Normalization for peak oxygen uptake increases the prognostic power of the ventilatory response to exercise in patients with chronic heart failure

被引:54
作者
Guazzi, M [1 ]
De Vita, S [1 ]
Cardano, P [1 ]
Barlera, S [1 ]
Guazzi, MD [1 ]
机构
[1] Univ Milan, Ist Cardiol, I-20138 Milan, Italy
关键词
D O I
10.1016/S0002-8703(03)00321-1
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Background Peak exercise oxygen uptake (peak VO2) and ventilation to CO, production (VE/VCO2) slope rare established prognostic indicators in patients with chronic heart failure (CHF). A high VE/VCO2 slope, however, does not take into account the level of physical performance as expressed by peakVO(2). We, hypothesized that the prognostic value of a high VE/VCO2 slope may be improved by normalization. for peak VO2 (VE/VCO2/VO2). Methods. One hundred patients with CHIF underwent pulmonary function tests at rest (spirometry and lung diffusion capacity) and maximal cardiopulmonary exercise testing. The prognostic value of VE/VCO2 slope, peak VO2 and VE/VCO2/VO2 was probed prospectively. Results Twenty-one patients died from cardiac reasons during a mean follow-up of 26 19 months. Nonsurvivors, compared to survivors, showed a lower peak VO2 (13.6 +/- 4.0 vs 17.5 +/- 4.1 mL.min(-1).kg(-1), P < .01) and a steeper VE/VCO2 slope (43 +/- 11 vs 31.6 +/- 5.0, P < .01). Nonetheless, in patients whose VE/VCO2 slope exceeded 34 (upper normal limit), there was no correlation with peak VO2 (r = -35,. P = not significant). Interestingly 35% of them showed a normal exercise performance (peak VO2 greater than or equal to 18 mL.min(-1).kg(-1)). At multivariate analysis, the VE/VCO2 slope showed a prognostic power stronger than that of peak VO2; however, the VE/VCO2/VO2 index retained a prognostic power greater than that of both VE/VCO2 slope and peak VO2. A VE/VCO2/VO2 greater than or equal to2.4 signaled cases at higher risk. Conclusions 'Discrepancies between VE/VCO2 slope and peak VO2 may generate uncertainty. Normalization of the former by the latter improves outcome prediction and may be considered a simple and effective way for maximizing the clinical applicability of these 2 indicators.
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页码:542 / 548
页数:7
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