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(Chest. 2002;121:1581-1588.)
© 2002 American College of Chest Physicians

Prognostic Power of Ventilatory Responses During Submaximal Exercise in Patients With Chronic Heart Disease*

Akira Koike, MD; Haruki Itoh, MD; Makoto Kato, MD; Hitoshi Sawada, MD; Tadanori Aizawa, MD; Long Tai Fu, MD and Hiroshi Watanabe, MD

* From The Cardiovascular Institute, Tokyo, Japan.

Correspondence to: Akira Koike, MD, The Cardiovascular Institute, 3–10, Roppongi 7-chome, Minato-ku, Tokyo 106-0032, Japan; e-mail: koike{at}cepp.ne.jp

Background: Although parameters obtained during submaximal exercise are known to be useful for predicting mortality in cardiac patients, it has been a matter of debate whether the submaximal parameters are superior to peak oxygen uptake (O2). For this purpose, we aimed to determine the best index among exercise variables in predicting long-term mortality in patients with chronic heart disease.

Methods: The study population consisted of 385 consecutive patients with chronic heart disease who performed a symptom-limited incremental exercise test on a cycle ergometer. Breath-by-breath respiratory gas analysis was used to estimate the peak O2, the ratio of the increase in O2 to the increase in work rate (WR) [O2/{Delta}WR], and the ratio of the increase in minute ventilation E to the increase in carbon dioxide output (CO2) [{Delta}E/{Delta}CO2].

Results: After 1,899 ± 495 days of follow-up (mean ± SD), 33 cardiovascular-related deaths occurred. Nonsurvivors achieved lower peak O2, lower O2/{Delta}WR, and higher {Delta}E/{Delta}CO2 compared to the survivors. In the univariate Cox proportional hazards analysis, peak O2, O2/{Delta}WR, and {Delta}E/{Delta}CO2 were found to be significant prognostic indexes of survival. However, multivariate analysis revealed O2/{Delta}WR as an independent predictor of mortality and {Delta}E/{delta}CO2 as a slightly weaker predictor. In this analysis, the prognostic power of peak O2 was insignificant.

Conclusion: Submaximal respiratory gas indexes are very likely to be more sensitive than peak O2 for predicting poor survival in ambulatory patients with chronic heart disease.

Key Words: cardiac patient • oxygen uptake • prognosis • ventilation




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