Non-Invasive Cardiac Index Monitoring During Cardiopulmonary Functional Testing Provides Additional Prognostic Value in Patients After Acute Heart Failure

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概要

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• The prognostic value of parameters derived from a cardiopulmonary exercise test (CPET) is well established in patients stabilized after acute heart failure (HF). Under multidisciplinary disease management, this study sought to test whether noninvasive cardiac output (CO) monitoring (NICOM) during the CPET provides additional prognostic value. In total, 131 patients stabilized after acute HF agreed to undergo the CPET with NICOM. Outcome follow-up focused on composite events of death and HF-related rehospitalization. Patients with a peak cardiac index (CI) of ≤ 4.5 L/minute/ m<Sup>2</Sup> (<I>n</I> = 32), compared to those with a peak CI of > 4.5 L/minute/m<Sup>2</Sup> (<I>n</I> = 99), had higher incidences of diabetes mellitus (DM) and hypertension, but had lower hemoglobin levels, estimated glomerular filtration rates (eGFR), oxygen uptake efficiency slope (OUES), and peak oxygen uptake (VO<SUB>2</SUB>). During the 1.2 ± 0.7 years of follow-up, there were 8 (6.1%) deaths, and 16 (12.2%) HF-related rehospitalizations. In a Cox univariable analysis, a lower event-free survival was associated with a history of DM, a higher Ve/VCO<SUB>2</SUB> slope, lower peak VCO<SUB>2</SUB> and eGFR, and a peak CI of ≤ 4.5 L/minute/ m<Sup>2</Sup> (<I>P</I> < 0.05). The Cox multivariable analysis showed that the Ve/VCO<SUB>2</SUB> slope (hazard ratio (HR) = 1.08, 95% confidence interval (CI): 1.01~1.16, <I>P</I> = 0.02) and peak CI of ≤ 4.5 L/minute/m<Sup>2 </Sup>(HR = 3.26, 95% CI: 1.18~9.01, <I>P</I> = 0.02) were significant independent predictors. In conclusion, NICOM during the CPET was demonstrated to provide prognostic information in addition to traditional risk factors, biomarkers, and other well-established CPET parameters.

著者

• HSU Chih-Chin

  Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital

• Hsu Chih-chin

  Department Of Physical Medicine And Rehabilitation Chang Gung Memorial Hospital

• Wang Jong-shyan

  Graduate Institute Of Rehabilitation Science And Healthy Aging Research Center Chang Gung University

• Lee Ming-Feng

  Heart Failure Center, Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital

• Huang Yu-Yen

  Heart Failure Center, Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital, Chang Gung University College of Medicine

• Wang Chao-Hung

  Heart Failure Center, Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital

• Cherng Wen-Jin

  Heart Failure Center, Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital

• Liu Min-Hui

  Heart Failure Center, Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital

• Chen Wei-Siang

  Heart Failure Center, Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital

• Fu Tieh-Cheng

  Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital

• Huang Yu-Yen

  Heart Failure Center, Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital

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