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Oxygen uptake efficiency plateau best predicts early death in heart failure: OUEP best predicts survival.
MedLine Citation:
PMID:  22030802     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
Abstract BACKGROUND:The responses of oxygen uptake efficiency (i.e. oxygen uptake/ventilation =$$\stackrel{.}{\mathrm{V}}$$O(2)/$$\stackrel{.}{\mathrm{V}}$$E) and its highest plateau (OUEP) during incremental cardiopulmonary exercise testing (CPET) in patients with chronic left heart failure (HF) have not been previously reported. We planned to test the hypothesis that OUEP during CPET is the best single predictor of early death in HF. METHODS:We evaluated OUEP, slope of $$\stackrel{.}{\mathrm{V}}$$O(2)/log($$\stackrel{.}{\mathrm{V}}$$E) (OUES), oscillatory breathing, and all usual CPET measurements in 508 low ejection fraction(<35%) HF patients. Each had further evaluations at other sites, including cardiac catheterization. Outcomes were 6-month all-reason mortality and morbidity (death or >24 hours cardiac hospitalization). Statistical analyses included area under curve (AUC) of receiver operating characteristics, odds ratios, univariate and multivariate Cox regression, and Kaplan-Meier plots. RESULTS:OUEP, which requires only moderate exercise, was often reduced in HF patients. A low %predicted OUEP was the single best predictor of mortality (p<0.0001), with an odds ratios of 13.0 (p<0.001). When combined with oscillatory breathing the odds ratio increased to 56.3, superior to all other resting or exercise parameters or combinations of parameters. Other statistical analyses and morbidity analysis confirmed those findings. CONCLUSIONS:OUEP is often reduced in HF patients. Low %predicted OUEP (<65%pred), is the single best predictor of early death, better than any other CPET or other cardiovascular measurement. Paired with oscillatory breathing, it is even more powerful.
Authors:
Xing-Guo Sun; James E Hansen; William W Stringer
Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2011-10-26
Journal Detail:
Title:  Chest     Volume:  -     ISSN:  1931-3543     ISO Abbreviation:  -     Publication Date:  2011 Oct 
Date Detail:
Created Date:  2011-10-27     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0231335     Medline TA:  Chest     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Affiliation:
Department of Medicine, Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, David Geffen School of Medicine at UCLA, St. John's Cardiovascular Research Center, 1124 West Carson Street, Torrance, CA 90502.
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