Oliveira Carvalho Vitor, Guimarães Guilherme Veiga, Vieira Marcelo Luiz Campos, Catai Aparecida Maria, Oliveira-Carvalho Vagner, Ayub-Ferreira Silvia Moreira, Bocchi Edimar Alcides
Hospital das Clínicas, Faculdade de Medicina, USP, São Paulo, Brazil.
Rev Bras Cir Cardiovasc. 2015 Jan-Mar;30(1):9-15. doi: 10.5935/1678-9741.20140055.
To establish the determinants of the peak VO2 in heart transplant recipients.
Patient's assessment was performed in two consecutive days. In the first day, patients performed the heart rate variability assessment followed by a cardiopulmonary exercise test. In the second day, patients performed a resting echocardiography. Heart transplant recipients were eligible if they were in a stable condition and without any evidence of tissue rejection diagnosed by endomyocardial biopsy. Patients with pacemaker, noncardiovascular functional limitations such as osteoarthritis and chronic obstructive pulmonary disease were excluded from this study.
Sixty patients (68% male, 48 years and 64 months following heart transplantation) were assessed. Multivariate analysis selected the following variables: receptor's gender (P=0.001), receptor age (P=0.049), receptor Body Mass Index (P=0.005), heart rate reserve (P <0.0001), left atrium diameter (P=0.016). Multivariate analysis showed r=0.77 and r2=0.6 with P <0.001. Equation: peakVO2=32.851 - 3.708 (receptor gender) - 0.067 (receptor age) - 0.318 (receptor BMI) + 0.145 (heart rate reserve) - 0.111 (left atrium diameter).
The determinants of the peak VO2 in heart transplant recipients were: receptor sex, age, Body Mass Index, heart rate reserve and left atrium diameter. Heart rate reserve was the unique variable positively associated with peak VO2. This data suggest the importance of the sympathetic reinnervation in peak VO2 in heart transplant recipients.
确定心脏移植受者峰值摄氧量的决定因素。
对患者进行连续两天的评估。第一天，患者先进行心率变异性评估，随后进行心肺运动试验。第二天，患者进行静息超声心动图检查。心脏移植受者若病情稳定且经心内膜心肌活检未发现任何组织排斥迹象，则符合入选标准。植入起搏器的患者、存在骨关节炎和慢性阻塞性肺疾病等非心血管功能限制的患者被排除在本研究之外。
共评估了60例患者（男性占68%，心脏移植后48岁，病程64个月）。多变量分析筛选出以下变量：受者性别（P=0.001）、受者年龄（P=0.049）、受者体重指数（P=0.005）、心率储备（P<0.0001）、左心房直径（P=0.016）。多变量分析显示r=0.77，r2=0.6，P<0.001。方程：峰值摄氧量=32.851 - 3.708（受者性别） - 0.067（受者年龄） - 0.318（受者体重指数） + 0.145（心率储备） - 0.111（左心房直径）。
心脏移植受者峰值摄氧量的决定因素为：受者性别、年龄、体重指数、心率储备和左心房直径。心率储备是与峰值摄氧量呈正相关的唯一变量。该数据表明交感神经再支配对心脏移植受者峰值摄氧量的重要性。
