Ortiz V, Martínez-Dolz L, Sánchez-Lacuesta E, Almenar L, Ten F, Andrés L, Moro J, Izquierdo M T, Agüero J, Salvador A
Unidad de Insuficiencia Cardiaca y Trasplante, Servicio de Cardiología, Hospital Universitario La Fe, Valencia, Spain.
Transplant Proc. 2007 Sep;39(7):2341-3. doi: 10.1016/j.transproceed.2007.06.049.
The present study evaluated the clinical and hemodynamic situation of patients with advanced heart failure considered for heart transplantation (HT) to examine the possible impact of prior cardiac disease.
We analyzed the pretransplant clinical, echocardiographic, and hemodynamic parameters of 422 consecutive HT patients. Pediatric and heart plus lung transplants were excluded, as were retransplantations. The results were compared by dividing the patients into three groups according to the background heart disease that led to HT: ischemic heart disease (IHD), dilated myocardiopathy (DMC), or valvular disease.
Differences were observed in the baseline characteristics according to the type of heart disease. Male gender, hypertension, and diabetes were more frequent among IHD, while DMC patients tended to be younger. There were no differences in the clinical parameters such as liver and kidney function, in the functional class, or in the need for inotropic treatment over the days prior to transplantation. Likewise, no differences were recorded in the hemodynamic parameters, such as pulmonary pressure, pulmonary vascular resistance, or transpulmonary pressure gradient. As regards the echocardiographic parameters, the patients with DMC showed greater ventricular diameters and lesser ejection fractions for both ventricles.
No important differences were recorded in the clinical situation or hemodynamic parameters of patients with advanced heart failure accepted for transplantation, according to the background cardiac disease. This observation could be due to the homogenization by strict transplant waiting list inclusion criteria.
本研究评估了考虑进行心脏移植（HT）的晚期心力衰竭患者的临床和血流动力学状况，以探讨既往心脏病可能产生的影响。
我们分析了422例连续接受HT患者的移植前临床、超声心动图和血流动力学参数。儿科患者以及心脏加肺移植患者被排除，再次移植患者也被排除。根据导致HT的基础心脏病将患者分为三组：缺血性心脏病（IHD）、扩张型心肌病（DMC）或瓣膜病，对结果进行比较。
根据心脏病类型，观察到基线特征存在差异。IHD患者中男性、高血压和糖尿病更为常见，而DMC患者往往更年轻。在移植前几天，肝功能、肾功能等临床参数、功能分级或使用正性肌力药物治疗的需求方面没有差异。同样，在血流动力学参数方面，如肺动脉压、肺血管阻力或跨肺压梯度，也没有差异。至于超声心动图参数，DMC患者的两个心室直径更大，射血分数更低。
根据基础心脏病，接受移植的晚期心力衰竭患者的临床状况或血流动力学参数没有显著差异。这一观察结果可能是由于严格的移植等待名单纳入标准导致的同质化。
