Department of Cardiovascular Medicine, Gunma University Graduate School of Medicine, 3-39-22 Showa-Machi, Maebashi, Gunma, 371-8511, Japan.
Division of Cardiology, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan.
Sci Rep. 2023 Mar 16;13(1):4355. doi: 10.1038/s41598-023-31381-6.
Cardiopulmonary exercise testing (CPET) may potentially differentiate heart failure (HF) with preserved ejection fraction (HFpEF) from noncardiac causes of dyspnea (NCD). While contemporary guidelines for HF recommend using CPET for identifying causes of unexplained dyspnea, data supporting this practice are limited. This study aimed to determine the diagnostic value of expired gas analysis to distinguish HFpEF from NCD. Exercise stress echocardiography with simultaneous expired gas analysis was performed in patients with HFpEF (n = 116) and those with NCD (n = 112). Participants without dyspnea symptoms were also enrolled as controls (n = 26). Exercise capacity was impaired in patients with HFpEF than in controls and those with NCD, evidenced by lower oxygen consumption (VO), but there was a substantial overlap between HFpEF and NCD. Receiver operating characteristic curve analyses showed modest diagnostic abilities of expired gas analysis data in differentiating individuals with HFpEF from the controls; however, none of these variables clearly differentiated between HFpEF and NCD (all areas under the curve < 0.61). Expired gas analysis provided objective assessments of exercise capacity; however, its diagnostic value in identifying HFpEF among patients with symptoms of exertional dyspnea was modest.
心肺运动试验（CPET）可能有助于区分射血分数保留的心力衰竭（HFpEF）与非心源性呼吸困难（NCD）的病因。尽管心力衰竭的当代指南建议使用 CPET 来确定不明原因呼吸困难的病因，但支持这一做法的数据有限。本研究旨在确定呼气末气体分析在区分 HFpEF 与 NCD 方面的诊断价值。对 HFpEF 患者（n=116）和 NCD 患者（n=112）进行了运动超声心动图检查，并同时进行了呼气末气体分析。无呼吸困难症状的参与者也被纳入对照组（n=26）。HFpEF 患者的运动能力较对照组和 NCD 患者受损，表现为耗氧量（VO₂）降低，但 HFpEF 与 NCD 之间存在较大重叠。受试者工作特征曲线分析显示，呼气末气体分析数据在区分 HFpEF 患者与对照组方面具有中等的诊断能力；然而，这些变量均不能明确区分 HFpEF 与 NCD（所有曲线下面积均<0.61）。呼气末气体分析可提供运动能力的客观评估；然而，其在识别有劳力性呼吸困难症状的患者中 HFpEF 的诊断价值有限。
