心脏异常与等待肝移植患者虚弱表型的相关性：来自肝移植功能评估研究。
Association of Cardiac Abnormalities to the Frail Phenotype in Cirrhotic Patients on the Waitlist: From the Functional Assessment in Liver Transplantation Study.
机构信息
Department of Gastroenterology, Hepatology Unit, Hospital Universitari i Politècnic La Fe, Valencia, Spain.
Division of Gastroenterology and Hepatology, Department of Medicine, University of California-San Francisco, San Francisco, CA.
出版信息
Transplantation. 2018 Mar;102(3):e101-e107. doi: 10.1097/TP.0000000000002025.
BACKGROUND
Frailty is a syndrome of decreased physiologic reserve that results from compromise of multiple physiologic systems including cardiovascular system. We aimed to determine the association between the frail phenotype and cardiac abnormalities in liver transplant (LT) candidates through evaluation of transthoracic echocardiography (TTE) indices.
METHODS
Included were consecutive outpatients listed for LT who underwent a frailty assessment from January 1, 2014, to June 30, 2016 (using the Liver Frailty Index) and a 2-dimensional/Doppler TTE examination. Patients were categorized as robust, intermediate frail, or frail by the Liver Frailty Index based on scores of less than 3.2, between 3.2 and 4.5, or 4.5 or greater. Linear regression assessed associations between the Liver Frailty Index and TTE indices.
RESULTS
Of 335 patients, 19% were robust, 65% intermediate frail, and 16% frail. TTE indices of left atrial (LA) dilatation differed significantly by frailty status: median LA dimension (P = 0.03), LA volume index (LAVI mL/m; P < 0.001) and %LAVI > 34 mL/m (P = 0.001). In linear regression adjusted for age, sex, hypertension, and diabetes, the Liver Frailty Index was positively associated with LA dimension (coeff, 0.20; 95% confidence interval [CI], 0.07-0.34), LAVI mL/m (coeff, 0.01; 95% CI, 0.005-0.02), ejection fraction (coeff, 1.59; 95% CI, 0.32-2.85), and pulmonary artery systolic pressure (coeff, 0.01; 95% CI, 0.003-0.02), and negatively associated with LV hypertrophy (coeff, -0.22; 95% CI, -0.37 to -0.06).
CONCLUSIONS
In LT candidates, frailty is associated with cardiac structural and functional changes, independent of known risk factors. Our study provides evidence to support that measures of frailty in cirrhotic patients encompass abnormalities of the cardiovascular system and may inform assessments of cardiovascular reserve in this population.
背景
衰弱是一种生理储备减少的综合征，是由包括心血管系统在内的多个生理系统受损引起的。我们旨在通过评估经胸超声心动图（TTE）指标，确定虚弱表型与肝移植（LT）候选者心脏异常之间的关联。
方法
本研究纳入了 2014 年 1 月 1 日至 2016 年 6 月 30 日期间连续接受 LT 并接受虚弱评估（采用肝衰竭指数）和二维/多普勒 TTE 检查的门诊患者。根据评分，患者被分为强壮、中度虚弱或虚弱：评分<3.2 分、3.2 至 4.5 分或≥4.5 分。线性回归评估了肝衰竭指数与 TTE 指数之间的关系。
结果
在 335 名患者中，19%为强壮，65%为中度虚弱，16%为虚弱。左心房（LA）扩张的 TTE 指数因虚弱状态而异：中位 LA 直径（P=0.03）、LA 容积指数（LAVI mL/m；P<0.001）和%LAVI>34 mL/m（P=0.001）。在调整年龄、性别、高血压和糖尿病后，肝衰竭指数与 LA 直径呈正相关（系数，0.20；95%置信区间 [CI]，0.07-0.34）、LAVI mL/m（系数，0.01；95% CI，0.005-0.02）、射血分数（系数，1.59；95% CI，0.32-2.85）和肺动脉收缩压（系数，0.01；95% CI，0.003-0.02），与左心室肥厚呈负相关（系数，-0.22；95% CI，-0.37 至-0.06）。
结论
在 LT 候选者中，虚弱与心脏结构和功能变化有关，与已知的危险因素无关。我们的研究提供了证据，证明肝硬化患者的虚弱程度包括心血管系统的异常，并可能为该人群的心血管储备评估提供信息。
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