地尔硫䓬对心脏移植后运动能力的影响。

Effect of diltiazem on exercise capacity after heart transplantation.

作者信息

Varnado Sara, Peled-Potashnik Yael, Huntsberry Ashley, Lowes Brian D, Zolty Ronald, Burdorf Adam, Lyden Elizabeth R, Moulton Michael J, Um John Y, Raichlin Eugenia

机构信息

Division of Cardiology, University of Nebraska Medical Center, Omaha, NE, USA.

Division of Cardiology, Sheba Medical Center, Tel-Hashomer, Israel.

出版信息

Clin Transplant. 2017 Aug;31(8). doi: 10.1111/ctr.12997. Epub 2017 Jul 21.

DOI:10.1111/ctr.12997

PMID:28477381

Abstract

BACKGROUND

Sinus tachycardia (ST) is common after heart transplantation (HTx). The aim of the study was to evaluate the effect of diltiazem treatment during the first year after HTx on heart rate (HR), cardiac allograft function, and exercise capacity.

METHODS

From the total cohort, 25 HTx recipients started diltiazem treatment 4±2 weeks after HTx and continued it for at least 1 year (diltiazem group). Each study case was matched to a control. All patients underwent hemodynamic assessment and cardiopulmonary exercise test (CPET) at 1 year after HTx.

RESULTS

HR decreased in the diltiazem group from 99±11 bpm to 94±7 bpm (P=.03) and did not change in the controls (98±11 bpm vs 100±13 bpm, P=.14). The difference between the groups at 1 year after HTx was significant (P=.04). In the diltiazem group left ventricular (LV), stroke volume and ejection fraction increased (48±16 vs 55±17 mL, P=.02, and 60%±10% vs 62%±12% P=.03, respectively) but did not differ from controls. E/E' decreased (10.7±2.7 vs 7.3±1.9, P=.003) while cardiac index was higher (3.5±0.8 vs 3.1±0.5; P=.05) in the diltiazem group at 1-year follow-up. The absolute peak VO (21±4 vs 18±6 mL/kg/min; P=.05) and normalized peak VO (73%±17% vs 58%±14%; P=.004) were significantly higher in the diltiazem group.

CONCLUSIONS

This study showed that diltiazem treatment reduces ST, may improve cardiac allograft function and exercise tolerance during the first year after HTx.

摘要

背景

窦性心动过速（ST）在心脏移植（HTx）后很常见。本研究的目的是评估HTx后第一年使用地尔硫䓬治疗对心率（HR）、心脏移植功能和运动能力的影响。

方法

在整个队列中，25名HTx受者在HTx后4±2周开始使用地尔硫䓬治疗，并持续至少1年（地尔硫䓬组）。每个研究病例都匹配了一个对照。所有患者在HTx后1年接受血流动力学评估和心肺运动试验（CPET）。

结果

地尔硫䓬组的HR从99±11次/分钟降至94±7次/分钟（P = 0.03），而对照组未发生变化（98±11次/分钟对100±13次/分钟，P = 0.14）。HTx后1年两组之间的差异具有统计学意义（P = 0.04）。地尔硫䓬组左心室（LV）、每搏输出量和射血分数增加（分别为48±16对55±17 mL，P = 0.02，以及60%±10%对62%±12%，P = 0.03），但与对照组无差异。在1年随访时，地尔硫䓬组的E/E'降低（10.7±2.7对7.3±1.9，P = 0.003），而心脏指数较高（3.5±0.8对3.1±0.5；P = 0.05）。地尔硫䓬组的绝对峰值VO（21±4对18±6 mL/kg/min；P = 0.05）和标准化峰值VO（73%±17%对58%±14%；P = 0.004）显著更高。