Department of Cardiology, Hospital Santa Cruz, Centro Hospitalar Lisboa Ocidental, Carnaxide, Portugal.
Department of Cardiology, Hospital Santa Cruz, Centro Hospitalar Lisboa Ocidental, Carnaxide, Portugal.
Heart Lung Circ. 2023 Aug;32(8):949-957. doi: 10.1016/j.hlc.2023.04.291. Epub 2023 Jun 15.
Several heart failure (HF) prognostic risk scores are available to guide the ideal time for listing candidates for a heart transplant (HTx). The detection of exercise oscillatory ventilation (EOV) during cardiopulmonary exercise testing (CPET) is associated with advanced HF and a worse prognosis, and yet it is not accounted for in these risk scores. Therefore, this study aimed to assess whether EOV further adds prognostic value to HF scores.
A single-centre retrospective cohort study was undertaken of consecutive HF patients with reduced ejection fraction (HFrEF) who underwent CPET from 1996 to 2018. The Heart Failure Survival Score (HFSS), Seattle Heart Failure Model (SHFM), Meta-analysis Global Group In Chronic Heart Failure (MAGGIC), and Metabolic Exercise Cardiac Kidney Index (MECKI) were calculated. The added value of EOV on top of those scores was assessed using a Cox proportional hazard model. The added discriminative power was also assessed by receiver operating characteristic curve comparison.
A total of 390 HF patients with a median age of 58 (IQR 50-65) years were investigated, of whom 78% were male and 54% had ischaemic heart disease. The median peak oxygen consumption was 15.7 mL/kg/min (IQR 12.8-20.1). Exercise oscillatory ventilation was detected in 153 (39.2%) patients. Over a median follow-up of 2 years, 61 patients died (49 due to a cardiovascular reason) and 54 had a HTx. Exercise oscillatory ventilation independently predicted the composite outcome of all-cause death and HTx. Furthermore, the presence of this ventilatory pattern significantly improved the prognostic performance of both HFSS and MAGGIC scores.
Exercise oscillatory ventilation was often found in a cohort of HF patients with reduced LVEF who underwent CPET. It was found that EOV added further prognostic value to contemporary HF scores, suggesting that this easily obtained parameter should be included in future modified HF scores.
有几种心力衰竭（HF）预后风险评分可用于指导候选者进行心脏移植（HTx）的理想时间。心肺运动测试（CPET）中运动性振荡通气（EOV）的检测与晚期 HF 和更差的预后相关，但这些风险评分并未考虑到这一点。因此，本研究旨在评估 EOV 是否进一步增加 HF 评分的预后价值。
对 1996 年至 2018 年期间接受 CPET 的射血分数降低的心力衰竭（HFrEF）连续患者进行了一项单中心回顾性队列研究。计算了心力衰竭生存评分（HFSS）、西雅图心力衰竭模型（SHFM）、Meta 分析全球慢性心力衰竭组（MAGGIC）和代谢运动心脏肾脏指数（MECKI）。使用 Cox 比例风险模型评估 EOV 在这些评分之上的额外价值。还通过接收者操作特征曲线比较评估了附加的判别能力。
共研究了 390 名年龄中位数为 58（IQR 50-65）岁的 HF 患者，其中 78%为男性，54%有缺血性心脏病。中位峰值摄氧量为 15.7 mL/kg/min（IQR 12.8-20.1）。153 名（39.2%）患者检测到运动性振荡通气。在中位数为 2 年的随访中，61 名患者死亡（49 名死于心血管原因），54 名患者进行了 HTx。运动性振荡通气独立预测了全因死亡和 HTx 的复合结局。此外，这种通气模式的存在显著提高了 HFSS 和 MAGGIC 评分的预后性能。
在接受 CPET 的射血分数降低的心力衰竭患者队列中，经常发现运动性振荡通气。结果发现，EOV 为当代 HF 评分增加了额外的预后价值，表明这个易于获得的参数应该包含在未来的改良 HF 评分中。
