Butler Javed, Khadim Ghazanfar, Paul Kimberly M, Davis Stacy F, Kronenberg Marvin W, Chomsky Don B, Pierson Richard N, Wilson John R
Department of Medicine, and Center for Health Services Research, Vanderbilt University Medical Center and Medicine Service, Nashville Veterans Affairs Medical Center, Tennessee 27232-6300, USA.
J Am Coll Cardiol. 2004 Mar 3;43(5):787-93. doi: 10.1016/j.jacc.2003.08.058.
We sought to assess the relationship between survival, peak exercise oxygen consumption (VO(2)), and heart failure survival score (HFSS) in the current era of heart failure (HF) therapy.
Based on predicted survival, HF patients with peak VO(2) <14 ml/min/kg or medium- to high-risk HFSS are currently considered eligible for heart transplantation. However, these criteria were developed before the widespread use of beta-blockers, spironolactone, and defibrillators-interventions known to improve the survival of HF patients.
Peak VO(2) and HFSS were assessed in 320 patients followed from 1994 to 1997 (past era) and in 187 patients followed from 1999 to 2001 (current era). Outcomes were compared between these two groups of patients and those who underwent heart transplantation from 1993 to 2000.
Survival in the past era was 78% at one year and 67% at two years, as compared with 88% and 79%, respectively, in the current era (both p < 0.01). One-year event-free survival (without urgent transplantation or left ventricular assist device) was improved in the current era, regardless of initial peak VO(2): 64% vs. 48% for peak VO(2) <10 ml/min/kg (p = 0.09), 81% vs. 70% for 10 to 14 ml/min/kg (p = 0.05), and 93% vs. 82% for >14 ml/min/kg (p = 0.04). Of the patients with peak VO(2) of 10 to 14 ml/min/kg, 55% had low-risk HFSS and exhibited 88% one-year event-free survival. One-year survival after transplantation was 88%, which is similar to the 85% rate reported by the United Network for Organ Sharing for 1999 to 2000.
Survival for HF patients in the current era has improved significantly, necessitating re-evaluation of the listing criteria for heart transplantation.
我们试图评估在当前心力衰竭（HF）治疗时代，生存率、峰值运动耗氧量（VO₂）和心力衰竭生存评分（HFSS）之间的关系。
基于预测的生存率，目前峰值VO₂<14 ml/min/kg或中到高风险HFSS的HF患者被认为符合心脏移植条件。然而，这些标准是在β受体阻滞剂、螺内酯和除颤器广泛应用之前制定的，而这些干预措施已知可提高HF患者的生存率。
对1994年至1997年随访的320例患者（过去时代）和1999年至2001年随访的187例患者（当前时代）进行峰值VO₂和HFSS评估。比较这两组患者以及1993年至2000年接受心脏移植患者的结局。
过去时代的1年生存率为78%，2年生存率为67%，而当前时代分别为88%和79%（均p<0.01）。无论初始峰值VO₂如何，当前时代的1年无事件生存率（无紧急移植或左心室辅助装置）均有所提高：峰值VO₂<10 ml/min/kg时为64%对48%（p = 0.09），10至14 ml/min/kg时为81%对70%（p = 0.05），>14 ml/min/kg时为93%对82%（p = 0.04）。在峰值VO₂为10至14 ml/min/kg的患者中，55%具有低风险HFSS，1年无事件生存率为88%。移植后的1年生存率为88%，与器官共享联合网络报告的1999年至2000年85%的比率相似。
当前时代HF患者的生存率显著提高，有必要重新评估心脏移植的列入标准。
