Systolic blood pressure influences the interpretation of cardiopulmonary exercise tests and helps identify a very high-risk cohort of heart failure patients
| Autor: | David C. Lange, Brenda W. Gillespie, John M. Nicklas, Agnes Pinter, Robert L. Bard |
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| Rok vydání: | 2013 |
| Předmět: |
Pulmonary and Respiratory Medicine
Adult Male medicine.medical_specialty Population Blood Pressure Risk Assessment Cohort Studies Oxygen Consumption Predictive Value of Tests Internal medicine medicine Humans Prospective Studies education Survival analysis Aged Heart Failure Transplantation education.field_of_study Proportional hazards model business.industry Pulmonary Gas Exchange Middle Aged medicine.disease Prognosis Surgery Blood pressure Quartile Heart failure Cohort Cardiology Exercise Test Heart Transplantation Female Heart-Assist Devices Cardiology and Cardiovascular Medicine business Lung Volume Measurements |
| Zdroj: | The Journal of heart and lung transplantation : the official publication of the International Society for Heart Transplantation. 33(4) |
| ISSN: | 1557-3117 |
| Popis: | Background Ventilatory inefficiency (high volume of expired air/volume of carbon dioxide eliminated [Ve/Vco 2 ] slope), and impaired exercise tolerance (low peak volume of oxygen consumption) obtained from cardiopulmonary exercise testing (CPX) strongly predict mortality in heart failure (HF) patients; however, other CPX variables may also contain prognostic information. Therefore, the purpose of this study was to determine the prognostic power of the aggregate of CPX data. Methods The study prospectively monitored 390 patients referred for cardiac transplantation evaluation for 10 years for events (death, urgent transplant, left ventricular assist devices). Cox regression was used to analyze 18 CPX variables to identify the best survival model. Results Ve/Vco 2 slope was the most powerful mortality predictor, and only resting systolic blood pressure (SBP) added additional independent prognostic power when expressed at its threshold effect value as SBP ≤ 100 mm Hg. Patients with low SBP had a greater risk than those who were within the next higher quartile of Ve/Vco 2 slope with SBP > 100 mm Hg. A very high-risk cohort included 9% of the population that had a Ve/Vco 2 slope > 41 and SBP ≤ 100 mm Hg and an associated 2-year event rate of 67%; conversely, a low-risk cohort had a Ve/Vco 2 slope ≤ 30 and SBP >100 mm Hg and associated 2-, 5-, and 10-year event rates of 5%, 12%, and 30%, respectively. Conclusions Ve/Vco 2 slope was the best individual predictive CPX variable and its interpretation was significantly altered by the presence of hypotension. An algorithm combining these CPX variables identifies a HF population at very high risk of early death and warranting advanced therapies. |
| Databáze: | OpenAIRE |
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