Low partial pressure of end-tidal carbon dioxide predicts left ventricular assist device implantation in patients with advanced chronic heart failure

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• 作者：Osamu Seguchi^a ; ^{oseguchi@ncvc.go.jp} ; Eriko Hisamatsu^a ; Atsushi Nakano^b ; Seiko Nakajima^a ; Kensuke Kuroda^a ; Takuya Watanabe^a ; Takuma Sato^a ; Haruki Sunami^a ; Masanobu Yanase^a ; Hiroki Hata^c ; Toshimitsu Hamasaki^d ; Tomoyuki Fujita^c ; Junjiro Kobayashi^c ; Takeshi Nakatani^a ; Masafumi Kitakaze^b ; Norihide Fukushima^a
• 关键词：Advanced heart failure ; Left ventricular assist device ; Partial pressure of end-tidal carbon dioxide ; Prognosis
• 刊名：International Journal of Cardiology
• 出版年：2017
• 出版时间：1 March 2017
• 年：2017
• 卷：230
• 期：Complete
• 页码：40-46
• 全文大小：437 K
• 卷排序：230

文摘

This study aimed to clarify the prognostic impact of partial pressure of end-tidal carbon dioxide (PETCO2) in patients with advanced chronic heart failure (HF).MethodsForty-eight patients (mean age 43.1 ± 11.9 years, 32 males) with chronic HF (44 with non-ischemic and 4 with ischemic cardiomyopathy) were prospectively enrolled. Echocardiography, blood tests, pulmonary function testing, and PETCO2 measurements were performed as noninvasive tests, whereas right heart catheterization and arterial blood gas analysis were conducted as invasive tests. The primary end point of this study was left ventricular assist device (LVAD) implantation or cardiac death.ResultsEighteen patients underwent LVAD implantation at the Interagency Registry for Mechanically Circulatory Support (INTERMACS) profile 3 during the follow-up period, and no patient died. PETCO2 was significantly lower in a stepwise manner with New York Heart Association functional class (class I or II, 34.2 ± 9.3 mmHg vs. class III or IV, 27.7 ± 2.5 mmHg; p < 0.001). Univariate and multivariate Cox proportional hazard models and time-dependent receiver operating characteristic curve analysis revealed that PETCO2 ≤ 31 mmHg is an independent noninvasive predictor of LVAD implantation. Univariable and multivariable linear regression analyses showed that pulmonary arterial pressure was independently and highly correlated with PETCO2 (r2 = − 0.512, p < 0.001).ConclusionsAmong various noninvasive clinical parameters investigated, PETCO2 was the independent predictor of LVAD implantation at the INTERMACS profile 3 in patients with chronic HF. Pulmonary congestion may significantly contribute to decreases in PETCO2 in patients with HF.