二氧化碳通气当量斜率对急性心肌梗死后心力衰竭的预测作用

Predictive effect of minute ventilation/carbon dioxide production slope on heart failure after acute myocardial infarction

目的评估二氧化碳通气当量斜率(VE/Vco_(2) slope)对急性心肌梗死(AMI)后心力衰竭的预测作用。方法收集2018年9月至2019年9月就诊于北京中日友好医院的131例急性心肌梗死患者,出院3个月后随访,分为发生心力衰竭组和未发生心力衰竭组。所有患者出院前行心肺运动试验。结果出院3个月后发生心力衰竭组患者VE/Vco2 slope水平显著高于未发生心力衰竭组患者(36.7±3.8 vs 29.7±4.0,P=0.014)。VE/Vco_(2) slope≥33.05可用于判断出院3个月后发生心力衰竭的风险(灵敏度81.4%,特异度80.6%,曲线下面积0.844,P<0.001)。VE/Vco_(2) slope水平是急性心肌梗死患者出院后发生心力衰竭的独立预测因子(OR=1.245,95%CI:1.021~1.366,P=0.019)。其他与心力衰竭独立相关指标还包括NT-proBNP水平(OR=1.283,95%CI:1.019~1.399,P=0.033)。结论VE/Vco_(2) slope是心肌梗死后患者发生心力衰竭的独立预测因子。

Objective To evaluate the independent prognostic value of minute ventilation/carbon dioxide production slope(VE/Vco_(2) slope)on heart failure after acute myocardial infarction.Methods 131 patients with acute myocardial infarction(AMI)treated in the cardiology department of China-Japan Friendship Hospital from September 2018 to September 2019 were collected and followed up 3 months after discharge.They were divided into heart failure(HF)group and non-heart failure(NHF)group.All the patients underwent cardiopulmonary exercise test(CPET)before discharge.Results Three months after discharge,the VE/Vco_(2) slope was higher in HF group than in NHF group(36.7±3.8 vs 29.7±4.0,P=0.014).The best VE/Vco2 slope cutoff for the prediction of heart failure after 3 month was 33.05 with a sensitivity of 81.4%and a specificity of 80.6%[area under curve(AUC)was 0.844,P<0.001].VE/Vco_(2) slope level was an independent predictor of heart failure in patients with acute myocardial infarction after discharge(OR=1.245,95%CI:1.021-1.366,P=0.019).Other independent indicators related to heart failure included N-terminal pro-B type natriuretic peptid(NT-proBNP)level(OR=1.283,95%CI:1.019-1.399,P=0.033).Conclusions VE/Vco_(2) slope yielded strong,independent predictive value for heart failure at 3 month after discharge to AMI patients.