만성 심부전 환자의 운동부하 심폐기능 평가 중단 원인에 따른 호흡가스 변인 분석

Purpose : The purpose of this study is to investigate cardiorespiratory parameters according to the termination reasons of graded exercise test in patients with chronic heart failure (CHF). Methods : The study population consisted of 116 patients with CHF (74.1% male, age 62 ± 10 years old). Each subject safely finished cardiopulmonary exercise test (CPET) without symptom limited emergency stop such as ventricular tachycardia or syncope, or chest pain. The CPET parameters were collected from Mar. 2014 to Feb. 2016. The reasons for test termination were subdivided into 3 groups: test end (9.5%, n=11); dyspnea (56%, n=65); leg pain & fatigue (34.5%, n=40). Results : The patients with leg pain & fatigue are older than those with dyspnea and test end (66 ± 10 vs. 61 ± 9 vs. 55 ± 7 years old, respectively, p=0.001), The HF patients with leg pain & fatigue showed lower peak VO 2 (18.9 ± 4.3 vs. 23.9 ± 4.4 vs. 31.6 ± 5.5 ml·kg -1 ·min -1 , respectively, p<0.001), higher VE/VCO 2 (35.5 ± 5.5 vs. 30.8 ± 4.4 vs. 29.1 ± 5.4, respectively, p<0.001) and higher prevalence of poor effort (respiratory exchange ratio, RER<1.1, 57.5% vs. 36.9% vs. 18.2%, respectively, p=0.028) than those with dyspnea and test end. Conclusion : Patients who terminated exercise due to leg pain & fatigue showed decreased exercise capacity which further leads to underestimation of cardiopulmonary function compared to other reasons. Thus, healthcare providers should evaluate patient’s underlying skeletal muscular diseases to provide comprehensive cardiac rehabilitation such as pain control and individualized leg muscle endurance training program.