对具有Fontan循环生理的患者进行运动振荡通气。
Exercise oscillatory ventilation in patients with Fontan physiology.
作者信息
Nathan Ashwin S, Loukas Brittani, Moko Lilamarie, Wu Fred, Rhodes Jonathan, Rathod Rahul H, Systrom David M, Ubeda Tikkanen Ana, Shafer Keri, Lewis Gregory D, Landzberg Michael J, Opotowsky Alexander R
机构信息
From the Department of Medicine, Brigham and Women's Hospital, Boston, MA (A.S.N., F.W., D.M.S., K.S., M.J.L., A.R.O.); Departments of Cardiology (B.L., L.M., F.W., J.R., R.H.R., A.U.T., K.S., M.J.L., A.R.O.) and Cardiovascular Surgery (A.U.T.), Boston Children's Hospital, MA; and Department of Medicine, Massachusetts General Hospital, Boston (G.D.L.).
出版信息
Circ Heart Fail. 2015 Mar;8(2):304-11. doi: 10.1161/CIRCHEARTFAILURE.114.001749. Epub 2014 Dec 30.
BACKGROUND
Exercise oscillatory ventilation (EOV) refers to regular oscillations in minute ventilation (VE) during exercise. Its presence correlates with heart failure severity and worse prognosis in adults with acquired heart failure. We evaluated the prevalence and predictive value of EOV in patients with single ventricle Fontan physiology.
METHODS AND RESULTS
We performed a cross-sectional analysis and prospective survival analysis of patients who had undergone a Fontan procedure and subsequent cardiopulmonary exercise test. Data were reviewed for baseline characteristics and incident mortality, heart transplant, or nonelective cardiovascular hospitalization. EOV was defined as regular oscillations for >60% of exercise duration with amplitude >15% of average VE. Survival analysis was performed using Cox regression. Among 253 subjects, EOV was present in 37.5%. Patients with EOV were younger (18.8±9.0 versus 21.7±10.1 years; P=0.02). EOV was associated with higher New York Heart Association functional class (P=0.02) and VE/VCO2 slope (36.8±6.9 versus 33.7±5.7; P=0.0002), but not with peak VO2 (59.7±14.3 versus 61.0±16.0% predicted; P=0.52) or noninvasive measures of cardiac function. The presence of EOV was associated with slightly lower mean cardiac index but other invasive hemodynamic variables were similar. During a median follow-up of 5.5 years, 22 patients underwent transplant or died (n=19 primary deaths, 3 transplants with 2 subsequent deaths). EOV was associated with increased risk of death or transplant (hazard ratio, 3.9; 95% confidence interval, 1.5-10.0; P=0.002) and also predicted the combined outcome of death, transplant, or nonelective cardiovascular hospitalization after adjusting for New York Heart Association functional class, peak VO2, and other covariates (multivariable hazard ratio, 2.0; 95% confidence interval, 1.2-3.6; P=0.01).
CONCLUSIONS
EOV is common in the Fontan population and strongly predicts lower transplant-free survival.
背景
运动振荡通气（EOV）是指运动期间分钟通气量（VE）的规律性振荡。其存在与成人获得性心力衰竭的严重程度及更差的预后相关。我们评估了单心室Fontan循环生理患者中EOV的患病率及预测价值。
方法与结果
我们对接受Fontan手术及后续心肺运动试验的患者进行了横断面分析和前瞻性生存分析。回顾数据以了解基线特征及事件死亡率、心脏移植或非选择性心血管住院情况。EOV定义为运动持续时间>60%时出现的规律性振荡，且振幅>平均VE的15%。使用Cox回归进行生存分析。在253名受试者中，37.5%存在EOV。有EOV的患者更年轻（18.8±9.0岁对21.7±10.1岁；P = 0.02）。EOV与更高的纽约心脏协会功能分级（P = 0.02）及VE/VCO2斜率相关（36.8±6.9对33.7±5.7；P = 0.0002），但与峰值VO2（59.7±14.3对预测值的61.0±16.0%；P = 0.52）或心功能的非侵入性测量无关。EOV的存在与平均心脏指数略低相关，但其他有创血流动力学变量相似。在中位随访5.5年期间，22例患者接受了移植或死亡（n = 19例原发性死亡，3例移植，其中2例随后死亡）。EOV与死亡或移植风险增加相关（风险比，3.9；95%置信区间，1.5 - 10.0；P = 0.002），并且在调整纽约心脏协会功能分级、峰值VO2及其他协变量后，也可预测死亡、移植或非选择性心血管住院的联合结局（多变量风险比，2.0；95%置信区间，1.2 - 3.6；P = 0.01）。
结论
EOV在Fontan人群中常见，且强烈预测较低的无移植生存率。
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