Ulrik C S, Carlsen J, Arendrup H, Aldershvile J
Department of Clinical Physiology and Nuclear Medicine KF, Rigshospitalet, University of Copenhagen, Denmark.
Scand Cardiovasc J. 1999;33(3):131-6. doi: 10.1080/14017439950141740.
To investigate the impact of chronic heart failure on pulmonary function in heart transplant recipients, pulmonary function was evaluated in 41 consecutive patients (mean age 43 years, range 15-57 years) before and 6 months after successful heart transplantation. The pulmonary function tests included measurements of forced vital capacity [FVC], forced expiratory volume in 1.s [FEV1], FEV1/FVC ratio, total lung capacity [TLC], and diffusion capacity for carbon monoxide [TLCO] and KCO [TLCO per l alveolar volume]. Compared to pretransplant values, spirometry after transplantation revealed modest improvements in FVC (from 77 +/- 16 to 88 +/- 21% of predicted [%pred]; p < 0.001) and FEV1 (from 75 +/- 16 to 85 +/- 22%pred; p < 0.001), whereas the FEV1/FVC ratio was unchanged (81% +/- 11 and 80% +/- 10; p = NS). A slight but statistically significant increase in TLC (from 78 +/- 15 to 86 +/- 18%pred, p < 0.001) was also observed. Prior to transplantation the mean TLCO was 76 +/- 17%pred; 7 of the patients had a TLCO below 60%pred (mean 51% pred). In 33 of the 41 patients a reduction in TLCO was observed after transplantation; for all 41 patients the mean fall in TLCO was 14% of the predicted value (SD 12%pred) (p < 0.0001). Likewise, a significant reduction in KCO was noted (p < 0.0001). Multiple regression analysis revealed that high pretransplant TLCO %pred (p = 0.02) and FVC %pred (p = 0.04) were associated with a less favorable outcome concerning posttransplant TLCO %pred. Although normalization of FEV1, FVC and TLC can be anticipated after correction of severe chronic left ventricular failure by heart transplantation, the pronounced concomitant decline in diffusion capacity observed in this study may be explained by underlying pulmonary disease caused by factors other than long-standing heart failure. Our findings support the notion that pulmonary function abnormalities attributable to chronic heart failure should not preclude consideration for heart transplantation.
为研究慢性心力衰竭对心脏移植受者肺功能的影响，对41例连续患者（平均年龄43岁，范围15 - 57岁）在成功进行心脏移植前及移植后6个月进行了肺功能评估。肺功能测试包括用力肺活量[FVC]、第1秒用力呼气容积[FEV1]、FEV1/FVC比值、肺总量[TLC]以及一氧化碳弥散量[TLCO]和KCO[每升肺泡容积的TLCO]的测量。与移植前的值相比，移植后的肺量计检查显示FVC（从预测值的77±16提高到88±21%[预测%]；p < 0.001）和FEV1（从预测值的75±16提高到85±22%预测值；p < 0.001）有适度改善，而FEV1/FVC比值未改变（81%±11和80%±10；p = 无显著性差异）。还观察到TLC有轻微但具有统计学意义的增加（从预测值的78±15提高到86±18%预测值，p < 0.001）。移植前平均TLCO为预测值的76±17%；7例患者的TLCO低于预测值的60%（平均51%预测值）。在41例患者中的33例中，移植后观察到TLCO下降；对于所有41例患者，TLCO的平均下降为预测值的14%（标准差12%预测值）（p < 0.0001）。同样，KCO也有显著下降（p < 0.0001）。多元回归分析显示，移植前较高的TLCO%预测值（p = 0.02）和FVC%预测值（p = 0.04）与移植后TLCO%预测值的不良结果相关。尽管通过心脏移植纠正严重慢性左心室衰竭后可预期FEV¹、FVC和TLC恢复正常，但本研究中观察到的弥散能力明显同时下降可能是由长期心力衰竭以外的因素引起的潜在肺部疾病所解释。我们的研究结果支持这样一种观点，即由慢性心力衰竭引起的肺功能异常不应排除心脏移植的考虑。
