ml/min/kg did not improve risk discrimination in device patients (p =0.772).
PETCO2ATmay outperform pVO2's prognostic power for adverse events in CRT patients. The current guideline-recommended pVO2 cut-off can precisely risk-stratify this population.
有证据表明，峰值摄氧量（pVO2）截定点为 10ml/kg/min 可更精确地对心脏再同步化治疗（CRT）患者进行风险分层。
比较该人群中几种心肺运动测试（CPET）参数的预后能力，并评估指南推荐的 pVO2 截定点的判别能力。
前瞻性评估连续左心室射血分数≤40%的心力衰竭（HF）患者。主要终点为 24 个月随访期间的心脏死亡和紧急心脏移植（HT）的复合终点，并通过 CRT 组中曲线下面积（AUC）最高的几种 CPET 参数进行分析。生存分析用于评估几种不同截定点提供的风险分层。p 值<0.05 被认为具有统计学意义。
共纳入 450 例 HF 患者，其中 114 例植入 CRT 装置。这些患者的基线风险特征更高，但主要结局无差异（13.2% vs 11.6%，p=0.660）。无氧阈时的呼气末二氧化碳分压（PETCO2AT）具有最高的 AUC 值，明显高于 CRT 组中的 pVO2（0.951 vs 0.778，p=0.046）。目前推荐的 pVO2 截定点在该人群中可准确进行风险分层（p<0.001），而装置患者中建议的 10ml/min/kg 的截定点并不能提高风险判别能力（p=0.772）。
PETCO2AT 可能优于 pVO2 对 CRT 患者不良事件的预后能力。目前指南推荐的 pVO2 截定点可精确对该人群进行风险分层。
