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(Circulation. 2000;101:2803.)
© 2000 American Heart Association, Inc.
Clinical Investigation and Reports |
Impairment of Ventilatory Efficiency in Heart Failure
Prognostic Impact
From Medizinische Klinik und Poliklinik I, Universitätsklinikum Charité, Arbeitsgruppe Medizinische Biometrie, Humboldt-Universität zu Berlin, Berlin, Germany.
Background—Impairment of ventilatory efficiency in congestive heart failure (CHF) correlates well with symptomatology and contributes importantly to dyspnea.
Methods and Results—We investigated 142 CHF patients (mean NYHA
class, 2.6; mean maximum oxygen consumption
[
O2max], 15.3 mL O2
· kg-1 · min-1; mean left
ventricular ejection fraction [LVEF], 27%). Patients
were compared with 101 healthy control subjects.
Cardiopulmonary exercise testing was performed, and ventilatory
efficiency was defined as the slope of the linear relationship of
CO2 and ventilation (VE). Results
are presented in percent of age- and sex-adjusted mean values.
Forty-four events (37 deaths and 7 instances of heart transplantation,
cardiomyoplasty, or left ventricular assist device
implantation) occurred. Among O2max,
NYHA class, LVEF, total lung capacity, and age, the most powerful
predictor of event-free survival was the VE versus
CO2 slope; patients with a slope 
130%
of age- and sex-adjusted normal values had a significantly better
1-year event-free survival (88.3%) than patients with a slope >130%
(54.7%; P<0.001).
Conclusions—The VE versus CO2
slope is an excellent prognostic parameter. It is easier to
obtain than parameters of maximal exercise capacity and is
of higher prognostic importance than
O2max.
Key Words: prognosis • heart failure • ventilation
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