| Noninvasive assessment of cardiac pumping capacity during exercise predicts prognosis in patients with congestive heart failure. | |
| | |
MedLine Citation:
|
PMID: 12377861 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
|
BACKGROUND: Prognostic parameters in patients with congestive heart failure (CHF) are important for guiding therapeutic options. Maximal oxygen uptake (O(2)max) is a widely used parameter for prognostic assessment in patients with CHF and correlates with exercise cardiac output; however, afterload is not taken into account. METHODS: The concept of a noninvasive surrogate of cardiac power output combines exercise systolic BP (SBP), as an estimate of afterload, with O(2)max, as an estimate of exercise cardiac output neglecting preload. Thus, a variable termed exercise cardiac power (ECP) is defined as the product of O(2)max (expressed as a percent predicted value) and SBP (ECP, expressed as %mm Hg, is the product of O(2)max, expressed as percentage of predicted maximum, times systolic pressure. The prognostic value of ECP obtained during routine treadmill ergospirometry was assessed in patients referred to our heart failure clinic. Patients undergoing heart transplantation were censored at the time of transplantation. RESULTS: One hundred fifty-four patients were followed prospectively for a mean (+/- SE) duration of 625 +/- 32 days. Thirty-two patients (21%) died. ECP was the most powerful predictor of mortality, was the combined end point of mortality or hospitalization for worsening heart failure (all p < 0.001), and was an independent predictor in multivariate analysis. An ECP of < 5,000 %mm Hg indicated a poor prognosis with a 1-year mortality rate of 37%, whereas only 2% of the patients having an ECP of > 9,000 %mm Hg died during the first year. CONCLUSION: The integration of afterload and O(2)max improves the prognostic value of each indicator, and provides an easily available and independent predictor of mortality and morbidity in CHF patients. This integrative concept of cardiac hydraulic performance is superior to O(2)max and can be used in routine ergospirometry. |
| | |
Authors:
|
Christoph Scharf; Tobias Merz; Wolfgang Kiowski; Erwin Oechslin; Christoph Schalcher; Hans Peter Brunner-La Rocca |
Publication Detail:
|
Type: Journal Article; Research Support, Non-U.S. Gov't |
Journal Detail:
|
Title: Chest Volume: 122 ISSN: 0012-3692 ISO Abbreviation: Chest Publication Date: 2002 Oct |
Date Detail:
|
Created Date: 2002-10-14 Completed Date: 2002-11-22 Revised Date: 2007-11-15 |
Medline Journal Info:
|
Nlm Unique ID: 0231335 Medline TA: Chest Country: United States |
Other Details:
|
Languages: eng Pagination: 1333-9 Citation Subset: AIM; IM |
Affiliation:
|
Heart Failure and Cardiac Transplantation Unit, Division of Cardiology, University Hospital of Zürich, Zürich, Switzerland. CScharf@umich.edu |
Export Citation:
|
APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
|
Analysis of Variance Cardiac Output / physiology* Cohort Studies Exercise / physiology* Exercise Test Exercise Tolerance* Female Heart Failure / diagnosis*, mortality, physiopathology Heart Function Tests Humans Male Oxygen Consumption / physiology Predictive Value of Tests Prognosis Prospective Studies Sensitivity and Specificity Severity of Illness Index Stroke Volume / physiology* Survival Rate |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
Previous Document: Angiographic morphologic features of infarct-related arteries and timely reperfusion in acute myocar...
Next Document: Left atrial functional reserve in patients with nonischemic dilated cardiomyopathy: an echocardiogra...