Document Detail


Ventilatory response to exercise improves risk stratification in patients with chronic heart failure and intermediate functional capacity.
MedLine Citation:
PMID:  11868046     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Peak oxygen consumption (VO2) has an important prognostic role in chronic heart failure (CHF), but its discriminatory power is limited in patients with intermediate exercise capacity (peak VO2 between 10-18 mL/kg/min). Thus, supplementary exertional indexes are greatly needed. METHODS: Six hundred patients with CHF with left ventricular ejection fraction (LVEF) < or = 40% who performed a symptom-limited cardiopulmonary exercise testing were screened and followed up for 780 +/- 450 days. RESULTS: Eighty-seven patients had major cardiac events (77 cardiac deaths and 10 urgent heart transplantations). Multivariate analysis revealed the rate of increase of minute ventilation per unit of increase of carbon dioxide production (VE/VCO2 slope) (chi2, 79.3, P <.0001), LVEF (chi2, 24.6, P <.0001), and peak VO2 (chi2, 9.4, P <.0001) as independent and additional predictors of major cardiac events. VE/VCO2 slope was the strongest independent predictor of outcome (chi2, 20.9, P =.0001) in patients with intermediate peak VO2 (n = 403), and the best cutoff value was 35 (chi2, 25.8; relative risk = 3.2, 95% CI 2.0-5.1, P <.0001). Total mortality rate was 30% in patients with VE/VCO2 slope > or = 35 (n = 103, 26%) and 10% in those with VE/VCO2 slope <35 (n = 300, 74%) (P <.0001). Patients with VE/VCO2 slope > or = 35 had a similar total mortality rate to those with peak VO2 < or = 10 mL/kg/min (30% vs 37%, P not significant). CONCLUSIONS: A rational and pragmatic risk stratification process with symptom-limited cardiopulmonary exercise testing in CHF should include both peak VO2 and VE/VCO2 slope, the latter index effectively predicting outcome in almost one fourth of patients with intermediate exercise capacity.
Authors:
Ugo Corrà; Alessandro Mezzani; Enzo Bosimini; Francesco Scapellato; Alessandro Imparato; Pantaleo Giannuzzi
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  American heart journal     Volume:  143     ISSN:  1097-6744     ISO Abbreviation:  Am. Heart J.     Publication Date:  2002 Mar 
Date Detail:
Created Date:  2002-02-27     Completed Date:  2002-03-25     Revised Date:  2007-11-15    
Medline Journal Info:
Nlm Unique ID:  0370465     Medline TA:  Am Heart J     Country:  United States    
Other Details:
Languages:  eng     Pagination:  418-26     Citation Subset:  AIM; IM    
Affiliation:
Division of Cardiology, Salvatore Maugeri Foundation, Istituto di Ricerca e Cura a Carettere Scientifico, Veruno, NO, Italy. ucorra@fsm.it
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MeSH Terms
Descriptor/Qualifier:
Carbon Dioxide / metabolism
Death, Sudden
Echocardiography
Exercise / physiology*
Exercise Test
Female
Follow-Up Studies
Heart Failure / mortality*,  physiopathology*
Humans
Male
Middle Aged
Multivariate Analysis
Oxygen Consumption / physiology*
Prognosis
Pulmonary Gas Exchange
Regression Analysis
Respiration*
Stroke Volume
Chemical
Reg. No./Substance:
124-38-9/Carbon Dioxide

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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