Targeting of High Peak Respiratory Exchange Ratio Is Safe and Enhances the Prognostic Power of Peak Oxygen Uptake for Heart Failure Patients
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- Nakanishi Michio
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
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- Takaki Hiroshi
- Department of Cardiovascular Dynamics, National Cerebral and Cardiovascular Center Research Institute
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- Kumasaka Reon
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
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- Arakawa Tetsuo
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
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- Noguchi Teruo
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
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- Sugimachi Masaru
- Department of Cardiovascular Dynamics, National Cerebral and Cardiovascular Center Research Institute
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- Goto Yoichi
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
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Background:Peak oxygen uptake (V̇O2) and ventilatory efficiency (V̇E/V̇CO2slope) measured on cardiopulmonary exercise testing (CPX) are prognostic indicators in heart failure (HF) patients, but peak V̇O2is influenced by patient effort. In CPX targeting a peak respiratory exchange ratio (pRER; an objective index of effort adequacy) higher than the commonly recommended level, we assessed the safety and prognostic value of CPX parameters compared with non-CPX parameters.Methods and Results:We studied 283 consecutive HF patients with left ventricular ejection fraction (LVEF) ≤45% (mean, 26.3%) who underwent CPX targeting pRER >1.20. The attained pRER (mean, 1.26) was consistently high irrespective of LVEF, and there was no major exercise-related adverse event. The composite of all-cause death or HF hospitalization occurred in 111 patients (39%) during a median follow-up of 47 months. Among well-known prognostic markers, peak V̇O2was the most powerful predictor of outcome as both a continuous and an optimal dichotomous variable, followed by V̇E/V̇CO2slope. On multivariate analysis, peak V̇O2was a significant independent predictor, whereas V̇E/V̇CO2slope, B-type natriuretic peptide, and LVEF were not.Conclusions:In CPX targeting pRER >1.20 for HF patients, peak V̇O2is the most powerful among well-known predictors, without an increased risk of exercise-related events. These findings advocate a high target pRER in CPX even in advanced HF. (Circ J 2014; 78: 2268–2275)
収録刊行物
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- Circulation Journal
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Circulation Journal 78 (9), 2268-2275, 2014
一般社団法人 日本循環器学会
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詳細情報 詳細情報について
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- CRID
- 1390001205107447680
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- NII論文ID
- 130004427975
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- NII書誌ID
- AA11591968
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- COI
- 1:STN:280:DC%2BC2cblt1ynsg%3D%3D
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- ISSN
- 13474820
- 13469843
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- NDL書誌ID
- 025704380
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- PubMed
- 25056425
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- 本文言語コード
- en
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- データソース種別
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- JaLC
- NDL
- Crossref
- PubMed
- CiNii Articles
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- 抄録ライセンスフラグ
- 使用不可