Prognostic Significance of Peak Workload-to-Weight Ratio by Cardiopulmonary Exercise Testing in Chronic Heart Failure
The prognostic impact of peak workload-to-weight ratio (PWR) during cardiopulmonary exercise testing (CPET) and its determinants in patients with chronic heart failure (CHF) are not well understood. Consecutive 514 patients with CHF referred for CPET at the Hokkaido University Hospital between 2013...
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| Veröffentlicht in: | The American journal of cardiology 2023-04, Vol.193, p.37-43 |
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| creator | Yasui, Yutaro Nakamura, Kosuke Omote, Kazunori Ishizaka, Suguru Takenaka, Sakae Mizuguchi, Yoshifumi Shimono, Yui Kazui, Sho Takahashi, Yuki Saiin, Kohei Naito, Seiichiro Tada, Atsushi Kobayashi, Yuta Sato, Takuma Kamiya, Kiwamu Nagai, Toshiyuki Anzai, Toshihisa |
| description | The prognostic impact of peak workload-to-weight ratio (PWR) during cardiopulmonary exercise testing (CPET) and its determinants in patients with chronic heart failure (CHF) are not well understood. Consecutive 514 patients with CHF referred for CPET at the Hokkaido University Hospital between 2013 and 2018 were identified. The primary outcome was a composite of hospitalization because of worsening heart failure and death. PWR was calculated as peak workload normalized to body weight (W/kg) by CPET. Patients with low PWR (cut-off median 1.38 [W/kg], n = 257) were older and more anemic than those with high PWR (n = 257). In CPET, patients with low PWR displayed reduced peak oxygen consumption and impaired ventilatory efficiency compared with those with high PWR, whereas the peak respiratory exchange ratio was not significantly different between the 2 groups. There were 89 patients with events over a median follow-up period of 3.3 (interquartile range 0.8 to 5.5) years. The incidence of composite events was significantly higher in patients with low PWR than in those with high PWR (log-rank p |
| doi_str_mv | 10.1016/j.amjcard.2023.01.052 |
| format | Article |
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Consecutive 514 patients with CHF referred for CPET at the Hokkaido University Hospital between 2013 and 2018 were identified. The primary outcome was a composite of hospitalization because of worsening heart failure and death. PWR was calculated as peak workload normalized to body weight (W/kg) by CPET. Patients with low PWR (cut-off median 1.38 [W/kg], n = 257) were older and more anemic than those with high PWR (n = 257). In CPET, patients with low PWR displayed reduced peak oxygen consumption and impaired ventilatory efficiency compared with those with high PWR, whereas the peak respiratory exchange ratio was not significantly different between the 2 groups. There were 89 patients with events over a median follow-up period of 3.3 (interquartile range 0.8 to 5.5) years. The incidence of composite events was significantly higher in patients with low PWR than in those with high PWR (log-rank p <0.0001). In the multivariable Cox regression, lower PWR was associated with adverse events (hazard ratio 0.31, 95% confidence interval 0.13 to 0.73, p = 0.008). Low hemoglobin concentration was strongly related to impaired PWR (β coefficient = 0.43, per 1 g/100 ml increased, p <0.0001). In conclusion, PWR was associated with worse clinical outcomes, where blood hemoglobin was strongly related to PWR. Further study is required to identify therapies targeting peak workload achievements in exercise stress tests to improve the outcome in patients with CHF.</description><identifier>ISSN: 0002-9149</identifier><identifier>EISSN: 1879-1913</identifier><identifier>DOI: 10.1016/j.amjcard.2023.01.052</identifier><identifier>PMID: 36867917</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>Blood pressure ; Body weight ; Carbon dioxide ; Cardiac arrhythmia ; Cardiac catheterization ; Chronic Disease ; Confidence intervals ; Congestive heart failure ; Dyspnea ; Ejection fraction ; Exercise Test ; Heart failure ; Heart Failure - drug therapy ; Heart rate ; Hemodynamics ; Hemoglobin ; Hospitalization ; Humans ; Intubation ; Mortality ; Oxygen Consumption ; Patients ; Prognosis ; Pulmonary arteries ; Regression analysis ; Statistical analysis ; Workload ; Workloads</subject><ispartof>The American journal of cardiology, 2023-04, Vol.193, p.37-43</ispartof><rights>2023 Elsevier Inc.</rights><rights>Copyright © 2023 Elsevier Inc. All rights reserved.</rights><rights>2023. Elsevier Inc.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c459t-5abfa2978b65c2f0fe24fde36ee4d5c55e677d746289653b6c10cab9d29154f83</citedby><cites>FETCH-LOGICAL-c459t-5abfa2978b65c2f0fe24fde36ee4d5c55e677d746289653b6c10cab9d29154f83</cites><orcidid>0000-0002-8132-7173</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.proquest.com/docview/2792894959?pq-origsite=primo$$EHTML$$P50$$Gproquest$$H</linktohtml><link.rule.ids>315,781,785,3551,27929,27930,46000,64390,64392,64394,72474</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/36867917$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Yasui, Yutaro</creatorcontrib><creatorcontrib>Nakamura, Kosuke</creatorcontrib><creatorcontrib>Omote, Kazunori</creatorcontrib><creatorcontrib>Ishizaka, Suguru</creatorcontrib><creatorcontrib>Takenaka, Sakae</creatorcontrib><creatorcontrib>Mizuguchi, Yoshifumi</creatorcontrib><creatorcontrib>Shimono, Yui</creatorcontrib><creatorcontrib>Kazui, Sho</creatorcontrib><creatorcontrib>Takahashi, Yuki</creatorcontrib><creatorcontrib>Saiin, Kohei</creatorcontrib><creatorcontrib>Naito, Seiichiro</creatorcontrib><creatorcontrib>Tada, Atsushi</creatorcontrib><creatorcontrib>Kobayashi, Yuta</creatorcontrib><creatorcontrib>Sato, Takuma</creatorcontrib><creatorcontrib>Kamiya, Kiwamu</creatorcontrib><creatorcontrib>Nagai, Toshiyuki</creatorcontrib><creatorcontrib>Anzai, Toshihisa</creatorcontrib><title>Prognostic Significance of Peak Workload-to-Weight Ratio by Cardiopulmonary Exercise Testing in Chronic Heart Failure</title><title>The American journal of cardiology</title><addtitle>Am J Cardiol</addtitle><description>The prognostic impact of peak workload-to-weight ratio (PWR) during cardiopulmonary exercise testing (CPET) and its determinants in patients with chronic heart failure (CHF) are not well understood. Consecutive 514 patients with CHF referred for CPET at the Hokkaido University Hospital between 2013 and 2018 were identified. The primary outcome was a composite of hospitalization because of worsening heart failure and death. PWR was calculated as peak workload normalized to body weight (W/kg) by CPET. Patients with low PWR (cut-off median 1.38 [W/kg], n = 257) were older and more anemic than those with high PWR (n = 257). In CPET, patients with low PWR displayed reduced peak oxygen consumption and impaired ventilatory efficiency compared with those with high PWR, whereas the peak respiratory exchange ratio was not significantly different between the 2 groups. There were 89 patients with events over a median follow-up period of 3.3 (interquartile range 0.8 to 5.5) years. The incidence of composite events was significantly higher in patients with low PWR than in those with high PWR (log-rank p <0.0001). In the multivariable Cox regression, lower PWR was associated with adverse events (hazard ratio 0.31, 95% confidence interval 0.13 to 0.73, p = 0.008). Low hemoglobin concentration was strongly related to impaired PWR (β coefficient = 0.43, per 1 g/100 ml increased, p <0.0001). In conclusion, PWR was associated with worse clinical outcomes, where blood hemoglobin was strongly related to PWR. Further study is required to identify therapies targeting peak workload achievements in exercise stress tests to improve the outcome in patients with CHF.</description><subject>Blood pressure</subject><subject>Body weight</subject><subject>Carbon dioxide</subject><subject>Cardiac arrhythmia</subject><subject>Cardiac catheterization</subject><subject>Chronic Disease</subject><subject>Confidence intervals</subject><subject>Congestive heart failure</subject><subject>Dyspnea</subject><subject>Ejection fraction</subject><subject>Exercise Test</subject><subject>Heart failure</subject><subject>Heart Failure - drug therapy</subject><subject>Heart rate</subject><subject>Hemodynamics</subject><subject>Hemoglobin</subject><subject>Hospitalization</subject><subject>Humans</subject><subject>Intubation</subject><subject>Mortality</subject><subject>Oxygen Consumption</subject><subject>Patients</subject><subject>Prognosis</subject><subject>Pulmonary arteries</subject><subject>Regression analysis</subject><subject>Statistical analysis</subject><subject>Workload</subject><subject>Workloads</subject><issn>0002-9149</issn><issn>1879-1913</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2023</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>8G5</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>AZQEC</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><sourceid>DWQXO</sourceid><sourceid>GNUQQ</sourceid><sourceid>GUQSH</sourceid><sourceid>M2O</sourceid><recordid>eNqFkU1vFSEUhonR2NvqT9CQuHEzIzDADCtjbvph0sRGa7okDJy5ZToDV5gx9t9Lc68u3LgiJM953wMPQm8oqSmh8sNYm3m0JrmaEdbUhNZEsGdoQ7tWVVTR5jnaEEJYpShXJ-g057FcKRXyJTppZCdbRdsNWm9S3IWYF2_xN78LfvDWBAs4DvgGzAO-i-lhisZVS6zuwO_uF_zVLD7i_hFvS72P-3WaYzDpEZ__gmR9BnwLJTDssA94e59iKOFXYNKCL4yf1gSv0IvBTBleH88z9P3i_HZ7VV1_ufy8_XRdWS7UUgnTD4aptuulsGwgAzA-OGgkAHfCCgGybV3LJeuUFE0vLSXW9MoxRQUfuuYMvT_k7lP8sZal9OyzhWkyAeKaNWu7hiveUVbQd_-gY1xTKNsVSpUCroQqlDhQNsWcEwx6n_xc3q4p0U9e9KiPXvSTF02oLl7K3Ntj-trP4P5O_RFRgI8HAMp3_PSQdLYeigjnE9hFu-j_U_Eb2MKhyQ</recordid><startdate>20230415</startdate><enddate>20230415</enddate><creator>Yasui, Yutaro</creator><creator>Nakamura, Kosuke</creator><creator>Omote, Kazunori</creator><creator>Ishizaka, Suguru</creator><creator>Takenaka, Sakae</creator><creator>Mizuguchi, Yoshifumi</creator><creator>Shimono, Yui</creator><creator>Kazui, Sho</creator><creator>Takahashi, Yuki</creator><creator>Saiin, Kohei</creator><creator>Naito, Seiichiro</creator><creator>Tada, Atsushi</creator><creator>Kobayashi, Yuta</creator><creator>Sato, Takuma</creator><creator>Kamiya, Kiwamu</creator><creator>Nagai, Toshiyuki</creator><creator>Anzai, Toshihisa</creator><general>Elsevier Inc</general><general>Elsevier Limited</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7RV</scope><scope>7TS</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8FD</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>8G5</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FR3</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>GUQSH</scope><scope>K9.</scope><scope>KB0</scope><scope>M0S</scope><scope>M1P</scope><scope>M2O</scope><scope>M7Z</scope><scope>MBDVC</scope><scope>NAPCQ</scope><scope>P64</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>Q9U</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0002-8132-7173</orcidid></search><sort><creationdate>20230415</creationdate><title>Prognostic Significance of Peak Workload-to-Weight Ratio by Cardiopulmonary Exercise Testing in Chronic Heart Failure</title><author>Yasui, Yutaro ; Nakamura, Kosuke ; Omote, Kazunori ; Ishizaka, Suguru ; Takenaka, Sakae ; Mizuguchi, Yoshifumi ; Shimono, Yui ; Kazui, Sho ; Takahashi, Yuki ; Saiin, Kohei ; Naito, Seiichiro ; Tada, Atsushi ; Kobayashi, Yuta ; Sato, Takuma ; Kamiya, Kiwamu ; Nagai, Toshiyuki ; Anzai, Toshihisa</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c459t-5abfa2978b65c2f0fe24fde36ee4d5c55e677d746289653b6c10cab9d29154f83</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2023</creationdate><topic>Blood pressure</topic><topic>Body weight</topic><topic>Carbon dioxide</topic><topic>Cardiac arrhythmia</topic><topic>Cardiac catheterization</topic><topic>Chronic Disease</topic><topic>Confidence intervals</topic><topic>Congestive heart failure</topic><topic>Dyspnea</topic><topic>Ejection fraction</topic><topic>Exercise Test</topic><topic>Heart failure</topic><topic>Heart Failure - 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Consecutive 514 patients with CHF referred for CPET at the Hokkaido University Hospital between 2013 and 2018 were identified. The primary outcome was a composite of hospitalization because of worsening heart failure and death. PWR was calculated as peak workload normalized to body weight (W/kg) by CPET. Patients with low PWR (cut-off median 1.38 [W/kg], n = 257) were older and more anemic than those with high PWR (n = 257). In CPET, patients with low PWR displayed reduced peak oxygen consumption and impaired ventilatory efficiency compared with those with high PWR, whereas the peak respiratory exchange ratio was not significantly different between the 2 groups. There were 89 patients with events over a median follow-up period of 3.3 (interquartile range 0.8 to 5.5) years. The incidence of composite events was significantly higher in patients with low PWR than in those with high PWR (log-rank p <0.0001). In the multivariable Cox regression, lower PWR was associated with adverse events (hazard ratio 0.31, 95% confidence interval 0.13 to 0.73, p = 0.008). Low hemoglobin concentration was strongly related to impaired PWR (β coefficient = 0.43, per 1 g/100 ml increased, p <0.0001). In conclusion, PWR was associated with worse clinical outcomes, where blood hemoglobin was strongly related to PWR. Further study is required to identify therapies targeting peak workload achievements in exercise stress tests to improve the outcome in patients with CHF.</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>36867917</pmid><doi>10.1016/j.amjcard.2023.01.052</doi><tpages>7</tpages><orcidid>https://orcid.org/0000-0002-8132-7173</orcidid></addata></record> |
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| subjects | Blood pressure Body weight Carbon dioxide Cardiac arrhythmia Cardiac catheterization Chronic Disease Confidence intervals Congestive heart failure Dyspnea Ejection fraction Exercise Test Heart failure Heart Failure - drug therapy Heart rate Hemodynamics Hemoglobin Hospitalization Humans Intubation Mortality Oxygen Consumption Patients Prognosis Pulmonary arteries Regression analysis Statistical analysis Workload Workloads |
| title | Prognostic Significance of Peak Workload-to-Weight Ratio by Cardiopulmonary Exercise Testing in Chronic Heart Failure |
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