Zannoni Jessica, Guazzi Marco, Milani Valentina, Bandera Francesco, Alfonzetti Eleonora, Arena Ross
Clinical and Interventional Cardiology Department, I.R.C.C.S. Policlinico San Donato, San Donato Milanese, Milan, Italy.
University of Milano School of Medicine, Department of Biological Sciences, Milano, Italy; San Paolo Hospital, Cardiology Division, Milano, Italy.
Int J Cardiol. 2023 Jan 1;370:402-404. doi: 10.1016/j.ijcard.2022.10.016. Epub 2022 Oct 11.
Cardiorespiratory fitness (CRF) is now considered a vital sign. Cardiopulmonary exercise testing (CPET) is the gold-standard assessment of CRF; peak oxygen consumption (VO) and the minute ventilation/carbon dioxide production (VE/VCO) slope are considered primary CPET measures of CRF. More work is needed to determine the role of this exercise assessment in the primary care setting.
695 subjects (mean age: 62 ± 13 years, body mass index: 28.9 ± 5.3 kg/m, 375 female and 320 male) underwent CPET using a cycle ergometer. 95% of the cohort had one or more major cardiovascular risk factor (i.e., obesity, smoking, dyslipidemia, hypertension, diabetes); no subject was diagnosed with cardiovascular disease (CVD) at the time of CPET. Subjects were tracked for the composite endpoint of cardiovascular mortality or hospital admission.
Mean peak VO, VE/VCO slope and peak respiratory exchange ratio were 17.8 ± 5.8 mlO•kg•min, 26.7 ± 4.1, and 1.18 ± 0.13, respectively. There were 42 composite events during the 64 ± 18 month tracking period. Both peak VO (Chi-square 16.3, p < 0.001) and the VE/VCO slope (Chi-square 14.9, p < 0.001) were significant univariate predictors of the composite endpoint. The VE/VCO slope added significant predictive value to peak VO and was retained in the multivariate regression (residual Chi-square 7.0, p = 0.008).
These results support the prognostic value of CPET prior to a CVD diagnosis. The prognostic value of the VE/VCO slope, not commonly the focus of CPET trials in patients with one or more major cardiovascular risk factors but without a confirmed CVD diagnosis, is a particularly novel finding in the current study.
心肺适能（CRF）现在被视为一项生命体征。心肺运动试验（CPET）是CRF的金标准评估方法；峰值摄氧量（VO）和分钟通气量/二氧化碳产生量（VE/VCO）斜率被视为CRF的主要CPET测量指标。需要开展更多工作来确定这种运动评估在初级保健环境中的作用。
695名受试者（平均年龄：62±13岁，体重指数：28.9±5.3kg/m，375名女性和320名男性）使用自行车测力计进行了CPET。该队列中95%的人有一个或多个主要心血管危险因素（即肥胖、吸烟、血脂异常、高血压、糖尿病）；在进行CPET时，没有受试者被诊断患有心血管疾病（CVD）。对受试者进行心血管死亡或住院的复合终点追踪。
平均峰值VO、VE/VCO斜率和峰值呼吸交换率分别为17.8±5.8mlO•kg•min、26.7±4.1和1.18±0.13。在64±18个月的追踪期内发生了42起复合事件。峰值VO（卡方值16.3，p<0.001）和VE/VCO斜率（卡方值14.9，p<0.001）都是复合终点的显著单变量预测指标。VE/VCO斜率为峰值VO增加了显著的预测价值，并保留在多变量回归中（残差卡方值7.0，p=0.008）。
这些结果支持了CPET在CVD诊断之前的预后价值。VE/VCO斜率的预后价值在当前研究中是一个特别新的发现，在有一个或多个主要心血管危险因素但未确诊CVD的患者中，VE/VCO斜率通常不是CPET试验的重点。
