Abstract: Background　Cardiopulmonary exercise testing（CPET） is the unique method and clinical technology for estimating integrative functional status objectively and quantitatively，which is widely used in management for heart and lung transplantation.With worries over insurance，many domestic specialists abandon evaluating the patients with severe heart failure objectively and quantitatively by using CPET.Objective　To retrospectively evaluate the safety and feasibility of CPET in patients with severe heart failure.Methods　In cardiopulmonary exercise test room of Fuwai Hospital，Chinese Academy of Medical Sciences,77 patients with severe heart failure who were waiting for heart transplantation,underwent CPET during December 2013 to November 2015,they were selected as study subjects,among whom 32 cases were rated as grade Ⅲ,45 cases were rated as grade Ⅳ according to New York Heart Association（NYHA） functional classification,all cases completed symptom-limited extreme exercise according to standard continuous incremental power scheme of Harbor-UCLA Medical Center.Pulmonary function indexes,common indexes，and CPET parameters were detected，the primary reasons for stopping CPET were recorded.Results　There were no significant differences in peak anaerobic threshold（ml/min,ml·min-1·kg-1,%pred）,peak oxygen uptake（ml/min,ml·min-1·kg-1,%pred）,oxygen pulse（ml/time,%pred）,oxygen uptake efficiency platform（OUEP）（ratio,%pred）,equivalent minimum value of carbon dioxide ventilation（ratio,%pred）,carbon dioxide ventilation slope（slope,%pred） between NYHA functional classification grade Ⅲ patients and grade Ⅳ patients（P>0.05）.The most common reason for stopping exercise was fatigue（n=38，49.3%），and other reasons including dyspnea（n=20,26.0%），chest distress（n=7,9.1%），dizziness（n=5,6.5%），dry mouth（n=4,5.2%），palpitation（n=2,2.6%）， and nausea（n=1,1.3%）.There was no significant difference between patients with NYHA functional classification grade Ⅲ and Ⅳ in the reasons of stopping exercise（P=0.442）.Conclusion　Because there is no significant abnormality in pulmonary function indexes,common indexes,and CPET parameters,it is safe and feasible to perform CPET in patients with severe heart failure.There are no statistical difference in the CPET parameters and reasons of stopping exercise between patients with NYHA functional classification grade Ⅲ and gradeⅣ.

Key words: Heart failure, Cardiopulmonary exercise testing, Treatment outcome, Safety

摘要： 背景　心肺运动试验（CPET）是目前唯一的整体功能状态客观定量评估方法和临床技术，广泛使用于心肺移植管理。但是国内仍有专家由于担心安全问题对重度心力衰竭患者放弃CPET的客观定量评估。目的　探讨重度心力衰竭患者临床实施CPET的安全性和可行性。方法　连续选取2013年12月—2015年11月中国医学科学院阜外医院心肺运动试验室接受检测的重度心力衰竭住院等待心脏移植的患者77例，其中心功能纽约心脏病协会（NYHA）分级Ⅲ级32例、Ⅳ级45例，均进行CPET，按照美国加州大学洛杉矶分校医学中心标准连续递增功率方案完成症状限制性极限运动，检测其肺通气功能指标、一般指标、CPET指标，并记录患者终止CPET主要原因。结果　心功能NYHA分级Ⅲ级、Ⅳ级患者无氧阈（ml/min、ml·min-1·kg-1、%pred）、峰值摄氧量（ml/min、ml·min-1·kg-1、%pred）、峰值氧脉搏（ml/次、%pred）、摄氧效率平台（OUEP）（比值、%pred）、二氧化碳通气当量最低值（比值、%pred）、二氧化碳通气当量斜率（slope、%pred）比较，差异均无统计学意义（P>0.05）。患者终止CPET主要原因有乏力38例（49.3%）、气喘20例（26.0%）、胸闷7例（9.1%）、头晕5例（6.5%）、口干4例（5.2%）、心慌2例（2.6%）、恶心1例（1.3%）。心功能NYHA分级Ⅲ级、Ⅳ级患者终止CPET主要原因比较，差异无统计学意义（P=0.442）。结论　重度心力衰竭患者临床实施CPET肺功能通气指标、一般指标、CPET指标均无显著异常，安全可行。心功能NYHA分级Ⅲ级、Ⅳ级患者CPET指标及终止CPET主要原因无差异。

关键词: 心力衰竭, 心肺运动试验, 治疗结果, 安全