在监测肥厚型心肌病患者的治疗效果方面，通气效率参数优于峰值耗氧量。

IF 5.6 2区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

Progress in cardiovascular diseases Pub Date : 2024-11-01 DOI:10.1016/j.pcad.2024.10.005

Stefan Seman , Milorad Tesic , Marija Babic , Lidija Mikic , Lazar Velicki , Nduka C Okwose , Sarah J Charman , Maria Tafelmeier , Iacopo Olivotto , Nenad Filipovic , Arsen Ristic , Ross Arena , Marco Guazzi , Djordje Jakovljevic , Thomas G Allison , Dejana Popovic , on behalf of SILICOFCM study investigators

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引用次数: 0

摘要

目的：我们寻找能最准确反映肥厚型心肌病（HCM）患者疗效的心肺运动测试（CPET）参数：在 II 期随机、开放标签多中心研究中，对有症状的非梗阻性 HCM 患者在接受传统治疗或沙库比曲利/缬沙坦治疗 16 周前后进行了健康问卷调查、N 端脑钠肽测量、超声心动图和 CPET。在首次 CPET 治疗 36 个月后对患者进行随访。主要终点是以下指标的变化1）峰值耗氧量（VO2）；2）无氧阈值（AT）时的 VO2；3）氧脉搏；4）分钟通气量（VE）/二氧化碳（CO2）产生斜率；5）AT 时的 VE/VCO2（VE/VCO2_AT）；6）VE/VCO2 最低值；7）VE/VCO2 截距；8）CPET 期间二氧化碳部分潮气末压（PETCO2）的变化：结果：在 115 名接受筛查的患者中，61 人（52 ± 14 岁，43% 为女性）入选。仅通过 VE/VCO2 截距和 PETCO2 变化来检测受试者内部的治疗效果，而通过治疗后 VE/VCO2 nadir 和 VE/VCO2_AT 变化的差异来检测医疗方案之间的差异。左心室流出道最大阶差和 VE/VCO2 截距（B = 0.41，0.36；SE = 0.16，0.30；CI = 0.14-0.79，0.15-1.14；P = 0.006，0.016）是预测健康状况变化的最佳指标。初始 VE/VCO2 最低值对不良心脏事件的预测效果最佳：结论：在衡量 HCM 患者的治疗效果方面，通气效率参数优于峰值 VO2。

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The ventilatory efficiency parameters outperform peak oxygen consumption in monitoring the therapy effects in patients with hypertrophic cardiomyopathy

Aim

We sought the cardiopulmonary exercise testing (CPET) parameter that most accurately reflected therapeutic efficacy in patients with hypertrophic cardiomyopathy (HCM).

Methods

Well-being questionnaire, N-terminal brain natriuretic peptide measurements, echocardiography, and CPET were performed in patients with symptomatic non-obstructive HCM during phase II, randomized, open-label multicentre study, before and after 16 weeks of traditional or sacubitril/valsartan treatment. Patients were followed 36 months after the initial CPET. Primary endpoints were changes in: 1) peak oxygen consumption (VO₂); 2) VO₂ at anaerobic threshold (AT); 3) oxygen pulse; 4) minute ventilation (VE)/carbon-dioxide (CO₂) production slope; 5) VE/VCO₂ at AT (VE/VCO₂_AT); 6) VE/VCO₂ nadir; 7) VE/VCO₂ intercept; and 8) partial end-tidal pressure of carbon-dioxide (P_ETCO₂) change during CPET.

Results

Of 115 screened patients, 61 (52 ± 14 years, 43 % women) were included. Within subject therapy effects were detected only by the VE/VCO₂ intercept and P_ETCO₂ change, whereas the differences between medical regimens were detected by differences in VE/VCO₂ nadir and VE/VCO₂_AT changes after the treatment. The best predictors of the change in well-being were left ventricular outflow tract maximal gradient and VE/VCO₂ intercept (B = 0.41,0.36; SE = 0.16,0.30; CI = 0.14–0.79, 0.15–1.14; p = 0.006,0.016, respectively). Adverse cardiac events were best predicted by the initial VE/VCO₂ nadir.

Conclusion

Ventilatory efficiency parameters outperform peak VO₂ in gauging therapy effects in patients with HCM.

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来源期刊

Progress in cardiovascular diseases 医学-心血管系统

CiteScore

10.90

自引率

6.60%

发文量

审稿时长

7 days

期刊介绍： Progress in Cardiovascular Diseases provides comprehensive coverage of a single topic related to heart and circulatory disorders in each issue. Some issues include special articles, definitive reviews that capture the state of the art in the management of particular clinical problems in cardiology.