Limited predictive value of cardiopulmonary exercise indices in patients with moderate chronic heart failure treated with carvedilol

被引:26
作者
Corrà, U [1 ]
Mezzani, A [1 ]
Bosimini, E [1 ]
Scapellato, F [1 ]
Temporelli, PL [1 ]
Eleuteri, E [1 ]
Giannuzzi, P [1 ]
机构
[1] Fdn S Maugeri, Div Cardiol, IRCCS, Inst Care & Res, I-28010 Veruno, NO, Italy
关键词
D O I
10.1016/j.ahj.2003.10.026
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Background Peak oxygen consumption (VO2) is traditionally used for risk stratification in chronic heart failure (CHF); however, its predictive value is unknown with carvedilol treatment. Therefore, we sought to investigate the prognostic role of gas-exchange parameters obtained from symptom-limited cardiopulmonary exercise testing (CPX) in patients with CHF that is treated with carvedilol. Methods A total of 508 consecutive patients (443 men, mean age [+/- SID] 59 +/- 9 years) with a mean left ventricular ejection fraction (LVEF) of 25% +/- 7% underwent CPX. The peak VO2 was 13.9 +/- 3 mL/kg/min; the rate of increase of minute ventilation per unit of increase of carbon dioxide production (VE/VCO2 slope) was 32 +/- 2. Outcomes (cardiovascular death or urgent heart transplantation) were determined when all patients who survived had been observed for a minimum of 6 months. Results Patients were divided into groups according to treatment (carvedilol and non-carvedilol); 236 patients were treated with carvedilol (46%), at a mean dose of 25 +/- 13 mg. The VE/CO2 slope, LVEF, peak VO2, and carvedilol treatment were revealed by means of multivariate analysis to be independent and additional predictors in the total population; VE/VCO2 slope, LVEF, and peak VO2 were revealed to be independent and additional predictors in the patients in the noncarvedilol group (all P < .001); and only peak VO2 was revealed to be an independent and additional predictor in the patients in the carvedilol group (P < .01). In the carvedilol group, mortality rates were 26%, 11%, 10%, and 4% (P < .05) in patients with peak VO2 <= 10 mL/kg/min, > 10 to less than or equal to14 mL/kg/min, > 14 to 18 mL/kg/min, and greater than or equal to18 mL/kg/min, respectively. No difference in mortality rates according to peak VO2 or additional outcome indices were identified in the 212 patients with peak VO2 > 10 mL/kg/min. Conclusions Peak VO2 provides limited predictive information in patients with CHF that is treated with carvedilol, and no additional gas exchange parameter yields supplementary advice.
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页码:553 / 560
页数:8
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