心肺运动测试与同时进行运动回声心脏成像在心力衰竭与保存的喷射分数的心脏衰竭的预后效用
Ayami Naito1,2, Kazuki Kagami1,2, Naoki Yuasa1
1Department of Cardiovascular Medicine, Gunma University Graduate School of Medicine, Maebashi, Japan.
European journal of heart failure
|June 6, 2024
概括
心肺运动测试与运动回声心脏图 (CPETecho) 结合,改善了心力衰竭风险预测,并保留了喷射分数 (HFpEF). 添加CPET变量,如峰值氧气消耗 (VO2) 和VE/VCO2斜率,可以提高预后准确度,超出传统标记.
科学领域:
- 心脏病学 心脏病学
- 肺部病理学 肺部病理学
- 运动生理学 运动生理学
背景情况:
- 保存喷射分数 (HFpEF) 的心力衰竭带来了诊断和预后挑战.
- 在运动期间同时评估心脏,肺和通风,可以提供更深入的见解.
- 心肺运动测试与运动心声学 (CPETecho) 结合,可进行全面的评估.
研究的目的:
- 为了评估CPET同步变量的附加预测值,在呼吸障碍患者的运动应激心声学上.
- 为了评估峰值氧气消耗 (VO2) 和每分钟通风到二氧化碳 (VE/VCO2) 生产的预后意义,HFpEF中的斜率.
- 确定CPETecho是否增强了疑似HFpEF的风险分层.
主要方法:
- 在443名怀疑有HFpEF的患者中进行了CPETecho (240名HFpEF,203名对照).
- 患者按峰值VO2 (<10对≥10毫升/分钟/公斤) 和VE/VCO2斜率 (<45.0对≥45.0) 分层.
- 主要终点:死亡率的复合,HF住院,或利尿强化.
主要成果:
- 升高的VE/VCO2斜率和降低的峰值VO2与HFpEF的不良结果有关.
- 与高峰VO2峰值较高的HFpEF相比,较低的VO2峰值显著增加了复合事件的风险 (HR 3.14,p=0.0003).
- 将峰值VO2或VE/VCO2斜率添加到临床模型中,显著提高了预测能力 (p<0.05).
结论:
- 同时CPETecho为HFpEF患者提供了有价值的预后信息.
- 峰值VO2和VE/VCO2斜率是该人群中不良事件的显著预测因素.
- 在传统的心声和临床参数之外,CPETecho增强了风险分层.
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