運動に対する呼吸器と心拍の反応:ピーク酸素消費よりも心不全の死亡率の予測が優れている
M Robbins1, G Francis, F J Pashkow
1George M. and Linda Kaufman Center for Heart Failure, Desk F25, Department of Cardiology, Cleveland Clinic Foundation, Cleveland, OH 44195, USA.
Circulation
|December 14, 1999
まとめ
高呼吸器応答 (VE/VCO2) と低クロノトロピック指数を含む異常な運動反応は,心不全による死亡率を予測する. これらの重要な指標は,管理を改善するために,高リスクの患者を特定するのに役立ちます.
科学分野:
- 心臓病学 心臓病学
- 運動生理学 運動生理学
背景:
- 重度の心不全は,運動中に異常なクロノトロプ的および呼吸器の反応を伴うことが多い.
- これらの反応の比較的な予後値は,まだ十分に研究されていない.
研究 の 目的:
- 心不全患者の死亡率に対する運動誘発クロノトロプおよび呼吸器反応の独立した予測価値を調査する.
- これらの反応が心不全のリスクを階層化できるかどうかを判断する.
主な方法:
- 470人の心不全患者のコホート (ベータブロッカーやイノトロップ剤なし) は,代謝ストレステストを受けた.
- クロノトロピー指数,ピーク酸素消費量 (VO2),呼吸器応答 (VE/VCO2) を測定した.
- 患者の死亡率は1.5年間追跡調査された.
主要な成果:
- 心不全の患者は,健康な対照群と比較して,有意に異常な呼吸器およびクロノトロプ反応を示した.
- 単変量分析では,高いVE/VCO2,低クロノトロピック指数,低VO2,低血圧,および高齢が死亡率の予測要因として特定されました.
- 多変量分析により,高 VE/VCO2 (RR 3.20) と低クロノトロプインデックス (RR 1.94) が死亡の独立した予測因子であると確認されました.
結論:
- 運動による呼吸器およびクロノトロピク反応は,心不全による死亡率の強力で独立した予測因子である.
- これらの生理学的測定は,心不全の管理におけるリスクの階層化に価値があります.
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