Wernhart Simon, Papathanasiou Maria, Rassaf Tienush, Luedike Peter
University Hospital Essen, University Duisburg-Essen, West German Heart- and Vascular Center, Department of Cardiology and Vascular Medicine, Hufelandstrasse 55, 45147 Essen, Germany.
University Hospital Essen, University Duisburg-Essen, West German Heart- and Vascular Center, Department of Cardiology and Vascular Medicine, Hufelandstrasse 55, 45147 Essen, Germany.
Int J Cardiol. 2023 Apr 1;376:157-164. doi: 10.1016/j.ijcard.2023.01.072. Epub 2023 Jan 27.
Heart failure with preserved (HFpEF), mildly reduced (HFmrEF) and reduced (HFrEF) ejection fraction (EF) remains a controversial categorization. Whether these three categories reflect a distinct pattern of exercise limitation in cardiopulmonary exercise testing (CPET) needs to be investigated. We aimed to analyze whether CPET variables differ between all heart failure categories (HF).
We analyzed CPET variables of stable HFpEF (n = 123), HFmrEF (n = 31), and HFrEF (n = 153; 74 patients with and 79 patients without left ventricular assist device, LVAD) patients. The association between HF and peak oxygen consumption (VO) was used as a primary outcome, while the association between HF, oxygen uptake efficiency slope (OUES), and increase of O pulse (ΔO pulse) were analyzed as secondary outcomes.
VO displayed a consistent decline across all HF categories (19.8 ml ± 6.2/kg/min vs. 17.5 ± 7.9 ml/kg/min vs. 13.7 ± 4.0 ml/kg/min, p < 0.001). OUES only showed differences between HFpEF and HFrEF (1.8 ± 0.6 vs. 1.4 ± 0.5, p < 0.001) as well as HFmrEF and HFrEF (1.9 ± 0.9 vs. 1.4 ± 0.5, p = 0.004). ΔO pulse differed between HFpEF and HFrEF (7.7 ± 3.5 ml/beat/kg100 vs. 5.5 ± 3.0 ml/beat/kg100, p < 0.001) as well as HFpEF and HFmrEF (7.7 ± 3.5 ml/beat/kg100 vs. 6.3 ± 4.1 ml/beat/kg100, p = 0.049). Outcome variables did not differ between HFrEF with and without LVAD support (VO: p = 0.364, OUES: p = 0.129, ΔO pulse: p = 0.564).
HF did not display a distinct CPET profile. Thus, EF-based categorization does not entirely reflect exercise limitations. CPET variables could contribute to better characterize HF phenotypes.
射血分数保留的心衰（HFpEF）、轻度降低的心衰（HFmrEF）和降低的心衰（HFrEF）仍是一个有争议的分类。这三种类型在心肺运动试验（CPET）中是否反映出不同的运动受限模式有待研究。我们旨在分析所有心衰类型（HF）之间CPET变量是否存在差异。
我们分析了稳定的HFpEF患者（n = 123）、HFmrEF患者（n = 31）和HFrEF患者（n = 153；74例有左心室辅助装置[LVAD]，79例无LVAD）的CPET变量。HF与峰值耗氧量（VO）之间的关联作为主要结局，而HF、摄氧效率斜率（OUES）和O脉搏增加（ΔO脉搏）之间的关联作为次要结局进行分析。
VO在所有心衰类型中均呈一致下降（19.8 ml±6.2/kg/min vs. 17.5±7.9 ml/kg/min vs. 13.7±4.0 ml/kg/min，p < 0.001）。OUES仅在HFpEF与HFrEF之间（1.8±0.6 vs. 1.4±0.5，p < 0.001）以及HFmrEF与HFrEF之间（1.9±0.9 vs. 1.4±0.5，p = 0.004）存在差异。ΔO脉搏在HFpEF与HFrEF之间（7.7±3.5 ml/次搏动/kg×100 vs. 5.5±3.0 ml/次搏动/kg×100，p < 0.001）以及HFpEF与HFmrEF之间（7.7±3.5 ml/次搏动/kg×100 vs. 6.3±4.1 ml/次搏动/kg×100，p = 0.049）存在差异。有LVAD支持和无LVAD支持的HFrEF患者的结局变量无差异（VO：p = 0.364，OUES：p = 0.129，ΔO脉搏：p = 0.564）。
HF未表现出独特的CPET特征。因此，基于射血分数的分类不能完全反映运动受限情况。CPET变量有助于更好地表征HF表型。
