Imamura Teruhiko, Kinugawa Koichiro, Nitta Daisuke, Fujino Takeo, Inaba Toshiro, Maki Hisataka, Hatano Masaru, Kinoshita Osamu, Nawata Kan, Kyo Shunei, Ono Minoru
Department of Therapeutic Strategy for Heart Failure, Graduate School of Medicine, University of Tokyo.
Circ J. 2015;79(3):560-6. doi: 10.1253/circj.CJ-14-1058. Epub 2014 Dec 25.
Although cardiopulmonary exercise (CPX) testing is an established tool for predicting survival in patients with heart failure (HF), its prognostic impact on explantation of left ventricular assist device (LVAD) was unknown. METHODS AND RESULTS: We enrolled 33 patients who had undergone implantation of extracorporeal pulsatile flow LVAD and symptom-limited CPX testing at 3 months after operation, and who were followed between 2005 and 2014. Patients who received conversion to continuous flow LVAD were excluded. On Cox regression analysis, E1 (maximum load ≥51W; HR, 27.55), E2 (minute ventilation/carbon dioxide output [V̇E/V̇CO2] slope ≤34; HR, 16.86), and E3 (peak oxygen consumption [PV̇O2] ≥12.8 ml·kg(-1)·min(-1); HR, 18.35) significantly predicted explantation expectancy during 2 years after LVAD implantation (P<0.05 for all). Explantation score, the sum of positive E1-3, significantly stratified 2-year cumulative explantation rate into low (0 points), intermediate (1-2 points), and high (3 points) expectancy groups (0%, 29%, and 86%, respectively, P<0.001). When the scoring system was used for 45 patients with continuous flow LVAD, the 2 patients who had explantation were assigned to the high expectancy group.
Explantation score, calculated simply from 3 postoperative symptom-limited CPX testing parameters, is a novel tool to predict explantation expectancy of LVAD and to select good candidates for the weaning test.
尽管心肺运动（CPX）测试是预测心力衰竭（HF）患者生存率的既定工具，但其对左心室辅助装置（LVAD）植入后取出的预后影响尚不清楚。方法与结果：我们纳入了33例接受体外搏动血流LVAD植入术并在术后3个月进行症状限制CPX测试的患者，这些患者在2005年至2014年期间接受随访。接受转换为连续血流LVAD的患者被排除。在Cox回归分析中，E1（最大负荷≥51W；风险比[HR]，27.55）、E2（分钟通气量/二氧化碳排出量[V̇E/V̇CO2]斜率≤34；HR，16.86）和E3（峰值耗氧量[PV̇O2]≥12.8 ml·kg⁻¹·min⁻¹；HR，18.35）显著预测LVAD植入后2年内的取出预期（所有P<0.05）。取出评分，即阳性E1 - 3的总和，将2年累积取出率显著分层为低（0分）、中（1 - 2分）和高（3分）预期组（分别为0%、29%和86%，P<0.001）。当将该评分系统用于45例连续血流LVAD患者时，2例接受取出的患者被归入高预期组。
取出评分简单地由3个术后症状限制CPX测试参数计算得出，是预测LVAD取出预期和选择撤机测试合适候选者的一种新工具。
