Geisberg C, Goring J, Listerman J, Nading M A, Huang R L, Butler J
Cardiology Division, Vanderbilt University, Nashville, Tennessee 37232-6300, USA.
Transplant Proc. 2006 Jun;38(5):1493-5. doi: 10.1016/j.transproceed.2006.02.099.
The data assessing the prognostic value of peak exercise oxygen consumption (VO2) in heart failure (HF) patients is largely derived from cross-sectional studies in which medical therapy was not maximized in all eligible patients and no clear explanation was given as to why such was the case. To assess the relative prognostic value of peak VO2 with respect to baseline medical therapy and its potential impact on transplant listing, 1-year event-free (death or left ventricular assist device placement) survival was compared among 341 HF patients, stratified in three groups based on peak VO2 (<10, 10 to 14, and >14 mL/min/kg). Similar analysis was performed on a subset of 288 patients who were on optimal medical therapy within this group. Average age of the study population was 55+/-11 years, ejection fraction was 23%+/-08%, and peak VO2 was 12.4+/-3.6 mL/min/kg. One-year event-free survival for the overall cohort was: peak VO2<10 (n=87), 63.2%; 10 to 14 (n=141), 81.1%; and >14 mL/min/kg (n=113), 90.2%. Patients with the same groups who were on optimal therapy had an event-free 1-year survival as follows: <10 (n=69), 72.4%; VO2 10 to 14 (n=127), 91.5%; and >14 mL/min/kg (n=92), 94.6%. In conclusion, cross-sectional assessment of HF prognosis may be misleading. In the intermediate risk group, this can significantly impact on medical decisions (eg, transplant listing). Optimization of therapy and long-term follow-up by a specialist may impact transplant listing.
评估峰值运动耗氧量（VO₂）对心力衰竭（HF）患者预后价值的数据，在很大程度上来自横断面研究，在这些研究中，并非所有符合条件的患者都接受了最大化的药物治疗，且未对为何如此给出明确解释。为了评估峰值VO₂相对于基线药物治疗的相对预后价值及其对移植名单的潜在影响，对341例HF患者进行了比较，这些患者根据峰值VO₂（<10、10至14以及>14 mL/min/kg）分为三组，比较了1年无事件（死亡或植入左心室辅助装置）生存率。对该组中接受最佳药物治疗的288例患者亚组进行了类似分析。研究人群的平均年龄为55±11岁，射血分数为23%±8%，峰值VO₂为12.4±3.6 mL/min/kg。整个队列的1年无事件生存率为：峰值VO₂<10（n = 87），63.2%；10至14（n = 141），81.1%；以及>14 mL/min/kg（n = 113），90.2%。接受最佳治疗的相同分组患者的1年无事件生存率如下：<10（n = 69），72.4%；VO₂ 10至14（n = 127），91.5%；以及>14 mL/min/kg（n = 92），94.6%。总之，HF预后的横断面评估可能会产生误导。在中度风险组中，这可能会对医疗决策（例如移植名单）产生重大影响。优化治疗并由专科医生进行长期随访可能会影响移植名单。
