Abstract：
OBJECTIVE: Cardiopulmonary exercise testing (CPET) combined with exercise echocardiography (CPETecho) allows simultaneous assessments of cardiac, pulmonary, and ventilation in heart failure (HF) with preserved ejection fraction (HFpEF). This study sought to determine whether simultaneous assessment of CPET variables could provide additive predictive value over exercise stress echocardiography in patients with dyspnoea.
RESULTS: CPETecho was performed in 443 patients with suspected HFpEF (240 HFpEF and 203 controls without HF). Patients with HFpEF were divided based on peak oxygen consumption (VO2, ≥10 or <10 ml/min/kg) or the slope of minute ventilation to carbon dioxide production (VE vs. VCO2 slope ≥45.0 or <45.0). The primary endpoint was defined as a composite of all-cause mortality, HF hospitalization, unplanned hospital visits requiring intravenous diuretics, or intensification of oral diuretics. During a median follow-up of 399 days, the composite outcome occurred in 57 patients. E/e\' ratio during peak exercise was associated with adverse outcomes. Patients with HFpEF and lower peak VO2 had increased risks of the composite event (hazard ratio [HR] 5.05, 95% confidence interval [CI] 2.65-9.62, p < 0.0001 vs. controls; HR 3.14, 95% CI 1.69-5.84, p = 0.0003 vs. HFpEF with higher peak VO2). Elevated VE versus VCO2 slope was also associated with adverse events in HFpEF. The addition of either the presence of abnormal peak VO2 or VE versus VCO2 slope increased the predictive ability over the model based on age, sex, atrial fibrillation, left atrial volume index, and exercise E/e\' (p < 0.05).
CONCLUSIONS: These data provide new insights into the role of CPETecho in patients with HFpEF.
RESULTS: CPETecho was performed in 443 patients with suspected HFpEF (240 HFpEF and 203 controls without HF). Patients with HFpEF were divided based on peak oxygen consumption (VO2, ≥10 or <10 ml/min/kg) or the slope of minute ventilation to carbon dioxide production (VE vs. VCO2 slope ≥45.0 or <45.0). The primary endpoint was defined as a composite of all-cause mortality, HF hospitalization, unplanned hospital visits requiring intravenous diuretics, or intensification of oral diuretics. During a median follow-up of 399 days, the composite outcome occurred in 57 patients. E/e\' ratio during peak exercise was associated with adverse outcomes. Patients with HFpEF and lower peak VO2 had increased risks of the composite event (hazard ratio [HR] 5.05, 95% confidence interval [CI] 2.65-9.62, p < 0.0001 vs. controls; HR 3.14, 95% CI 1.69-5.84, p = 0.0003 vs. HFpEF with higher peak VO2). Elevated VE versus VCO2 slope was also associated with adverse events in HFpEF. The addition of either the presence of abnormal peak VO2 or VE versus VCO2 slope increased the predictive ability over the model based on age, sex, atrial fibrillation, left atrial volume index, and exercise E/e\' (p < 0.05).
CONCLUSIONS: These data provide new insights into the role of CPETecho in patients with HFpEF.
摘要：
目的：心肺运动试验（CPET）结合运动超声心动图（CPETecho）可以同时评估心脏，肺,心力衰竭（HF）的通气和射血分数保留（HFpEF）。这项研究旨在确定同时评估CPET变量是否可以为呼吸困难患者的运动负荷超声心动图提供附加的预测价值。
结果：在443例疑似HFpEF患者（240例HFpEF和203例无HF的对照）中进行了CPETecho。HFpEF患者根据峰值耗氧量（VO2，≥10或<10ml/min/kg）或分钟通气量与二氧化碳产生的斜率进行划分（VE与VCO2斜率≥45.0或<45.0)。主要终点定义为全因死亡率的复合，HF住院治疗，需要静脉利尿剂的计划外医院就诊，或加强口服利尿剂。在399天的中位随访中，57例患者出现复合结局.高峰运动期间的E/E比值与不良后果相关。HFpEF和较低峰值VO2的患者发生复合事件的风险增加（风险比[HR]5.05，95％置信区间[CI]2.65-9.62，p<0.0001vs.对照组；HR3.14，95%CI1.69-5.84，p=0.0003与具有较高峰值VO2的HFpEF)。VE与VCO2斜率升高也与HFpEF的不良事件相关。VO2异常峰值或VE相对于VCO2斜率的存在增加了基于年龄的模型的预测能力，性别,心房颤动,左心房容积指数,和运动E/E'（p<0.05）。
结论：这些数据为CPETecho在HFpEF患者中的作用提供了新的见解。
结果：在443例疑似HFpEF患者（240例HFpEF和203例无HF的对照）中进行了CPETecho。HFpEF患者根据峰值耗氧量（VO2，≥10或<10ml/min/kg）或分钟通气量与二氧化碳产生的斜率进行划分（VE与VCO2斜率≥45.0或<45.0)。主要终点定义为全因死亡率的复合，HF住院治疗，需要静脉利尿剂的计划外医院就诊，或加强口服利尿剂。在399天的中位随访中，57例患者出现复合结局.高峰运动期间的E/E比值与不良后果相关。HFpEF和较低峰值VO2的患者发生复合事件的风险增加（风险比[HR]5.05，95％置信区间[CI]2.65-9.62，p<0.0001vs.对照组；HR3.14，95%CI1.69-5.84，p=0.0003与具有较高峰值VO2的HFpEF)。VE与VCO2斜率升高也与HFpEF的不良事件相关。VO2异常峰值或VE相对于VCO2斜率的存在增加了基于年龄的模型的预测能力，性别,心房颤动,左心房容积指数,和运动E/E'（p<0.05）。
结论：这些数据为CPETecho在HFpEF患者中的作用提供了新的见解。
