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Impact of High Respiratory Exchange Ratio During Submaximal Exercise on Adverse Clinical Outcome in Heart Failure

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Title: Impact of High Respiratory Exchange Ratio During Submaximal Exercise on Adverse Clinical Outcome in Heart Failure
Authors: Kakutani, Naoya Browse this author
Fukushima, Arata Browse this author →KAKEN DB
Yokota, Takashi Browse this author →KAKEN DB
Katayama, Takashi Browse this author
Nambu, Hideo Browse this author
Shirakawa, Ryosuke Browse this author
Maekawa, Satoshi Browse this author
Abe, Takahiro Browse this author
Takada, Shingo Browse this author →KAKEN DB
Furihata, Takaaki Browse this author →KAKEN DB
Ono, Kota Browse this author
Okita, Koichi Browse this author →KAKEN DB
Kinugawa, Shintaro Browse this author →KAKEN DB
Anzai, Toshihisa Browse this author →KAKEN DB
Keywords: Anaerobic threshold
Cardiopulmonary exercise testing
Heart failure
Respiratory exchange ratio
Submaximal exercise
Issue Date: 2018
Publisher: The Japanese Circulation Society
Journal Title: Circulation Journal
Volume: 82
Issue: 11
Start Page: 2753
End Page: 2760
Publisher DOI: 10.1253/circj.CJ-18-0103
Abstract: Background: Oxygen uptake (V̇O2) at peak workload and anaerobic threshold (AT) workload are often used for grading heart failure (HF) severity and predicting all-cause mortality. The clinical relevance of respiratory exchange ratio (RER) during exercise, however, is unknown.Methods and Results: We retrospectively studied 295 HF patients (57±15 years, NYHA class I–III) who underwent cardiopulmonary exercise testing. RER was measured at rest; at AT workload; and at peak workload. Peak V̇O2 had an inverse correlation with RER at AT workload (r=−0.256), but not at rest (r=−0.084) or at peak workload (r=0.090). Using median RER at AT workload, we divided the patients into high RER (≥0.97) and low RER (<0.97) groups. Patients with high RER at AT workload were characterized by older age, lower body mass index, anemia, and advanced NYHA class. After propensity score matching, peak V̇O2 tended to be lower in the high-RER than in the low-RER group (14.9±4.5 vs. 16.1±5.0 mL/kg/min, P=0.06). On Kaplan-Meier analysis, HF patients with a high RER at AT workload had significantly worse clinical outcomes, including all-cause mortality and rate of readmission due to HF worsening over 3 years (29% vs. 15%, P=0.01). Conclusions: High RER during submaximal exercise, particularly at AT workload, is associated with poor clinical outcome in HF patients.
Type: article
Appears in Collections:北海道大学病院 (Hokkaido University Hospital) > 雑誌発表論文等 (Peer-reviewed Journal Articles, etc)

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