Myers J, Gullestad L
Palo Alto VA Health Care System, Cardiology, CA 94304, USA.
Curr Opin Cardiol. 1998 May;13(3):145-55.
Functional impairment has long been recognized as an important factor in the risk paradigm among patients with heart disease. In chronic heart failure, this issue has been even more important in recent years because of the steady growth in the number of patients awaiting heart transplantation relative to the available pool of donor hearts. The use of gas-exchange techniques to assess patients with heart failure has attracted interest because these techniques provide a more precise, reproducible, objective, and physiologic expression of exercise tolerance. Numerous studies published in the 1990s demonstrate that maximal oxygen uptake (peak VO2) is an independent predictor of mortality in patients with heart failure. Achievement of a peak VO2 that is less than 14 mL/kg/min has been recognized as one of the relative indications for transplantation, because patients who achieve a measurement that is higher than 14 mL/kg/min have a 1-year mortality rate similar to that of patients who undergo transplantation (i.e., > 90%). However, some debate exists regarding the optimal cutpoint that separates survivors from nonsurvivors, and studies have not consistently defined the timing of the test relative to optimization of medical therapy. It has also been debated which hemodynamic variables, at rest or during exercise, should be used in combination with peak VO2 to optimally stratify risk in these patients. This article reviews the applications of cardiopulmonary exercise testing in prognosis among patients with chronic heart failure.
功能障碍长期以来一直被认为是心脏病患者风险模式中的一个重要因素。在慢性心力衰竭中，近年来这个问题变得更加重要，因为相对于可用的供体心脏库，等待心脏移植的患者数量稳步增长。使用气体交换技术来评估心力衰竭患者引起了人们的兴趣，因为这些技术能更精确、可重复、客观且生理地表达运动耐量。20世纪90年代发表的众多研究表明，最大摄氧量（峰值VO2）是心力衰竭患者死亡率的独立预测指标。峰值VO2低于14 mL/kg/min已被视为移植的相对指征之一，因为峰值VO2高于14 mL/kg/min的患者1年死亡率与接受移植的患者相似（即>90%）。然而，关于区分幸存者和非幸存者的最佳切点存在一些争议，并且研究对于测试时间相对于优化药物治疗的定义并不一致。对于在静息或运动时哪些血流动力学变量应与峰值VO2结合使用以最佳地对这些患者进行风险分层也存在争议。本文综述了心肺运动试验在慢性心力衰竭患者预后评估中的应用。
