Di Salvo T G, Mathier M, Semigran M J, Dec G W
Department of Medicine, Massachusetts General Hospital, Boston 02114.
J Am Coll Cardiol. 1995 Apr;25(5):1143-53. doi: 10.1016/0735-1097(94)00511-n.
This study was undertaken to determine which exercise and radionuclide ventriculographic variables predict prognosis in advanced heart failure.
Although cardiopulmonary exercise testing is frequently used to predict prognosis in patients with advanced heart failure, little is known about the prognostic significance of ventriculographic variables.
The results of maximal symptom-limited cardiopulmonary exercise testing and first-pass radionuclide ventriculography in patients with advanced heart failure referred for evaluation for cardiac transplantation were analyzed.
Sixty-seven patients with advanced heart failure (mean [+/- SD]; age 51 +/- 10 years, New York Heart Association functional classes III (58%) and IV (18%); mean left ventricular ejection fraction 0.22 +/- 0.07) underwent simultaneous upright bicycle ergometric cardiopulmonary exercise testing and first-pass rest/exercise radionuclide ventriculography. Mean peak oxygen consumption (VO2) was 11.8 +/- 4.2 ml/kg per min, and mean peak age- and gender-adjusted percent predicted oxygen consumption (%VO2) was 38 +/- 11.9%. Univariate predictors of overall survival included right ventricular ejection fraction > or = 0.35 at rest and > or = 0.35 at exercise and %VO2 > or = 45% (all p < 0.05). In a multivariate proportional hazards survival model, right ventricular ejection fraction > or = 0.35 at exercise (p < 0.01) and %VO2 > or = 45% (p = 0.01) were selected as independent predictors of overall survival. Univariate predictors of event-free survival included right ventricular ejection fraction > or = 0.35 at rest (p = 0.01) and > or = 0.35 at exercise (p < 0.01), functional class II (p < 0.05) and %VO2 > or = 45% (p = 0.05). Right ventricular ejection fraction > or = 0.35 at exercise (p = 0.01) was the only independent predictor of event-free survival in a multivariate proportional hazards model. Cardiac index at rest, VO2, left ventricular ejection fraction at rest, and exercise-related increase or decrease > 0.05 in left or right ventricular ejection fraction were not predictive of overall or event-free survival in any univariate or multivariate analysis.
本研究旨在确定哪些运动和放射性核素心室造影变量可预测晚期心力衰竭的预后。
尽管心肺运动试验常用于预测晚期心力衰竭患者的预后，但对于心室造影变量的预后意义知之甚少。
分析了因心脏移植评估而转诊的晚期心力衰竭患者进行的最大症状限制心肺运动试验和首次通过放射性核素心室造影的结果。
67例晚期心力衰竭患者（平均[±标准差]；年龄51±10岁，纽约心脏协会功能分级III级（58%）和IV级（18%）；平均左心室射血分数0.22±0.07）同时进行了直立自行车测力计心肺运动试验和首次通过静息/运动放射性核素心室造影。平均峰值耗氧量（VO₂）为11.8±4.2 ml/kg每分钟，平均峰值年龄和性别校正的预测耗氧量百分比（%VO₂）为38±11.9%。总体生存的单因素预测指标包括静息时右心室射血分数≥0.35、运动时右心室射血分数≥0.35以及%VO₂≥45%（均p<0.05）。在多因素比例风险生存模型中，运动时右心室射血分数≥0.35（p<0.01）和%VO₂≥45%（p = 0.01）被选为总体生存的独立预测指标。无事件生存的单因素预测指标包括静息时右心室射血分数≥0.35（p = 0.01）、运动时右心室射血分数≥0.35（p<0.01）、功能分级II级（p<0.05）和%VO₂≥45%（p = 0.05）。运动时右心室射血分数≥0.35（p = 0.01）是多因素比例风险模型中无事件生存的唯一独立预测指标。静息时心脏指数、VO₂、静息时左心室射血分数以及运动相关的左或右心室射血分数增加或减少>0.05在任何单因素或多因素分析中均不能预测总体或无事件生存。
1）静息和运动时右心室射血分数≥0.35比VO₂或%VO₂更能有效预测晚期心力衰竭的生存；2）在晚期心力衰竭中，%VO₂而非VO₂可预测生存；3）%VO₂和VO₂均不能预测晚期心力衰竭患者死亡或因使用正性肌力药物或机械支持而入院这一联合终点的生存情况。
