循環器ジャーナル67巻2号

2019年04月発行

特集 心疾患治療としての心臓リハビリテーション Ⅱ．心臓リハビリテーション実施法

CPXのパラメータ

著者： 西功¹ 小池朗²

所属機関： ¹筑波大学附属病院土浦市地域臨床教育センター ²筑波大学医学医療系循環器内科

ページ範囲：P.210 - P.217

Point
・呼気ガス分析を併用した運動負荷試験である心肺運動負荷試験（CPX）により，心疾患患者の運動中の呼吸循環状態に関する重要な情報を得ることができる．
・最高酸素摂取量，嫌気性代謝閾値，換気量・二酸化炭素排出量スロープがCPXから得られる一般的な指標である．
・CPXから得られる指標は単独でも有用であるが，諸指標を組み合わせて解釈することで，その有用性はさらに高まる．
・心不全症例のなかには，運動中の換気量に周期性変化を呈する例があり，本現象が心不全の重症度や生命予後とも関係することから，こうした特徴的な所見の出現にも注目する必要がある．

参考文献

1) Myers J, Prakash M, Froelicher V, et al:Exercise capacity and mortality among men referred for exercise testing. N Engl J Med 346:793-801, 2002

2) Goraya TY, Jacobsen SJ, Pellikka PA, et al:Prognostic value of treadmill exercise testing in elderly persons. Ann Intern Med 132:862-870, 2000

3) Gulati M, Pandey DK, Arnsdorf MF, et al:Exercise capacity and the risk of death in women:The St James Women Take Heart Project. Circulation 108:1554-1559, 2003

4) Myers J, Kaykha A, George S, et al:Fitness versus physical activity patterns in predicting mortality in men. Am J Med 117:912-918, 2004

5) Leon AS, Franklin BA, Costa F, et al;American Heart Association;Council on Clinical Cardiology（Subcommittee on Exercise, Cardiac Rehabilitation, and Prevention）;Council on Nutrition, Physical Activity, and Metabolism（Subcommittee on Physical Activity）;American association of Cardiovascular and Pulmonary Rehabilitation:Cardiac rehabilitation and secondary prevention of coronary heart disease:an American Heart Association scientific statement from the Council on Clinical Cardiology（Subcommittee on Exercise, Cardiac Rehabilitation, and Prevention）and the Council on Nutrition, Physical Activity, and Metabolism（Subcommittee on Physical Activity）, in collaboration with the American association of Cardiovascular and Pulmonary Rehabilitation. Circulation 111:369-376, 2005

6) Wasserman K, Beaver WL, Whipp BJ:Gas exchange theory and the lactic acidosis（anaerobic）threshold. Circulation 81（suppl）:II-14-II-30, 1990

7) Myers J, Ashley E:Dangerous curves:a perspective on exercise, lactate, and the anaerobic threshold. Chest 111:787-795, 1997

8) Itoh H, Ajisaka R, Koike A, et al;Committee on Exercise Prescription for Patients（CEPP）Members:Heart rate and blood pressure response to ramp exercise and exercise capacity in relation to age, gender, and mode of exercise in a healthy population. J Cardiol 61:71-78, 2013

9) Balady GJ, Arena R, Sietsema K, et al;American Heart Association Exercise, Cardiac Rehabilitation, and Prevention Committee of the Council on Clinical Cardiology;Council on Epidemiology and Prevention;Council on Peripheral Vascular Disease;Interdisciplinary Council on Quality of Care and Outcomes Research:Clinician's Guide to cardiopulmonary exercise testing in adults:a scientific statement from the American Heart Association. Circulation 122:191-225, 2010

10) 長嶋正實：循環器病の診断と治療に関するガイドライン．心疾患患者の学校，職域，スポーツにおける運動許容条件に関するガイドライン（2008年改訂版）http://www.j-circ.or.jp/guideline/pdf/JCS2008_nagashima_h.pdf

11) Koike A, Itoh H, Taniguchi K, et al:Detecting abnormalities in left ventricular function during exercise by respiratory measurement. Circulation 80:1737-1746, 1989

prognostic reliability in patients with chronic heart failure and severely reduced exercise capacity. Am Heart J 145:1102-1107, 2003

13) Wada O, Asanoi H, Miyagi K, et al:Importance of abnormal lung perfusion in excessive exercise ventilation in chronic heart failure. Am Heart J 125:790-798, 1993

14) Reindl I, Wernecke KD, Opitz C, et al:Impaired ventilatory efficiency in chronic heart failure:possible role of pulmonary vasoconstriction. Am Heart J 136:778-785, 1998

15) Guazzi M, Reina G, Tumminello G, et al:Alveolar-capillary membrane conductance is the best pulmonary function correlate of exercise ventilation efficiency in heart failure patients. Eur J Heart Fail 7:1017-1022, 2005

16) Ponikowski P, Chua TP, Piepoli M, et al:Ventilatory response to exercise correlates with impaired heart rate variability in patients with chronic congestive heart failure. Am J Cardiol 82:338-344, 1998

17) Sun XG, Hansen JE, Garatachea N, et al:Ventilatory efficiency during exercise in healthy subjects. Am J Respir Crit Care Med 166:1443-1448, 2002

18) Koike A, Itoh H, Kato M, et al:Prognostic power of ventilatory responses during submaximal exercise in patients with chronic heart disease. Chest 121:1581-1588, 2002

19) Nishi I, Noguchi T, Furuichi S, et al:Are cardiac events during exercise therapy for heart failure predictable from the baseline variables? Circ J 71:1035-1039, 2007

20) Baba R, Nagashima M, Goto M, et al:Oxygen intake efficiency slope:a new index of cardiorespiratory functional reserve derived from the relationship between oxygen consumption and minute ventilation during incremental exercise. Nagoya J Med Sci 59:55-62, 1996

21) Davies LC, Wensel R, Georgiadou P, et al:Enhanced prognostic value from cardiopulmonary exercise testing in chronic heart failure by non-linear analysis:oxygen uptake efficiency slope. Eur Heart J 27:684-690, 2006

22) Wasserman K, Hansen JE, Sue DY, et al:Principles of Exercise Testing and Interpretation:Including Pathophysiology and Clinical Applications. 5th ed, Lippincott Williams ＆ Wilkins, Philadelphia, 2011

23) Murphy RM, Shah RV, Malhotra R, et al:Exercise oscillatory ventilation in systolic heart failure:an indicator of impaired hemodynamic response to exercise. Circulation 124:1442-1451, 2011

uptake during exercise in cardiac patients. Am J Cardiol 115:691-696, 2015

25) Himi T, Koike A, Nagayama O, et al:Clinical Significance of the Presence of Oscillatory Breathing Both at Rest and During Exercise in Cardiac Patients. Int Heart J 59:713-718, 2018

26) Guazzi M, Myers J, Peberdy MA, et al:Exercise oscillatory breathing in diastolic heart failure:prevalence and prognostic insights. Eur Heart J 29:2751-2759, 2008

27) Corrà U, Giordano A, Bosimini E, et al:Oscillatory ventilation during exercise in patients with chronic heart failure:clinical correlates and prognostic implications. Chest 121:1572-1580, 2002

28) Leite JJ, Mansur AJ, de Freitas HF, et al:Periodic breathing during incremental exercise predicts mortality in patients with chronic heart failure evaluated for cardiac transplantation. J Am Coll Cardiol 41:2175-2181, 2003

29) Guazzi M, Arena R, Ascione A, et al;Gruppo di Studio Fisiologia dell' Esercizio, Cardiologia dello Sport e Riabilitazione Cardiovascolare of the Italian Society of Cardiology:Exercise oscillatory breathing and increased ventilation to carbon dioxide production slope in heart failure:an unfavorable combination with high prognostic value. Am Heart J 153:859-867, 2007

30) Myers J, Arena R, Dewey F, et al:A cardiopulmonary exercise testing score for predicting outcomes in patients with heart failure. Am Heart J 156:1177-1183, 2008