title: Low partial pressure of end-tidal carbon dioxide predicts left ventricular assist device implantation in patients with advanced chronic heart failure.
abstract: BACKGROUND
  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).
  
  
  METHODS
  Forty-eight patients (mean age 43.1±11.9years, 32 males) with chronic HF (44 with non-ischemic and 4 with ischemic cardiomyopathy) were prospectively enrolled. Echocardiography, blood tests, pulmonary function testing, and PETCO2measurements 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.
  
  
  RESULTS
  Eighteen patients underwent LVAD implantation at the Interagency Registry for Mechanically Circulatory Support (INTERMACS) profile 3 during the follow-up period, and no patient died. PETCO2was significantly lower in a stepwise manner with New York Heart Association functional class (class I or II, 34.2±9.3mmHg vs. class III or IV, 27.7±2.5mmHg; p<0.001). Univariate and multivariate Cox proportional hazard models and time-dependent receiver operating characteristic curve analysis revealed that PETCO2≤31mmHg 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).
  
  
  CONCLUSIONS
  Among various noninvasive clinical parameters investigated, PETCO2was the independent predictor of LVAD implantation at the INTERMACS profile 3 in patients with chronic HF. Pulmonary congestion may significantly contribute to decreases in PETCO2in patients with HF.
authors.affiliation: Department of Transplantation,National Cerebral and Cardiovascular Center, Osaka, Japan. Electronic address: oseguchi@ncvc.go.jp.
authors.forename: Osamu
authors.initials: O
authors.lastname: Seguchi
authors.affiliation: Department of Transplantation,National Cerebral and Cardiovascular Center, Osaka, Japan.
authors.forename: Eriko
authors.initials: E
authors.lastname: Hisamatsu
authors.affiliation: Department of Clinical Research, National Cerebral and Cardiovascular Center, Osaka, Japan.
authors.forename: Atsushi
authors.initials: A
authors.lastname: Nakano
authors.affiliation: Department of Transplantation,National Cerebral and Cardiovascular Center, Osaka, Japan.
authors.forename: Seiko
authors.initials: S
authors.lastname: Nakajima
authors.affiliation: Department of Transplantation,National Cerebral and Cardiovascular Center, Osaka, Japan.
authors.forename: Kensuke
authors.initials: K
authors.lastname: Kuroda
authors.affiliation: Department of Transplantation,National Cerebral and Cardiovascular Center, Osaka, Japan.
authors.forename: Takuya
authors.initials: T
authors.lastname: Watanabe
authors.affiliation: Department of Transplantation,National Cerebral and Cardiovascular Center, Osaka, Japan.
authors.forename: Takuma
authors.initials: T
authors.lastname: Sato
authors.affiliation: Department of Transplantation,National Cerebral and Cardiovascular Center, Osaka, Japan.
authors.forename: Haruki
authors.initials: H
authors.lastname: Sunami
authors.affiliation: Department of Transplantation,National Cerebral and Cardiovascular Center, Osaka, Japan.
authors.forename: Masanobu
authors.initials: M
authors.lastname: Yanase
authors.affiliation: Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center, Osaka, Japan.
authors.forename: Hiroki
authors.initials: H
authors.lastname: Hata
authors.affiliation: Department of Data Science, National Cerebral and Cardiovascular Center, Osaka, Japan.
authors.forename: Toshimitsu
authors.initials: T
authors.lastname: Hamasaki
authors.affiliation: Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center, Osaka, Japan.
authors.forename: Tomoyuki
authors.initials: T
authors.lastname: Fujita
authors.affiliation: Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center, Osaka, Japan.
authors.forename: Junjiro
authors.initials: J
authors.lastname: Kobayashi
authors.affiliation: Department of Transplantation,National Cerebral and Cardiovascular Center, Osaka, Japan.
authors.forename: Takeshi
authors.initials: T
authors.lastname: Nakatani
authors.affiliation: Department of Clinical Research, National Cerebral and Cardiovascular Center, Osaka, Japan.
authors.forename: Masafumi
authors.initials: M
authors.lastname: Kitakaze
authors.affiliation: Department of Transplantation,National Cerebral and Cardiovascular Center, Osaka, Japan.
authors.forename: Norihide
authors.initials: N
authors.lastname: Fukushima
mesh_terms: D000328:Adult; D000368:Aged; D001784:Blood Gas Analysis; D002908:Chronic Disease; D005260:Female; D006333:Heart Failure / Q000097:blood* / Q000503:physiopathology* / Q000628:therapy; D006353:Heart-Assist Devices; D006801:Humans; D008297:Male; D008875:Middle Aged; D010313:Partial Pressure; D011379:Prognosis; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012307:Risk Factors
keywords: Advanced heart failure; Left ventricular assist device; Partial pressure of end-tidal carbon dioxide; Prognosis