Prediction of left ventricular reverse remodeling in patients with heart failure with reduced ejection fraction using cardiopulmonary exercise testing.

IF 2.5 3区 医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS
Yoshihiro Hosoda, Ayumi Goda, Yoshiaki Yanagisawa, Yusuke Miura, Ryo Nakamaru, Sayaka Funabashi, Mika Tashiro, Tomoko Nishi, Shinsuke Takeuchi, Kyoko Soejima, Takashi Kohno
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Abstract

Background: With advances in the treatment of heart failure with reduced ejection fraction (HFrEF), the prediction of left ventricular reverse remodeling (LVRR) has become increasingly important. Cardiopulmonary exercise testing (CPET) is a non-invasive test recommended for prognostic risk assessment in HFrEF; however, it is not known whether it predicts LVRR. We aimed to investigate whether the parameters obtained from CPET are useful in predicting LVRR in HFrEF.

Methods: We retrospectively evaluated 230 consecutive patients with HFrEF [left ventricular ejection fraction (LVEF) ≤40 %] hospitalized for acute heart failure (59 ± 14 years, 78 % males) who underwent CPET before discharge. We investigated whether the CPET parameters, peak oxygen consumption (VO2), and the minute ventilation (VE) vs. carbon dioxide production (VCO2) slope could predict LVRR within 1 year (LVEF >50 %).

Results: Among 230 patients, 89 (39 %) exhibited LVRR. In multivariable logistic analysis, higher peak VO2 [odds ratio (OR): 1.13, 95 % confidence interval (CI): 1.05-1.22, p < 0.001] and lower VE vs. VCO2 slope (OR: 0.95, 95 % CI: 0.91-0.98, p < 0.001) were independently associated with LVRR. In receiver operating characteristic curve analysis, peak VO2 [area under the curve (AUC): 0.657, p < 0.001, optimal cut-off: 15.5 mL/min/kg] and VE vs. VCO2 slope (AUC: 0.663, p < 0.001, optimal cut-off: 35.8) were significant predictors of LVRR. Moreover, combining the peak VO2 and VE vs. VCO2 slope improved the predictive value (AUC: 0.682).

Conclusions: CPET is a valuable test for the non-invasive detection of LVRR. The combination of peak VO2 and the VE vs. VCO2 slope is useful for predicting LVRR among hospitalized patients with HFrEF receiving pharmacological treatment.

用心肺运动试验预测心力衰竭伴射血分数降低患者左心室反向重构。
背景:随着心力衰竭伴射血分数降低(HFrEF)治疗的进展,左心室反向重构(LVRR)的预测变得越来越重要。心肺运动试验(CPET)是一种推荐用于HFrEF预后风险评估的无创试验;然而,尚不清楚它是否能预测LVRR。我们的目的是研究从CPET获得的参数是否有助于预测HFrEF的LVRR。方法:我们回顾性评估了230例因急性心力衰竭住院的HFrEF[左室射血分数(LVEF)≤40 %]患者(59 ± 14 岁,78 %男性)在出院前接受CPET治疗。我们研究了CPET参数、峰值耗氧量(VO2)和分钟通气量(VE)与二氧化碳产量(VCO2)斜率是否可以预测1 年内的LVRR (LVEF >50 %)。结果:230例患者中,89例(39% %)出现LVRR。在多变量logistic分析中,较高的峰值VO2[比值比(OR): 1.13, 95 %置信区间(CI): 1.05-1.22, p 2斜率(OR: 0.95, 95 % CI: 0.91-0.98, p 2]曲线下面积(AUC): 0.657, p 2斜率(AUC: 0.663, p 2)和VE vs. VCO2斜率提高了预测值(AUC: 0.682)。结论:CPET是一种有价值的无创检测LVRR的方法。VO2峰值和VE与VCO2斜率的组合可用于预测接受药物治疗的HFrEF住院患者的LVRR。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Journal of cardiology
Journal of cardiology CARDIAC & CARDIOVASCULAR SYSTEMS-
CiteScore
4.90
自引率
8.00%
发文量
202
审稿时长
29 days
期刊介绍: The official journal of the Japanese College of Cardiology is an international, English language, peer-reviewed journal publishing the latest findings in cardiovascular medicine. Journal of Cardiology (JC) aims to publish the highest-quality material covering original basic and clinical research on all aspects of cardiovascular disease. Topics covered include ischemic heart disease, cardiomyopathy, valvular heart disease, vascular disease, hypertension, arrhythmia, congenital heart disease, pharmacological and non-pharmacological treatment, new diagnostic techniques, and cardiovascular imaging. JC also publishes a selection of review articles, clinical trials, short communications, and important messages and letters to the editor.
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