Usefulness of anaerobic threshold to peak oxygen uptake ratio to determine the severity and pathophysiological condition of chronic heart failure

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• 作者：Junichi Tomono ; MD^a ; Hitoshi Adachi ; MD^b ; ^{h-adachi@ops.dti.ne.jp" class="auth_mail" title="E-mail the corresponding author} ; Shigeru Oshima ; MD ; FJCC^b ; Masahiko Kurabayashi ; MD ; FJCC^a
• 关键词：Anaerobic threshold/peak ratio ; Heart failure ; Muscle strength ; Cardiopulmonary exercise test
• 刊名：Journal of Cardiology
• 出版年：2016
• 出版时间：November 2016
• 年：2016
• 卷：68
• 期：5
• 页码：373-378
• 全文大小：1161 K

文摘

Anaerobic threshold (AT) and peak oxygen uptake neImage" height="15" width="39" alt="View the MathML source" style="margin-top: -5px; vertical-align: middle" title="View the MathML source" src="/sd/grey_pxl.gif" data-inlimgeid="1-s2.0-S0914508716000125-si2.gif">ner hidden">$(\dot{\text{V}}{\text{O}}_2)$ are well known as indicators of severity and prognosis of heart failure. Since these parameters are regulated by many factors, multiple organ dysfunction may occur in chronic heart failure, and these two parameters would vary among patients. However, it is not clear whether AT and peak neImage" height="14" width="29" alt="View the MathML source" style="margin-top: -5px; vertical-align: middle" title="View the MathML source" src="/sd/grey_pxl.gif" data-inlimgeid="1-s2.0-S0914508716000125-si1.gif">ner hidden">$\dot{\text{V}}{\text{O}}_2$ deteriorate similarly. Therefore, we planned to compare the degree of deterioration of these two parameters using a ratio of AT and peak neImage" height="14" width="29" alt="View the MathML source" style="margin-top: -5px; vertical-align: middle" title="View the MathML source" src="/sd/grey_pxl.gif" data-inlimgeid="1-s2.0-S0914508716000125-si1.gif">ner hidden">$\dot{\text{V}}{\text{O}}_2$ (%AT/peak), and evaluated its significance in heart failure subjects.

Methods

One hundred ninety-four stable heart failure patients who had optimal medical treatment for at least 3 months were enrolled. Cardiopulmonary exercise testing, echocardiography, and blood sampling were examined within one week. Since %AT/peak varied from 50.3% to 108.5%, we divided patients into tertiles of %AT/peak [Group A, 50.1–70.0 (n = 112), Group B, 70.1–90.0 (n = 64), Group C, 90.1–110.0 (n = 18)], and compared factors relating with skeletal muscle and heart failure among these 3 groups.

Results

In Group A, ratio of measured AT against predicted value (%AT) and measured peak neImage" height="14" width="29" alt="View the MathML source" style="margin-top: -5px; vertical-align: middle" title="View the MathML source" src="/sd/grey_pxl.gif" data-inlimgeid="1-s2.0-S0914508716000125-si1.gif">ner hidden">$\dot{\text{V}}{\text{O}}_2$ against predicted value (%peak neImage" height="14" width="29" alt="View the MathML source" style="margin-top: -5px; vertical-align: middle" title="View the MathML source" src="/sd/grey_pxl.gif" data-inlimgeid="1-s2.0-S0914508716000125-si1.gif">ner hidden">$\dot{\text{V}}{\text{O}}_2$) were similar (80.3 ± 19.0% and 80.4 ± 17.1%, respectively). Peak neImage" height="14" width="29" alt="View the MathML source" style="margin-top: -5px; vertical-align: middle" title="View the MathML source" src="/sd/grey_pxl.gif" data-inlimgeid="1-s2.0-S0914508716000125-si1.gif">ner hidden">$\dot{\text{V}}{\text{O}}_2$ became lower as %AT/peak increased (Group B; 65.6 ± 14.8%, p < 0.01 vs. Group A, Group C; 38.3 ± 9.7%, p < 0.01 vs. Group B). On the other hand, %AT in Group B (77.1 ± 18.5%) was similar to Group A, and diminished in Group C (58.0 ± 8.2%, p < 0.05 vs. Group B). Peak work rate and lean body mass were smaller in Group B than those in Group A. Although, left ventricular ejection fraction and E/E’ deteriorated in Group B compared with Group A, plasma B-type natriuretic peptide and estimated glomerular filtration rate stayed constant in Group B and deteriorated in Group C.

Conclusions

%AT/peak showed negative correlation with peak neImage" height="14" width="29" alt="View the MathML source" style="margin-top: -5px; vertical-align: middle" title="View the MathML source" src="/sd/grey_pxl.gif" data-inlimgeid="1-s2.0-S0914508716000125-si1.gif">ner hidden">$\dot{\text{V}}{\text{O}}_2$. In chronic heart failure, muscle weakness occurs at an early stage, and this can be evaluated using %AT/peak.