Division of Rehabilitation Cardiology, Istituti Clinici Scientifici, IRCCS, Istituto di Veruno, Gattico-Veruno, Italy.
Life Science Institute, Scuola Superiore Sant'Anna, Pisa, Italy; UOC Cardiologia, G. da Saliceto Hospital, Piacenza, Italy.
Am J Cardiol. 2022 Oct 1;180:65-71. doi: 10.1016/j.amjcard.2022.06.034. Epub 2022 Jul 30.
Cardiopulmonary exercise testing is a prognostic tool in heart failure with reduced left ventricular ejection fraction (HFrEF). Prognosticating algorithms have been proposed, but none has been validated. In 2017, a predictive algorithm, based on peak oxygen consumption (VO), ventilatory response to exercise (ventilation [VE] carbon dioxide production [VCO2], the VE/VCO slope), exertional oscillatory ventilation (EOV), and peak respiratory exchange ratio, was recommended, according treatment with β blockers: patients with HFrEF registered in the metabolic exercise test data combined with cardiac and kidney indexes (MECKIs) database were used to validated this algorithm. According to the inclusion/exclusion criteria, 4,683 MECKI patients with HFrEF were enrolled. At 3 years follow-up, the end point was cardiovascular death and urgent heart transplantation (cardiovascular events [CV]). CV events occurred in 25% in patients without β blockers, whereas those with β-blockers had 11% (p <0.0001). In patients without β blockers, 36%, 24%, and 7% CV events were observed in those with peak VO2 ≤10, with peak VO2 >10 <18, and with peak VO2 ≥18 ml/kg/min (p = 0.0001), respectively; in MECKI patients with peak VO2 ≤10 and patients with intermediate exercise capacity, a peak respiratory exchange ratio (≥1.15) and VE/VCO slope (≥35) were diriment, respectively (p = 0.0001). EOV, when occurred, increased risk. In MECKI patients on β blockers, 29%, 17%, and 8% CV events were noticed in those with a peak VO2 ≤8, with peak VO2 = 8 to 12, and patients with peak VO2 ≥12 ml/kg/min, respectively (p = 0.0000); when EOV was monitored an increment of risk was witnessed. In conclusion, the outcome of this algorithm was confirmed with the MECKI cohort.
心肺运动试验是射血分数降低的心力衰竭（HFrEF）的预后工具。已经提出了预后算法，但没有一个得到验证。2017 年，根据峰值摄氧量（VO）、运动时通气反应（VE 二氧化碳产生[VCO2]、VE/VCO 斜率）、运动时呼吸震荡通气（EOV）和峰值呼吸交换率，提出了一种预测算法，根据β受体阻滞剂的治疗情况：使用代谢运动试验数据结合心脏和肾脏指数（MECKI）数据库登记的 HFrEF 患者来验证该算法。根据纳入/排除标准，共纳入 4683 例 MECKI 心力衰竭患者。在 3 年随访时，终点为心血管死亡和紧急心脏移植（心血管事件[CV]）。无β受体阻滞剂的患者中 CV 事件发生率为 25%，而有β受体阻滞剂的患者为 11%（p<0.0001）。在无β受体阻滞剂的患者中，峰值 VO2≤10、峰值 VO2>10<18 和峰值 VO2≥18 ml/kg/min 的患者 CV 事件分别为 36%、24%和 7%（p=0.0001）；在 MECKI 中，峰值 VO2≤10 和运动能力中等的患者，峰值呼吸交换率（≥1.15）和 VE/VCO 斜率（≥35）是重要的预后指标（p=0.0001）。当发生 EOV 时，风险增加。在 MECKI 中接受β受体阻滞剂治疗的患者中，峰值 VO2≤8、峰值 VO2=8-12 和峰值 VO2≥12 ml/kg/min 的患者 CV 事件发生率分别为 29%、17%和 8%（p=0.0000）；当监测到 EOV 时，风险增加。总之，该算法的结果在 MECKI 队列中得到了验证。
