心肺运动试验在心肺疾病中的应用进展

许多心肺疾病在静息状态下往往处于代偿状态,在运动状态下才会出现一系列病理生理学改变。目前临床广泛应用的彩色超声、肺功能仪、心电图、冠状动脉造影等方法多数只能反映静态下心肺及血管功能情况,易导致疾病诊断、治疗延误。心肺运动试验是通过检测人体静息和运动状态时氧和二氧化碳变化趋势分析心肺协调性及功能状态的一种方法,其理论基础是气体交换。     

心肺运动试验在慢性心力衰竭预后评估中的价值

心肺运动试验通过测定机体对运动的反应,可以评估包括心血管、肺、骨骼肌等多系统的功能和储备,显示出其独特的优势,特别是对于慢性心力衰竭患者的功能状态及预后能够进行客观定量的评估,具有极其重要的价值和意义。本文重点阐述心肺运动试验主要指标的意义及其在慢性心力衰竭预后评估中的价值。     

心肺运动试验在心血管疾病中的诊疗和预后价值探讨

心血管疾病发病率和病死率持续增高,心肌缺血和心肌梗死是主要病因。心肺耐力反应了个体的心肺功能契合度以及对最大运动强度的耐受程度。心肺耐力为人体五大生命体征之一,可用于评价心血管疾病患病风险。心肺运动试验(CPET)作为新兴的心肺一体化客观无创检测技术,可以较早的推测出患者潜在的病理生理改变。CPET的数据解读相对复杂及未得到广泛普及,其在临床的应用潜力巨大。目前CPET应用领域包括疾病的诊断、病情及预后风险评估、运动处方制定等。用CPET对心血管疾病的早期风险予以评估和诊断,实现早干预、早治疗,符合心脏康复的主流。     

心肺运动试验动态指导下的家庭运动康复对心力衰竭患者的疗效观察

目的 探讨心肺运动试验动态指导下的家庭运动康复对心力衰竭患者的疗效.方法 将84例心力衰竭好转出院的患者分为观察组(n=42)和对照组(n=42),观察组患者在常规药物治疗基础上,行心肺运动试验,根据试验的结果指导运动方案,定期随访,每隔3个月复查心肺运动试验,根据检查结果重新调整运动方案.对照组予常规药物治疗,行心肺...     

心肺运动试验在介入心脏病学中的临床应用

心肺运动试验（cardiopulmonary exercise testing，CPET）是通过分析运动时患者的呼吸气体（包括氧气、二氧化碳）通气参数以及监测运动中的代谢指标、心排量及心电图等来评估患者的心肺功能的一种无创方法。CPET更精确、全面地评价心血管疾病患者的心肺功能，更可靠的为心血管疾病患者提供运动康复的指导，更有助于提高心血管疾病患者的劳动能力和生活质量。     

心肺运动试验在呼吸系统疾病中的应用

心肺运动试验作为一项新兴的,动态化测量患者心肺功能的评估工具,已在心血管疾病中广泛运用。如今心肺运动试验具有巨大的潜力,在越来越多的非心血管疾病中发挥作用,现就心肺运动试验在呼吸系统疾病中的应用做一综述。     

心肺运动试验在肺动脉高压的应用进展

心肺运动试验（CPET）能够对休息、运动以及恢复过程中的气体交换进行分析,同步评估心血管系统和呼吸系统对同一运动应激的反应情况。这些数据经过计算机系统的处理,并与运动过程中的心率、血压、功率、心电图结果和症状进行综合分析,可以提供全面的运动耐受性和运动反应的数据,如与成像技术联合应用,可以提供更多的诊断信息,已被安全地用于心肺血管病患者。本文重点讨论近年CPET在肺动脉高压早期诊断和预后评估的应用进展。     

心肺运动试验在心血管疾病中的应用

心肺运动试验(cardiopulmonary exercise testing,CPET)是在一定负荷下测出摄氧量和二氧化碳排出量等代谢、通气指标及心电图变化,反映细胞呼吸功能的变化[1]。1975年呼吸疾病学者Wasserman提出:单独给心脏或肺脏增加负荷是不可能的,所有的运动均需要心肺的协调,以及周围循环与     

Abnormal heart rate recovery immediately after cardiopulmonary exercise testing in heart failure patients

An attenuated heart rate recovery (HRR) immediately after exercise has been shown to be predictive of mortality. It is not known whether HRR predicts mortality when measured in patients with heart failure. The present study was undertaken to evaluate the ability of HRR to predict mortality in patients with heart failure. We studied 84 NYHA class II or III chronic congestive heart failure patients who had a left ventricular ejection fraction < or = 40%. All patients underwent symptom limited cardiopulmonary exercise testing. The value for the HRR was defined as the difference in heart rate between peak exercise and one-minute later; a value < or = 18 beats per minute was considered abnormal. The patients were divided into 2 groups according to the value of HRR. Those with abnormal HRR were assigned to group I and those with normal HRR were assigned to group II. The 2 groups were compared with each other regarding baseline characteristics and exercise capacity assessed by peak VO2. There were 26 patients (31%) in group I and 58 patients (69%) in group II. Group II patients had better performance on treadmill exercise testing than group I patients. They had greater exercise duration (7.5 +/- 3.8 minutes versus 5 +/- 3.5 minutes, P = 0.006), better heart-rate reserve (79 +/- 25% versus 63 +/- 27%, P = 0.01), and higher values of maximal heart-rate (141 +/- 18 beats/min versus 132 +/- 17 beats/min, P = 0.04). Group II patients also had higher peak VO2 values (16.8 +/- 4.4 mL/kg/min versus 14.4 +/- 3.6 mL/kg/min, P = 0.01). When we separated the groups according to beta-blocker usage, beta-blockers had no prominent effect on HRR. In the follow-up period (mean 14.1 +/- 6.1 months), the presence of abnormal HRR and lower peak VO2 (< or = 14 mL/kg/min) were the only significant predictors of mortality in our patient population (adjusted hazard ratio [HR] 5.2, 95% CI, 1.3 to 24, P = 0.03 and adjusted HR 13, 95% CI, 2.1 to 25.6, P = 0.005, respectively). It seems that the attenuated HRR value one minute after peak exercise appears to be a reliable index of the severity of exercise intolerance in heart failure patients and this study supports the value of HRR as a prognostic marker among heart failure patients referred for cardiopulmonary exercise testing for prediction of prognosis.     

Standardizing and predicting results from cardiopulmonary exercise testing in patients with heart failure

PURPOSE: Cardiopulmonary exercise testing is a common prognostic tool in heart failure, yet it is not standardized. The purpose of this study was to evaluate a means of standardizing oxygen consumption (VO(2)) measurement and to evaluate the ability to predict peak VO(2) from submaximal exercise. METHODS: Fifty consecutive exercise tests with a respiratory exchange ratio > or =1.10 were evaluated. VO(2) was graphed against respiratory exchange ratio and the peak VO(2) was determined with logarithmic, linear, power, and exponential regression lines. To predict a peak VO(2), each patient's submaximal exercise data (respiratory exchange ratio < or =0.98) were fitted to each regression line. The mean of the last 30 seconds of un-averaged breath-by-breath data was used as the reference value. Peak VO(2) assessments are also provided from the metabolic cart, a rolling time average, and the graphical method. RESULTS: Logarithmic regression best standardized peak VO(2). Mean absolute bias (mL x kg x min) was 0.60 +/- 0.44 for logarithmic, 0.61 +/- 0.47 for linear, 0.85 +/- 0.67 for power, and 1.44 +/- 2.22 for exponential. The mean absolute bias between the peak logarithmic predicted VO(2) and the reference peak VO(2) was 1.62 +/- 1.20 mL x kg x min (9.5% of the peak VO(2)). CONCLUSION: Among the methods studied, logarithmic regression analysis was the best method to standardize and predict peak VO(2) in this cohort of patients with heart failure.     

Optimizing the clinical application of cardiopulmonary exercise testing in patients with heart failure

Cardiopulmonary exercise testing (CPX) is a well-accepted evaluation technique in patients with heart failure (HF). Even so, interpretation of the wealth of data obtained from CPX remains a challenge. The body of evidence demonstrating the clinical value of CPX in HF point toward several key variables that should be assessed in each patient. These variables include ventilatory efficiency, aerobic capacity, expired carbon dioxide and heart rate recovery. Furthermore, a simple clinical evaluation form, prompting the assessment of key variables, has yet to be developed. The purpose of the present clinical case study in a patient with HF is to highlight key CPX variables and propose a clinical evaluation form.     

B-type natriuretic peptide kinetics and cardiopulmonary exercise testing in heart failure

BackgroundIn patients with chronic heart failure (CHF), B-type natriuretic peptide (BNP) is related to peak oxygen consumption (peak VO₂) and the relationship between minute ventilation and carbon dioxide production (VE/VCO₂ slope). However, the exercise response depends on the mode of exercise. This study sought to compare peak treadmill and bicycle exercise responses with respect to their relationship with BNP and to assess whether BNP measured at rest or during exercise could identify patients with greater functional impairment and ventilatory inefficiency.MethodsTwenty-three patients with mild-to-moderate stable systolic CHF (age 72 ± 8 years, left ventricular ejection fraction 32 ± 7%) underwent treadmill and bicycle cardiopulmonary exercise testing within 5 (interquartile range 3–7) days. BNP was measured at rest and at peak exercise.ResultsBNP at rest was an independent multivariate predictor of both peak VO₂ and the VE/VCO₂ slope for both exercise modes. However, the proportion of variance explained univariately and multivariately was ≤ 0.55, indicating that BNP did not strongly explain the variation of peak VO₂ and the VE/VCO₂ slope. The exercise-induced rise in circulating BNP did not differ between the test modes [treadmill: 50 (24–89) pg/ml vs. bicycle: 46 (15–100) pg/ml; p = 0.73]. BNP levels at peak exercise were strongly related to resting values, but did not provide additional information on peak VO₂ or the VE/VCO₂ slope.ConclusionsIn typical CHF patients, BNP measured at rest or at peak exercise does not strongly predict peak VO₂ or the VE/VCO₂ slope regardless of the exercise mode, and is therefore not a sufficiently accurate surrogate for cardiopulmonary exercise testing.     

A new cardiopulmonary exercise testing prognosticating algorithm for heart failure patients treated with beta-blockers

In 2004, a cardiopulmonary exercise testing (CPET) prognosticating algorithm for heart failure (HF) patients was proposed. The algorithm employed a stepwise assessment of peak oxygen consumption (VO2), slope of regression relating minute ventilation to carbon dioxide output (VE/VCO2) and peak respiratory exchange ratio (RER), and was proposed as an alternative to the traditional strategy of using a single CPET parameter to describe prognosis. Since its initial proposal, the prognosticating algorithm has not been reassessed, although a re-evaluation is in order given the fact that new HF therapies, such as beta-blocker therapy, have significantly improved survival in HF. The present review, based on a critical examination of CPET outcome studies in HF patients regularly treated with beta-blockers, suggests a new prognosticating algorithm. The algorithm comprises four CPET parameters: peak RER, exertional oscillatory ventilation (EOV), peak VO2 and peak systolic blood pressure (SBP). Compared to previous proposals, the present preliminary attempt includes EOV instead of VE/VCO2 slope as ventilatory CPET parameter, and peak SBP as hemodynamic-derived index.     

Prognostic value of neurohormonal activation and cardiopulmonary exercise testing in patients with chronic heart failure

We compared the value of plasma neurohormones and cardiopulmonary exercise testing for predicting long-term prognosis in patients with moderate congestive heart failure (CHF). We studied 264 consecutive patients with CHF due to left ventricular systolic dysfunction. Plasma atrial natriuretic peptide (ANP), norepinephrine, and endothelin-1 were measured at rest in all patients, who also underwent a symptom-limited maximal exercise with oxygen consumption (VO(2)) determination. After a median follow-up of 789 days, 52 deaths and 31 heart transplantations occurred, of which 4 were urgent. In an univariate analysis, New York Heart Association functional class, systolic blood pressure at rest, left ventricular end-diastolic diameter, left ventricular ejection fraction, peak VO(2), percent of predicted peak VO(2), plasma ANP, plasma norepinephrine, and plasma endothelin-1 were associated with survival without urgent heart transplantation. In a multivariate stepwise regression analysis, only plasma ANP (p = 0.0001), left ventricular ejection fraction (p = 0.007), and plasma norepinephrine (p = 0.035), but neither peak VO(2) nor percentage of predicted peak VO(2), were independent predictors of death or urgent heart transplantation. Determination of plasma ANP and norepinephrine provides additional independent information for long-term prognostic determination compared with exercise testing alone. Measurement of plasma neurohormones should therefore be considered routinely as a complementary or alternative tool for identifying high-risk patients with moderate CHF.     

Prognostic value and diagnostic potential of cardiopulmonary exercise testing in patients with chronic heart failure

Cardiopulmonary exercise testing (CPET) is a well established technique for stratifying cardiovascular risk in patients with chronic heart failure (CHF). Important prognostic variables include a reduced peak oxygen uptake which has a central use in cardiac transplant selection, and the abnormal relation between minute ventilation (VE) and carbon dioxide production (VCO(2)), often referred to as the elevated VE/VCO(2) slope. We will discuss the pathophysiology of these abnormal responses to exercise in CHF, and how these are interpreted during CPET. The potential of CPET for diagnosing circulatory, respiratory, metabolic, musculoskeletal or mixed limitations is an emerging field of research. We will speculate on how CHF manifests during CPET, and clarify the pathophysiological basis of these exercise responses. To improve our understanding of the diagnostic value of CPET, further investigation is required by clinicians to develop reference ranges for CHF patients from a co-ordinated multicentre approach. The use of CPET technology is becoming increasingly prevalent in cardiology services, and it is likely that, in the future, CPET will take a more prominent role in guiding patient management provision.